The utility of routine electrolytes and blood cell counts in patients withchest pain

The objective of the study was to determine whether the routine screening l aboratory tests, electrolytes (E) and hemoglobin and hematocrits (HM), coul d have been safely avoided in ED patients presenting with chest pain. Retro spective case series over a 3-month period were reviewed. Acceptable indica tions for E and WH test ordering were prospectively developed using America n College of Emergency Physicians (ACEP) guidelines. Charts were reviewed t o determine whether any indications were present, whether the E and WH labo ratory tests were abnormal, and whether the abnormal test affected treatmen t or disposition, Patients were excluded if they had an abnormal electrocar diogram (ECG) indicating ischemia or electrolyte abnormality, This resulted in 191 patients meeting inclusion criteria, Sixty eight patients did not h ave any criteria for ordering E or WH, Of these, only one (1.5%) had an abn ormal laboratory test. The sensitivity of the guidelines for predicting an abnormal laboratory test was 96% (95 CI, 82 to 100%) and the specificity wa s 46% (95CI, 38 to 54%), There were no interventions, consultations, or any change in disposition based on E or HM testing in these patients. Of the 1 23 patients that met at least one criteria for ordering laboratory tests, 2 7 (18%) had an abnormal result, It was concluded that practice guidelines m ay reduce the number of E and WH tests ordered without missing significant abnormalities. A prospective trial is needed to validate these findings. (A m J Emerg Med 2001;19:198-198, Copyright (C) 2001 by W.B. Saunders Company) .