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The impact of routine admission tests on the care of Third-World children
1Department of Paediatrics, Cecilia Makiwane Hospital, Mdantsane, Ciskei.
Insights
Routine diagnostic tests in hospitalized children in developing countries often lack clinical impact. While Mantoux tests altered treatment, urinalysis and hemoglobin measurements were frequently ignored, limiting their usefulness in patient care.
Area of Science:
- Pediatric Medicine
- Clinical Diagnostics
- Global Health
Background:
- Routine diagnostic tests are commonly employed upon hospital admission.
- Assessing the clinical utility of these tests in resource-limited settings is crucial for optimizing patient care.
- Previous studies have indicated variable impact of routine diagnostics in different populations.
Purpose of the Study:
- To evaluate the clinical usefulness of routine diagnostic tests in hospitalized children in a developing country.
- To determine the impact of urinalysis, Mantoux testing, and bedside hemoglobin measurement on patient treatment and management.
- To identify factors influencing the clinical utility of these diagnostic interventions.
Main Methods:
- Retrospective review of medical records for 306 children admitted to a Ciskei hospital.
- Analysis of data from 'dipstick' urinalysis, Mantoux testing, and bedside hemoglobin measurements.
- Assessment of treatment changes resulting from unexpected abnormal test results.
Main Results:
- Mantoux testing showed significant impact, with 94% of positive results leading to treatment changes.
- Bedside hemoglobin measurements revealed unexpected low values in 11% of patients, but 90% of these results were ignored.
- Urinalysis yielded unexpected abnormal results in 33% of cases, with 95% of these being disregarded, leading to negligible impact on care.
Conclusions:
- Routine urine and hemoglobin testing had minimal impact on patient care due to the frequent disregard of unexpected abnormal results.
- The Mantoux test demonstrated significant clinical utility, contrasting with the limited impact of urinalysis and hemoglobin testing.
- Findings suggest a need to re-evaluate the implementation and utilization of routine diagnostic tests in similar healthcare settings.
Abstract:
To determine the clinical usefulness of routine diagnostic tests on admission of Third-World children to hospital, the records of 306 children admitted to a Ciskei hospital were examined. The tests performed were 'dipstick' urinalysis, Mantoux testing and bedside haemoglobin measurement. Of the 164 Mantoux tests performed, 16 were unexpectedly positive and 15 (94%) of these 16 patients had their treatment changed as a result. Measurement of the haemoglobin concentration revealed that 31 of 278 patients had a haemoglobin value unexpectedly below 10 g/dl, but in 28 of these 31 cases (90%) this result was ignored. Of the 3 patients followed up, 2 had their treatment changed. An unexpected abnormal result was obtained in 76 of 233 urinalyses performed, but 72 (95%) of these were ignored. Follow-up in the remaining 4 cases did not result in any change in treatment. Routine urine and haemoglobin testing had negligible impact on patient care because unexpected abnormal results were ignored. This finding is similar to those of similar studies on Western adults. The possible reasons for this, and for the striking exception of the Mantoux test, are discussed.