scholarly journals Laboratory testing in the emergency department: An Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mauro Panteghini ◽  
Sergio Bernardini ◽  
Laura Bonfanti ◽  
Paolo Carraro ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Molecular Biology ◽  
Laboratory Testing ◽  
Clinical Biochemistry ◽  
National Level ◽  
Mean Value ◽  
Italian Society ◽  
Emergency Setting ◽  
Consensus Document ◽  
The Mean

The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated <em>strongly recommended</em>, 2 <em>recommended in specific circumstances</em>, and 3 <em>strongly discouraged</em>. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as <em>strongly recommended</em> (mean value, 1.0-1.5), <em>somehow recommended</em> (mean value, 1.5-2.0), <em>discouraged</em> (mean value, 2.0-2.5) and <em>strongly discouraged</em> (mean value, 2.5-3.0). The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were <em>strongly recommended</em>. The use of 5 common tests was instead <em>strongly discouraged</em>. For 16 additional parameters in the list, the consensus ranged between <em>somehow recommended</em> and <em>discouraged</em>. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.

scholarly journals Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

2018 ◽  
Vol 56 (10) ◽  
pp. 1655-1659 ◽  
Author(s):  
Giuseppe Lippi ◽  
Mauro Panteghini ◽  
Sergio Bernardini ◽  
Laura Bonfanti ◽  
Paolo Carraro ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Molecular Biology ◽  
Laboratory Testing ◽  
Clinical Biochemistry ◽  
National Level ◽  
Mean Value ◽  
Italian Society ◽  
Emergency Setting ◽  
Consensus Document ◽  
The Mean

Abstract Background: The mainstay of patient-oriented laboratory testing in emergency settings entails selecting a number and the type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. Methods: A survey, containing the most commonly ordered urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated “strongly recommended”, 2 “recommended in specific circumstances”, and 3 “strongly discouraged”. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as “strongly recommended” (mean value, 1.00–1.49), “weakly recommended” (mean value, 1.50–1.99), “discouraged” (mean value, 2.00–2.49) and “strongly discouraged” (mean value, 2.50–3.00). Results: The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were “strongly recommended”. The use of five common tests was instead “strongly discouraged”. For 16 additional parameters in the list, the consensus ranged between “weakly recommended” and “discouraged”. Conclusions: We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patterns in emergency setting, at least at a national level.

scholarly journals Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Martina Montagnana ◽  
Fiamma Balboni ◽  
Andrea Bellone ◽  
Ivo Casagranda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Biochemistry ◽  
Clinical Information ◽  
Clinical Value ◽  
Suspected Sepsis ◽  
Consensus Document ◽  
Diagnostic Threshold ◽  
High Negative Predictive Value ◽  
Routine Assessment

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained.

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