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Data mining for prothrombin time and international normalized ratio reference intervals in children.

Muhammad Shariq Shaikh1, Sibtain Ahmed1

  • 1Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

Plos One
|October 27, 2022
PubMed
Summary

Establishing pediatric reference intervals (RIs) for prothrombin time (PT) and International Normalized Ratio (INR) is crucial. An indirect data mining method using the KOSMIC algorithm was effective for determining these PT/INR RIs in children.

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Area of Science:

  • Clinical Biochemistry
  • Pediatric Hematology
  • Data Mining in Healthcare

Background:

  • Reference intervals (RIs) are essential for clinical diagnosis, but establishing them for coagulation tests like prothrombin time (PT) and International Normalized Ratio (INR) in children presents challenges.
  • Interlaboratory variability in PT/INR measurements arises from differences in instruments and reagents.
  • Direct methods for determining pediatric RIs are often logistically difficult, costly, and ethically restricted.

Purpose of the Study:

  • To determine pediatric reference intervals (RIs) for prothrombin time (PT) and International Normalized Ratio (INR) using an indirect data mining approach.
  • To evaluate the feasibility of the KOSMIC algorithm for establishing PT/INR RIs in a pediatric population.
  • To provide age-stratified PT/INR RIs for improved clinical decision-making in children.

Main Methods:

  • Retrospective analysis of PT/INR measurements from 37,356 (PT) and 37,192 (INR) children aged 0-18 years.
  • Application of the indirect KOSMIC algorithm, assuming Gaussian distribution of non-pathologic samples after Box-Cox transformation.
  • Stratification of RIs into nine distinct age groups.

Main Results:

  • The KOSMIC algorithm successfully computed PT/INR reference intervals for the pediatric cohort.
  • Calculated RIs showed good agreement with established pediatric thrombosis and hemostasis guidelines across different age groups.
  • The study demonstrated the utility of data mining for establishing PT/INR RIs in resource-limited settings.

Conclusions:

  • Indirect data mining using the KOSMIC algorithm is a viable and efficient alternative for establishing pediatric PT/INR reference intervals.
  • The derived RIs can aid clinicians in better interpreting coagulation test results in children.
  • This approach facilitates understanding of age-related coagulation pathway dynamics and supports evidence-based clinical practice.