DETECTION OF ELECTROLYTE ABNORMALITIES IN CHILDREN PRESENTING TO THE EMERGENCY DEPARTMENT - A MULTICENTER, PROSPECTIVE ANALYSIS

Objective: To prospectively derive high-yield criteria for the detecti on of clinically significant electrolyte abnormalities (CSEAs) in chil dren presenting to the ED. Methods: A prospective, multicenter, observ ational study was performed at the EDs of 2 urban teaching hospitals, a university medical center, and a children's hospital with a combined census of >275,000 patient visits/year (100,000 visits for children < 13 years old). All children <13 years old who had electrolyte panels o btained were eligible for analysis. A data form containing potential p redictor variables for a CSEA was completed by the clinician prior to receipt of electrolyte results. A CSEA was any abnormal electrolyte va lue that I) stimulated constructive assessment of the patient's condit ion (monitoring, reevaluation of nonspurious laboratory values, or adm ission), 2) led to further diagnostic studies, 3) led to a new diagnos is, or 4) affected therapy, chi(2) recursive partitioning was used to derive a decision rule for ordering electrolytes. Results: Of 715 elig ible patient visits, 488 (68%) electrolyte panels contained a laborato ry abnormality, with 182 (25%) CSEAs, A decision rule requiring 1 of 6 clinical criteria was 100% sensitive (95% CI 98-100%) and 24% specifi c (95% CI 21-28%) in detecting CSEAs with positive and negative predic tive values of 31% (95% CI 28-34%) and 100% (95% CI 97-100%), respecti vely. If these criteria had been used to screen patients for whom elec trolyte panels were ordered, 128 patients (18%) would not have had ele ctrolyte panels obtained and no CSEAs would have been missed. Conclusi on: A set of clinical criteria was derived that may be useful for limi ting electrolyte panels ordering in children, This criterion set requi res prospective validation in a separate patient population.