Objective.
—To determine the usefulness of a routine, comprehensive battery of laboratory tests in a severely impaired elderly nursing home population.
Design.
—Prospective observational survey.
Setting.
—Skilled nursing facility wards of a geriatric and extended care veterans hospital.
Patients.
—Consecutive sample of 108 veterans with severe cognitive and functional impairments, who had been hospitalized at least 6 months.
Main Outcome Measures.
—Proportions of tests categorized as screening, monitoring, follow-up, or diagnostic; frequency of abnormal test results, interventions warranted and performed on the basis of these abnormalities, and beneficial or adverse effects.
Results.
—Of 6771 individual nondiagnostic tests performed, 17.2% yielded abnormal results; of these, 33.3% were new. However, only 0.2% of tests resulted in patient benefit. Of 989 panels performed, 31.0% contained at least one abnormality, but only 1.0% of panels (10 patients) yielded any benefit. Overall usefulness was related to the purpose of the testing, with 31.5% of screening tests yielding abnormalities, compared with 45.5%, 78.2%, and 68.7% of monitoring, follow-up, and diagnostic panels, respectively (P<.05 for each compared with screening panels). None of the screening panels detected an abnormality that led to patient benefit, compared with 1.0%, 1.4%, and 3.0% of monitoring, follow-up, and diagnostic panels.
Conclusions.
—Routine comprehensive laboratory panels may not be warranted in the most severely impaired elderly patients in long-term care settings. Discontinuing true screening tests and limiting testing strictly to monitoring, followup, or diagnostic purposes could minimize the costs of laboratory assessment without losing its potential benefits.
(JAMA. 1994;272:1447-1452)
