Are We Overusing Coagulation Studies in the Emergency Department?

Area of Science:

• Clinical Pathology
• Emergency Medicine
• Health Economics

Background:

• Coagulation profile tests (Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], International Normalized Ratio [INR]) are essential diagnostic tools in emergency departments (EDs).
• However, concerns exist regarding the appropriateness and cost-effectiveness of routine coagulation testing in all ED patients.

Purpose of the Study:

• To evaluate the utilization and necessity of coagulation profile tests in the ED.
• To determine the cost associated with unnecessary coagulation testing.
• To identify potential strategies for optimizing coagulation test ordering in the ED.

Main Methods:

• A retrospective observational study was conducted at King Saud University Medical City (KSUMC) ED in Riyadh, Saudi Arabia.
• Data from 1,754 patients included demographic information, clinical history, medication use, and coagulation test results (PT, APTT, INR).
• Two ED consultants independently assessed the appropriateness of each coagulation test request, and costs were calculated based on unnecessary tests.

Main Results:

• The majority of patients (80.3% for PT, 71.9% for APTT, 97.4% for INR) had results within normal ranges.
• Two independent consultants identified 59.9% of coagulation tests as unnecessary, with substantial agreement (Cohen's kappa = 0.681).
• An estimated annual cost saving of approximately US$ 503,232 could be achieved by eliminating unnecessary tests.

Conclusions:

• Coagulation profile tests are overutilized in the ED setting, leading to significant unnecessary costs.
• Targeted coagulation testing guided by specific patient presentation and medical history is recommended.
• Optimizing test ordering can improve resource allocation and reduce healthcare expenditure without compromising patient care.