Unreported test results not always good news
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When it comes to telling patients about abnormal test results, no news is not necessarily good news, a new study says.
A survey of 23 primary care practices found that doctors failed to report one in 14 abnormal test results to their patients following cholesterol checks, mammograms, or a dozen other tests, a team led by Dr. Lawrence P. Casalino of Weill Cornell Medical College found.
Analyzing the records of more than 5,000 patients who were 50 to 69 years old, the researchers looked for abnormal test results that were clinically important and then searched for evidence that the patient had been told about them, which could be a note documenting a phone call, a referral to a specialist, a procedure, or a retest. Among the 1,889 abnormal test results, 7 percent, or 135, were not conveyed to patients. In the four practices using both paper and electronic medical records, the failure-to-inform rate ranged from 7 to 23 percent while offices with either paper only or electronic records only had failure rates of 4 to 7 percent.
“If you have any kind of test and you haven’t heard the results in a couple of weeks, you should call the doctor’s office and make sure someone gives you the results,’’ Casalino said. “It’s really without exaggeration a potentially fatal mistake to assume that no news is good news.’’
BOTTOM LINE: About 1 out of 14 abnormal test results were never reported to patients, according to a survey of primary care medical records.
CAUTIONS: The practices that agreed to participate in the survey - all on the West Coast or in the Midwest - might be different from a random sample of practices.
WHERE TO FIND IT: Archives of Internal Medicine, June 22
Is it appendicitis?
Appendicitis is the most common surgical emergency among children, but it can be difficult to diagnose because its main symptom - abdominal pain - is common to many other ailments. CT scans have helped clarify the picture somewhat, but up to 30 percent of appendectomies are still unnecessary, while in up to 45 percent of appendicitis cases, the appendix ruptures because the diagnosis is missed.Researchers led by Dr. Alex Kentsis of Children’s Hospital Boston searched for substances in urine that could more accurately signal appendicitis. Using sophisticated screening tools, they analyzed levels of 57 substances in urine samples collected from 67 children, 25 of whom turned out to have appendicitis. One protein, called leucine-rich alpha-2-glycoprotein, was high both in appendicitis patients’ urine samples and in diseased appendix tissue. All but one appendicitis case was correctly identified based on LRG levels in a urine sample, but one patient’s kidney infection was mistakenly called appendicitis. In two appendicitis patients whose appendices appeared normal on their CT scans, LRG was elevated in their urine samples. The more LRG present in the urine, the more severe the appendicitis.
BOTTOM LINE: A protein found in the urine of children with appendicitis might lead to a better way to accurately diagnose the disease.
CAUTIONS: The scientists tested the biomarker as a sign of appendicitis only in children, so its value in testing adults is not known.
WHAT’S NEXT: Larger studies using simpler techniques such as urine dipsticks are needed to validate what the scientists found in their small study.
WHERE TO FIND IT: Annals of Emergency Medicine, online June 23
ELIZABETH COONEY
