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Symptomorientierte Notfalldiagnostik im Praxislabor


Risch, Lorenz; Senn, Oliver (2015). Symptomorientierte Notfalldiagnostik im Praxislabor. Therapeutische Umschau. Revue thérapeutique, 72(2):105-112.

Abstract

Point of care testing (POCT) allows, among others, for efficient care of patients presenting with acute problems to primary care physicians. A combination of clinical information and laboratory results enables physicians to obtain posttest probabilities for the presence or absence of a specific disease. In order to rule in or rule out a disease, the physician has to know both the pretest probability for a disease in a patient as well as the analytical and diagnostic characteristics of the employed test. Pretest probability can be assessed by scores or by personal judgment of the experienced clinician. This article presents the basics of the Bayes theorem together with its clinical applications in acute scenarios in primary health care. These scenarios comprise the use of D-Dimer testing in ruling out venous thromboembolism, rapid testing of group A streptococci in the setting of acute pharyngitis, troponin testing in patients with thoracic pain, c-reactive protein (CRP) testing in patients presenting with acute cough and fever, as well as urine dipstick testing in suspected urinary tract infection. These examples illustrate, that risk stratification before conducting laboratory analysis is of utmost importance in order to obtain valid results for ruling in or ruling out diseases in POCT-settings.

Abstract

Point of care testing (POCT) allows, among others, for efficient care of patients presenting with acute problems to primary care physicians. A combination of clinical information and laboratory results enables physicians to obtain posttest probabilities for the presence or absence of a specific disease. In order to rule in or rule out a disease, the physician has to know both the pretest probability for a disease in a patient as well as the analytical and diagnostic characteristics of the employed test. Pretest probability can be assessed by scores or by personal judgment of the experienced clinician. This article presents the basics of the Bayes theorem together with its clinical applications in acute scenarios in primary health care. These scenarios comprise the use of D-Dimer testing in ruling out venous thromboembolism, rapid testing of group A streptococci in the setting of acute pharyngitis, troponin testing in patients with thoracic pain, c-reactive protein (CRP) testing in patients presenting with acute cough and fever, as well as urine dipstick testing in suspected urinary tract infection. These examples illustrate, that risk stratification before conducting laboratory analysis is of utmost importance in order to obtain valid results for ruling in or ruling out diseases in POCT-settings.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of General Practice
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:February 2015
Deposited On:19 Aug 2015 15:35
Last Modified:21 Nov 2017 17:50
Publisher:Hogrefe Verlag
ISSN:0040-5930
Publisher DOI:https://doi.org/10.1024/0040-5930/a000651
PubMed ID:25630292

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