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Re: [Gnumed-devel] state of test results handling

From: James Busser
Subject: Re: [Gnumed-devel] state of test results handling
Date: Sun, 30 Mar 2008 10:45:12 -0700

On 30-Mar-08, at 4:30 AM, Adrian Midgley wrote:
Our lab reports results with a _reference range_ rather than making a
statement about normality.

Most labs do the above, they just may or may not additionally provide an accompanying "flag" value (high, low, abnormal). For some tests, labs will maintain threshold values for "critical" that require the technician to inform the lab doctor and for one of them to contact the ordering doctor or, if they are unable to contact an involved doctor, the patient, however they tend to not communicate the second- level flag as part of the results, but this is not necessarily always true, I suspect some use * and ** to denote mild vs more marked abnormalities.

Some patients have a congenitally different result on some measurement
from the general run, a large but trivial example is those with
GIlbert's syndrome having a higher bilirubin.

For patients who do have a chronic abnormality (like the above, or macroamylasemia, or even chronic renal failure with ... say... a creatinine of 400) using the target range to set a value for the patient, below which the abnormalities could be clinically ignored (even though they are clinically relevant or significant). This seems already supported in the contextual note expansion per result.

Some labs can indicate when test results have significantly changed from their last value(s).

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