Excessive diagnostic testing in acute kidney injury

Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adu...
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Autor*in:	Leaf, David E. [verfasserIn] Srivastava, Anand Zeng, Xiaoxi McMahon, Gearoid M. Croy, Heather E. Mendu, Mallika L. Kachalia, Allen Waikar, Sushrut S.

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2016

Schlagwörter:	Acute renal failure AKI Diagnostic yield

Anmerkung:	© Leaf et al. 2016

Übergeordnetes Werk:	Enthalten in: BMC nephrology - London : BioMed Central, 2000, 17(2016), 1 vom: 15. Jan.
Übergeordnetes Werk:	volume:17 ; year:2016 ; number:1 ; day:15 ; month:01

Links:	Volltext

DOI / URN:	10.1186/s12882-016-0224-8

Katalog-ID:	SPR027516059

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520			\|a Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility.
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allfields	10.1186/s12882-016-0224-8 doi (DE-627)SPR027516059 (SPR)s12882-016-0224-8-e DE-627 ger DE-627 rakwb eng Leaf, David E. verfasserin aut Excessive diagnostic testing in acute kidney injury 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Leaf et al. 2016 Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213 Srivastava, Anand aut Zeng, Xiaoxi aut McMahon, Gearoid M. aut Croy, Heather E. aut Mendu, Mallika L. aut Kachalia, Allen aut Waikar, Sushrut S. aut Enthalten in BMC nephrology London : BioMed Central, 2000 17(2016), 1 vom: 15. Jan. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:17 year:2016 number:1 day:15 month:01 https://dx.doi.org/10.1186/s12882-016-0224-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 17 2016 1 15 01
spelling	10.1186/s12882-016-0224-8 doi (DE-627)SPR027516059 (SPR)s12882-016-0224-8-e DE-627 ger DE-627 rakwb eng Leaf, David E. verfasserin aut Excessive diagnostic testing in acute kidney injury 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Leaf et al. 2016 Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213 Srivastava, Anand aut Zeng, Xiaoxi aut McMahon, Gearoid M. aut Croy, Heather E. aut Mendu, Mallika L. aut Kachalia, Allen aut Waikar, Sushrut S. aut Enthalten in BMC nephrology London : BioMed Central, 2000 17(2016), 1 vom: 15. Jan. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:17 year:2016 number:1 day:15 month:01 https://dx.doi.org/10.1186/s12882-016-0224-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 17 2016 1 15 01
allfields_unstemmed	10.1186/s12882-016-0224-8 doi (DE-627)SPR027516059 (SPR)s12882-016-0224-8-e DE-627 ger DE-627 rakwb eng Leaf, David E. verfasserin aut Excessive diagnostic testing in acute kidney injury 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Leaf et al. 2016 Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213 Srivastava, Anand aut Zeng, Xiaoxi aut McMahon, Gearoid M. aut Croy, Heather E. aut Mendu, Mallika L. aut Kachalia, Allen aut Waikar, Sushrut S. aut Enthalten in BMC nephrology London : BioMed Central, 2000 17(2016), 1 vom: 15. Jan. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:17 year:2016 number:1 day:15 month:01 https://dx.doi.org/10.1186/s12882-016-0224-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 17 2016 1 15 01
allfieldsGer	10.1186/s12882-016-0224-8 doi (DE-627)SPR027516059 (SPR)s12882-016-0224-8-e DE-627 ger DE-627 rakwb eng Leaf, David E. verfasserin aut Excessive diagnostic testing in acute kidney injury 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Leaf et al. 2016 Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213 Srivastava, Anand aut Zeng, Xiaoxi aut McMahon, Gearoid M. aut Croy, Heather E. aut Mendu, Mallika L. aut Kachalia, Allen aut Waikar, Sushrut S. aut Enthalten in BMC nephrology London : BioMed Central, 2000 17(2016), 1 vom: 15. Jan. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:17 year:2016 number:1 day:15 month:01 https://dx.doi.org/10.1186/s12882-016-0224-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 17 2016 1 15 01
