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目的回顾性分析成人临床生物化学和血液学检验危急值警示阈值的相关文献,并统计警示阈值的证据来源。方法检索2006至2016年文献,用1999年斯德哥尔摩检验医学分析性能规范对证据来源评估与分级。结果确定了临床检验危急值警示阈值报告数量最多的30个分析物,并以证据等级形式呈现。92篇报告临床检验危急值警示阈值的文献显示了4种警示阈值的确定方案,70%由个体机构建立,18%来自临床实验室或临床医生的调查,2%来源于专业机构的推荐,10%通过临床研究结果评估;其证据来源分别为4、3、2、1级。7种分析物用前后检验结果的差值(δ)作为警示阈值。结论目前临床检验危急值警示阈值的确定方案以个体机构建立为主,其次是来自临床医生或临床实验室的调查,总体证据来源级别较低。
Objective To retrospectively analyze the literature about the critical value warning thresholds for clinical biochemistry and hematology in adults, and to calculate the sources of evidence for the warning thresholds. METHODS: The literature from 2006 to 2016 was retrieved and the source of evidence was assessed and graded using the 1999 Stockholm Medical Practice Performance Survey. The results identified 30 analytes that reported the highest number of critical value alert thresholds for clinical testing and presented as evidence-based. Ninety-two articles that reported the threshold value for clinical critical value warnings identified four thresholds for alerting, 70% were established by an individual agency, 18% were from a clinical laboratory or clinician, and 2% were from professional agencies, 10% % Through the clinical research evaluation; the sources of evidence were 4,3,2,1 level. The seven analytes used as the alert threshold the difference (δ) between the test results before and after. Conclusion At present, the identification of critical value warning threshold for clinical tests is based on the establishment of individual institutions, followed by the investigation by clinicians or clinical laboratories, and the overall level of evidence sources is relatively low.