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Interpreting clinical and laboratory tests: importance and implications of context

  • Alan N. Charney EMAIL logo and Jordan T. Dourmashkin
Published/Copyright: August 17, 2019
Diagnosis
From the journal Diagnosis Volume 8 Issue 1

Abstract

Clinical and laboratory tests in clinical medicine include a range of measurements that may be categorized as “normal range” tests, positive or negative tests, or contextual tests. Normal range test results are quantitative and are compared to a reference interval or range provided by the laboratory. Positive or negative tests are also quantitative tests and characteristically have a cutoff value that specifies the result. Contextual tests require a context, a physiological condition, to correctly interpret the result. A closer examination of reference intervals suggests that these also are contextual. The fact that there is a range of apparently normal values indicates the presence of cultural, biological, physiological and behavioral diversity in the population sampled to determine normality. As such, the reference interval describes the population from which it was determined and may have utility in this regard.

Keywords: clinical decisions; context; contextual; laboratory tests; normal range; normality; reference interval
Corresponding author: Alan N. Charney, MD, Clinical Professor, Department of Internal Medicine, NYU Langone Health, Division of Nephrology, 550 1st Avenue, New York, NY 10016, USA; and 47 Laura Lane, Morristown, NJ 07960, USA, E-mail:

  1. Author contributions: Alan N. Charney, MD, conceived, researched and wrote the submitted manuscript. Jordan T. Dourmashkin, PA-C researched and wrote the submitted manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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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Received: 2019-02-13
Accepted: 2019-07-31
Published Online: 2019-08-17
Published in Print: 2021-02-23

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
  7. Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
https://doi.org/10.1515/dx-2019-0009
Keywords for this article
clinical decisions; context; contextual; laboratory tests; normal range; normality; reference interval

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
  7. Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
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