Recommended ‘starter’ alert thresholds for a selection of chemical pathology tests

The RCPA-AACB High Risk Results Working Party has employed an evidence and risk based approach to identify alert thresholds for a selection of chemical pathology tests.1 A systematic literature review training program was conducted by the Australian Institute Health Innovation at Macquarie University, which produced outcome study mortality associated with seven chemistry blood tests. For each these tests, working party gathered information on: (A) clinical management patients abnormal results, (B) current professional recommendations thresholds, (C) transferability test results that were measured different analytical methods, (D) laboratory flagging rates range candidate thresholds. above evaluated, following identified: Ammonia >150 umol/L (neonate) or >100 (infant/child/adult); Adjusted Calcium <1.80 mmol/L >3.20 mmol/L; Delta Creatinine rise (adult) >50 (paediatric); Absolute >350 Glucose <2.5 mmol/L, >15.0 (paediatric) bicarbonate ≤15 >30.0 >15 (adult); Lactate ≥4.0 Magnesium <0.40 >2.00 Sodium <120 5mmol/L. Laboratories should assess recommended respect their local population, consult key users service fine tuning as required. Reference 1. Campbell CA, Lam Q, Horvath AR. An evidence- risk-based harmonized list in Australia New Zealand. Clin Chem Lab Med 2018; 57: 89–94.