allfieldsSound	10.1186/s12882-016-0224-8 doi (DE-627)SPR027516059 (SPR)s12882-016-0224-8-e DE-627 ger DE-627 rakwb eng Leaf, David E. verfasserin aut Excessive diagnostic testing in acute kidney injury 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Leaf et al. 2016 Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213 Srivastava, Anand aut Zeng, Xiaoxi aut McMahon, Gearoid M. aut Croy, Heather E. aut Mendu, Mallika L. aut Kachalia, Allen aut Waikar, Sushrut S. aut Enthalten in BMC nephrology London : BioMed Central, 2000 17(2016), 1 vom: 15. Jan. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:17 year:2016 number:1 day:15 month:01 https://dx.doi.org/10.1186/s12882-016-0224-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 17 2016 1 15 01
language	English
source	Enthalten in BMC nephrology 17(2016), 1 vom: 15. Jan. volume:17 year:2016 number:1 day:15 month:01
sourceStr	Enthalten in BMC nephrology 17(2016), 1 vom: 15. Jan. volume:17 year:2016 number:1 day:15 month:01
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Acute renal failure AKI Diagnostic yield
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authorswithroles_txt_mv	Leaf, David E. @@aut@@ Srivastava, Anand @@aut@@ Zeng, Xiaoxi @@aut@@ McMahon, Gearoid M. @@aut@@ Croy, Heather E. @@aut@@ Mendu, Mallika L. @@aut@@ Kachalia, Allen @@aut@@ Waikar, Sushrut S. @@aut@@
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Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. 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author	Leaf, David E.
spellingShingle	Leaf, David E. misc Acute renal failure misc AKI misc Diagnostic yield Excessive diagnostic testing in acute kidney injury
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topic_title	Excessive diagnostic testing in acute kidney injury Acute renal failure (dpeaa)DE-He213 AKI (dpeaa)DE-He213 Diagnostic yield (dpeaa)DE-He213
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title	Excessive diagnostic testing in acute kidney injury
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title_full	Excessive diagnostic testing in acute kidney injury
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author_browse	Leaf, David E. Srivastava, Anand Zeng, Xiaoxi McMahon, Gearoid M. Croy, Heather E. Mendu, Mallika L. Kachalia, Allen Waikar, Sushrut S.
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title_sort	excessive diagnostic testing in acute kidney injury
title_auth	Excessive diagnostic testing in acute kidney injury
abstract	Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. © Leaf et al. 2016
abstractGer	Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. © Leaf et al. 2016
abstract_unstemmed	Background The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. Conclusions In patients with AKI, many of the diagnostic tests performed, even when positive or abnormal, may have limited clinical utility. © Leaf et al. 2016
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title_short	Excessive diagnostic testing in acute kidney injury
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author2	Srivastava, Anand Zeng, Xiaoxi McMahon, Gearoid M. Croy, Heather E. Mendu, Mallika L. Kachalia, Allen Waikar, Sushrut S.
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Methods We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage. We manually reviewed electronic medical records to evaluate the diagnostic yield of selected urine, blood, and radiology tests. Diagnostic yield of urine and blood tests was determined based on whether an abnormal test affected AKI diagnosis or management, whereas diagnostic yield of radiology tests was based on whether an abnormal test resulted in a procedural intervention. In sensitivity analyses we also evaluated appropriateness of testing using prespecified criteria. Results Frequency of testing increased with higher AKI stage for nearly all diagnostic tests, whereas frequency of detecting an abnormal result increased for some, but not all, tests. Frequency of detecting an abnormal result was highly variable across tests, ranging from 0 % for anti-glomerular basement membrane testing to 71 % for urine protein testing. Many of the tests evaluated had low diagnostic yield. In particular, selected urine and blood tests were unlikely to impact AKI diagnosis or management, whereas radiology tests had greater clinical utility. 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Excessive diagnostic testing in acute kidney injury

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