PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of pchealthLink to Publisher's site
 
Paediatr Child Health. 1998 Nov-Dec; 3(6): 421.
PMCID: PMC2851308

Paediatric admissions, investigations and procedures

A paediatric hospital admission should not mandate any routine investigations. A review of the medical literature indicates that routine investigations and/or preoperative tests give a very low yield for unsuspected significant disease in children.

All tests, investigations and/or procedures should be based specifically on the problems identified by a complete medical history and physical examination. They should be ordered at the discretion of the attending physician after a careful review of the diagnostic value of the examinations with respect to the management of the specific illness suspected.

Along with these considerations, the health care provider should also weigh the risk to benefit ratio of the tests, particularly concerning the potential trauma to the child.

However, if investigations are deemed necessary, blood tests should be performed by the micromethod technique whenever possible, and preprocedural sedation, analgesia or local anesthesia should be available as required.

Footnotes

COMMUNITY PAEDIATRICS COMMITTEE

Members: Drs Fabian P Gorodzinsky, London, Ontario; Cecelia Baxter, Edmonton (Alberta), Denis Leduc, Montreal, Quebec (chair and principal author); Paul Munk, Toronto, Ontario (director responsible); Peter G Noonan, Charlottetown, Prince Edward Island; Sandra Woods, Val-d’Or, Quebec

The recommendations in this Clinical Practice Guideline do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

BIBLIOGRAPHY

  • Feldman BM, Stephens D, Wang EE. How should excess admission laboratory test utilization be curtailed? –Pediatricans’ preferences. Clin Investig Med. 1995;18:502–9. [PubMed]
  • Farnsworth PB, Steiner E, Klein RM, SanFilippo JA. The value of routine preoperative chest roentgenograms in infants and children. JAMA. 1980;244:582–3. [PubMed]
  • Hannallah RS. Preoperative investigation. Pediatr Anaesthesia. 1995;5:325–9. [PubMed]
  • Marcello PW, Roberts PL. “Routine” preoperative studies. Which studies in which patients? Surg Clin North Am. 1996;76:11–23. [PubMed]
  • Mignonsin D, Degul S, Kane M, et al. Intérets de la prescription sélective des examens complémentaires préanaesthésiques [Value of specific prescription of preanesthetic laboratory tests] Cahiers d’Anesthesiologie. 1996;44:13–7. [PubMed]
  • Munro J, Booth A, Nicholl J. Routine preoperative testing: A systematic review of evidence. Health Technol Assess. 1997;1(I–IV):1–62. [PubMed]
  • Nardell A, Pechet L, Snyder LM. Continuous improvement, quality control, and cost containment in clinical laboratory testing. Effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med. 1995;199:518–22. [PubMed]
  • Narr BJ, Wamer ME, Schroeder DR, et al. Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. Mayo Clin Proc. 1997;72:505–9. [PubMed]
  • Sagel SS, Evens RG, Forrest JV, Bramson RT. Efficacy of routine screening and lateral chest radiographs in a hospital-based population. N Engl J Med. 1974;29:1001–4. [PubMed]
  • Smith MBH. The Canadian Task Force on the Periodic Health Examination Canadian Guide to Clinical Preventive Health Care. Ottawa: Public Works and Government Services Canada; 1994. Screnneing for urinary infection in asymptomatic infants and children.
  • United States Preventive Services Task Force . Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams & Wilkins; 1989.

Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press