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Thrombophilia testing in a tertiary paediatric hospital: Indications, outcomes and appropriateness
Author(s) -
Sudarmana Aryanto,
Monagle Paul
Publication year - 2015
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.12917
Subject(s) - medicine , thrombophilia , pediatrics , thrombosis , emergency medicine , surgery
Aim The association between inherited thrombophilia and thrombotic disease in children is unclear. As a result, whether expensive thrombophilia tests are indicated in children is a contentious issue. This retrospective study aimed to assess the appropriateness of thrombophilia testing and the associated cost of inappropriate testing at a tertiary paediatric hospital. Methods We conducted a search for thrombophilia tests ordered at the R oyal C hildren's H ospital between 1 J anuary 2011 and 31 D ecember 2013. Using pathology and clinical records, we collected data relating to demographics, clinical data, indications, requesting departments and impact on patient management. Results Over the 3‐year period, 3867 tests were ordered for 613 patients costing the hospital $102 579. Tests were most commonly ordered by gastroenterology on patients receiving liver transplants, by neurology as part of the stroke protocol, and by cardiology and cardiac surgery for patients anticoagulated on heparin infusions. Testing for thrombosis‐related indications was relatively uncommon. Thrombophilia testing only directly affected management in one‐third of patients. Overall, 70% of thrombophilia tests ordered were considered appropriate. However, some departments were found to have rates of inappropriate testing in excess of 50%. Conclusion With improvements in thrombophilia testing practices at the R oyal C hildren's H ospital AU $29 645.40 could be saved over 3 years. While there are improvements to be made in this area, in the overall context of the hospital's pathology testing budget, review of other areas such as inappropriate use of low‐cost, high‐volume tests may be of greater value in reducing the cost of pathology testing.