Methods to identify saline-contaminated electrolyte profiles
-
Devin K. Patel
,
Rishi D. Naik
Abstract
Background: With providers becoming more selective in ordering daily chemistry profiles, it is critical that profiles ordered are accurate. Contaminated electrolyte profiles are an overlooked and potentially dangerous source of inaccurate clinical data. This study aimed to develop a method to accurately identify electrolyte profiles contaminated with normal saline to prevent reporting of erroneous measurements.
Methods: We conducted a retrospective cohort study of 76,497 electrolyte profiles from 5032 patients in a deidentified clinical database of all patients in the electronic medical record at Vanderbilt University Medical Center. Five methods to identify errors in quantification based on either deviations from observed concentration distributions or expected numerical changes from saline contamination were developed and tested. Potentially contaminated measurements were validated based on changes in electrolyte concentrations observed in the subsequent sample.
Results: Identification of erroneous electrolyte profiles based on absolute and percent deviations from normal variation rarely resulted in >50% of identified samples validated as contaminated. A targeted methodology based on expected changes in calcium and chloride concentrations due to saline contamination validated approximately 80% of identified samples when higher thresholds for changes in electrolyte concentration were used and 50% of identified samples when lower thresholds were used.
Conclusions: Targeted methodology based on changes in chloride and calcium successfully identified electrolyte profiles suspicious for contamination. Implementation of this methodology could prevent misinterpretation of a patient’s clinical course, inappropriate interventions, and unwarranted changes in treatment strategy.
Acknowledgments
The dataset used for the analyses described were obtained from Vanderbilt University Medical Center’s Synthetic Derivative, which is supported by institutional funding and by the Vanderbilt CTSA grant ULTR000445 from NCATS/NIH. Dr. Vasilevskis is supported by the National Institutes of Health (K23AG040157), the Veterans Affairs Clinical Research Center of Excellence, and the Geriatric Research, Education and Clinical Center (GRECC).
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Financial support: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Supplemental Material
The online version of this article (DOI: 10.1515/cclm-2014-0955) offers supplementary material, available to authorized users.
©2015 by De Gruyter
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- Editorial
- New endocrine biomarkers and cardiovascular disease: is it time for routinely screening?
- Reviews
- Quantitative detection of amyloid-β peptides by mass spectrometry: state of the art and clinical applications
- Recent advances in biomarkers for Parkinson’s disease focusing on biochemicals, omics and neuroimaging
- Mini Review
- Serum calcitonin negative medullary thyroid carcinoma: a systematic review of the literature
- Genetics and Molecular Diagnostics
- ABCB1 (MDR-1) pharmacogenetics of tacrolimus in renal transplanted patients: a Next Generation Sequencing approach
- Novel association of FCGR2A polymorphism with age-related macular degeneration (AMD) and development of a novel CFH real-time genotyping method
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