Employing a results-based algorithm to reduce laboratory utilization in ACTH stimulation testing.

Journal of Pediatric Endocrinology & Metabolism : JPEM
Ryan J McDonoughJoseph T Cernich

Abstract

The High Dose Adrenocorticotropic Hormone (ACTH) Stimulation Test is the gold standard to diagnose adrenal insufficiency. Normal adrenal function is defined as a peak cortisol response to pharmacologic stimulation with cosyntropin of ≥18 μg/dL. Our practice was to obtain cortisol levels at 0, 30 and 60 min after cosyntropin administration. Once a value of ≥18 μg/dL has been obtained, adrenal insufficiency is ruled out and there is little diagnostic utility in subsequent stimulated levels. We aimed to decrease laboratory utilization by developing a results-based algorithm in the electronic medical record (EMR). Cortisol levels were analyzed on the 0 and 60 min samples; then an EMR discern rule automatically generated an order to analyze the 30-min sample if the 60-min cortisol level was subnormal. Exclusion of adrenal insufficiency was excluded using one stimulated cortisol level in 8% prior to algorithm development. After several plan-do-study-act cycles, 99% of normal tests were performed using only one stimulated cortisol level. This laboratory-based algorithm resulted in reduced laboratory utilization, and aligned our practice to recommendations of the Pediatric Endocrine Society. Similar algorithms could be created for othe...Continue Reading

References

Jun 6, 2003·Lancet·Wiebke Arlt, Bruno Allolio
Aug 6, 2003·Annals of Internal Medicine·Richard I DorinLawrence M Crapo
Aug 23, 2003·Lancet·Alex Poteliakhoff
Jan 24, 2007·Pediatrics·Dorothy I ShulmanUNKNOWN Lawson Wilkins Drug and Therapeutics Committee
Feb 5, 2009·Journal of Pediatric Endocrinology & Metabolism : JPEM·T MushtaqN P Wright
Dec 8, 2009·Journal of Pediatric Endocrinology & Metabolism : JPEM·Vardhini DesikanThomas A Wilson
Jan 28, 2010·Journal of Pediatric Endocrinology & Metabolism : JPEM·Gülay KaragüzelAyşenur Okten

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Citations

Dec 12, 2018·Journal of Pediatric Endocrinology & Metabolism : JPEM·Rajni SharmaVandana Jain
Mar 12, 2019·Current Opinion in Endocrinology, Diabetes, and Obesity·Nydia BurgosNaykky Singh-Ospina

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