Laboratory diagnostics, evaluation.

BackgroundOlder patients presenting with nonspecific complaints (NSC) in the Emergency Department (ED) pose diagnostic challenges. The lack of clear symptoms leads to high misdiagnosis rates, extended hospital stays, and functional impairment. However, limited research exists on diagnostic test utilization for this population.MethodsA secondary analysis was conducted on data from 399 older patients (aged 70+) at two hospitals in the Netherlands. These patients presented with NSC and were assessed using a standardized care-pathway that included diagnostic tests such as blood tests, ECGs, chest X-rays, and bladder ultrasounds. Data from a control group (164 patients) and an intervention group (235 patients) were compared, focusing on adherence to the diagnostic pathway, test frequency, and clinical outcomes.ResultsThe intervention group showed significantly greater use of several diagnostic tests compared to the control group, specifically calcium, TSH, glucose, ALAT, ECGs, chest X-rays, and bladder ultrasounds. Notably, abnormal findings were relatively low across tests, particularly for ALAT, TSH and calcium. Urinalysis, chest X-rays and ECGs were used more frequently and identified clinically significant findings. Head CT scans were used more frequently in the intervention group, though not statistically significant.ConclusionWe recommend a standardized laboratory work-up for patients presenting with NSC. There is no justification for the routine use of ALAT, TSH and calcium measurements. We also recommend to incorporate bladder scans into routine care, and continuing the standardized use of ECGs, chest X-rays and urinalysis. Head CT scans, on the other hand, should be based on individualized clinical decisions.Trial number: Dutch Trial register, number NL8960.背景：急诊室（Emergency Department，ED）中因非特异性主诉（nonspecific complaints，NSC）就诊的老年患者，往往给临床诊断带来极大挑战。由于缺乏明确的症状表现，此类患者的误诊率居高不下，住院时间延长，且易出现功能受损。但目前针对该人群的诊断检查应用相关研究仍较为有限。 方法：本研究对荷兰两家医院的399名70岁及以上老年患者的数据进行二次分析。上述患者均因非特异性主诉就诊，并接受了包含血液检查、心电图（ECG）、胸部X线检查、膀胱超声等诊断检查在内的标准化诊疗路径评估。本研究纳入对照组（164例）与干预组（235例）的数据，对比两组对诊断路径的依从性、检查频次及临床结局。 结果：相较于对照组，干预组多项诊断检查的使用率显著更高，具体包括血钙、促甲状腺激素（TSH）、血糖、丙氨酸氨基转移酶（ALAT）、心电图、胸部X线检查及膀胱超声。值得注意的是，各项检查的异常检出率相对较低，其中以丙氨酸氨基转移酶、促甲状腺激素及血钙尤为明显。尿液分析、胸部X线检查与心电图的使用频次更高，且检出了具有临床意义的异常结果。干预组头部CT扫描的使用率也更高，但该差异未达到统计学显著性。 结论：本研究建议针对非特异性主诉就诊患者采用标准化实验室检查方案。但并无证据支持常规开展丙氨酸氨基转移酶、促甲状腺激素及血钙检测。同时，建议将膀胱超声纳入常规诊疗流程，并继续标准化使用心电图、胸部X线检查及尿液分析。而头部CT扫描则应依据个体化临床决策进行选择。 试验注册号：荷兰试验注册库（Dutch Trial register），编号NL8960。