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Predictive Variables for Abnormal Comprehensive Metabolic Panel Testing and Potential Cost Savings in Children
Matthew David Huckaby1, Shayla Freeman, Christopher Thurmond
1From the *Louisiana State University Health Science Center Shreveport, Shreveport, LA; and †Medical University of South Carolina, Charleston, SC.
Insights
In pediatric emergency departments, a basic metabolic panel (BMP) may suffice for patients without specific clinical indicators, potentially saving costs. This approach avoids unnecessary comprehensive metabolic panels (CMP).
Area of Science:
- Pediatric Emergency Medicine
- Clinical Chemistry
- Health Economics
Background:
- Comprehensive metabolic panels (CMP) are frequently ordered in pediatric emergency departments (PEDs).
- Identifying which pediatric patients truly require a CMP versus a basic metabolic panel (BMP) is crucial for optimizing resource utilization and cost-effectiveness.
Purpose of the Study:
- To identify clinical variables that predict abnormal liver function test (LFT) results in pediatric patients.
- To evaluate the potential cost savings of utilizing a BMP instead of a CMP when specific clinical indicators are absent.
Main Methods:
- A retrospective cross-sectional descriptive study was conducted on 207 children (<18 years) in an urban academic PED.
- Twelve clinical variables and liver function test (LFT) results were analyzed to identify predictors of abnormal CMP results.
Main Results:
- History of liver disease, history of heart disease, jaundice, and hepatomegaly were significantly associated with abnormal LFT results (P < 0.05).
- A false-negative rate of 16% was observed for LFTs, with marginally abnormal values in most cases.
- Ordering only a BMP for patients lacking the 12 clinical variables could result in an estimated annual cost saving of $7125.
Conclusions:
- A BMP may be adequate for pediatric patients in the PED who present without specific clinical variables suggestive of liver dysfunction.
- Implementing a strategy to limit CMP testing to higher-risk patients could lead to significant cost savings in the pediatric emergency setting.
Objective:
The aim of this study was to determine variables predictive of abnormal comprehensive metabolic panel (CMP) results in pediatric emergency department (PED) patients and the potential cost savings of a basic metabolic panel (BMP) versus a CMP.
Methods:
This is a retrospective cross-sectional descriptive study of children (<18 y) at an urban academic PED (annual census, 22,000). Clinical data included 12 clinical variables: right upper quadrant pain, overdose, emesis, liver disorder, malignancy, heart disease, bleeding disorder, jaundice, right upper quadrant tenderness, hepatomegaly, ascites/peripheral edema and shock, and the liver function test (LFT) results not in a BMP (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein, and albumin).
Results:
There were 207 children in the study population. The mean age was 8 years. There were 106 boys (51%).Variables significantly associated with abnormal LFT result were history of liver disease (P = 0.007), history of heart disease (P = 0.040), jaundice (P = 0.045), and hepatomegaly (P = 0.048). The false-negative rate was 16%. However, of the 10 patients for whom this false-negative rate remained true, the LFT values were marginally abnormal, and performance of further investigation of these results was minimal to none. There were 66 patients with no clinical variables and normal CMP results. With a cost difference of $21 between BMP and CMP, this gives a potential savings of $7125 if extrapolated for 1 year in our PED.
Conclusions:
Limiting testing to a BMP for patients with none of the 12 clinical variables has the potential annual cost savings of $7125.
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