Utility of calcium, magnesium and phosphate testing in the emergency department

Objective To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4) tests change ED patient management. Methods We undertook a retrospective observational study in an Australian tertiary referral ED. We enrolled adult patients (aged ≥18 years) who presented between 1 January and 3...

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Published in:Emergency medicine Australasia 2020-02, Vol.32 (1), p.39-44
Main Authors: Date, Patrick A, Smith, Jesse L, Spencer, William S, de Tonnerre, Erik J, Yeoh, Michael J, Taylor, David McD
Format: Article
Language:English
Subjects:
Adult
Aged
Biomarkers - blood
calcium
Calcium - blood
choosing wisely
Diagnostic Tests, Routine
emergency health service
Emergency Service, Hospital
Female
Humans
magnesium
Magnesium - blood
Male
Middle Aged
phosphate
Phosphates - blood
Retrospective Studies
utility
Victoria
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Summary:Objective To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4) tests change ED patient management. Methods We undertook a retrospective observational study in an Australian tertiary referral ED. We enrolled adult patients (aged ≥18 years) who presented between 1 January and 30 June 2017 and who had a serum Ca, Mg or PO4 test ordered and completed during their ED stay. Patient symptoms, medical history, electrolyte levels and ED management changes were extracted from the electronic medical record. Results Of the 33 120 adults presented during the study period, 1716 (5.2%, 95% confidence interval [CI] 5.0–5.4) had at least one Ca, Mg or PO4 test completed in the ED. This included 4776 individual electrolyte tests, of which 776 (16.2%, 95% CI 15.2–17.3) were abnormal. Fifty‐six (7.2% [95% CI 5.5–9.3] of patients with abnormal tests, 1.2% [95% CI 0.9–1.5] of all tests) tests were associated with a change in ED management. Twenty‐six out of 1683 (1.5%) Ca levels were low with six (23.1%) management changes; 203 (12.1%) were high with 10 (4.9%) management changes. One hundred and twenty‐eight out of 1579 (8.1%) Mg levels were low with 33 (25.8%) management changes; 30 (1.9%) were high with no management changes. Two hundred and twenty‐five out of 1514 (14.9%) PO4 levels were low with six (2.7%) management changes; 164 (10.8%) were high with one (0.6%) management change. Fifty (2.9%) patients had management changes despite normal electrolyte levels. Conclusion Ca, Mg and PO4 testing is common. However, the yield of clinically significant abnormal levels is low and patient management is rarely changed. Testing of these electrolytes needs to be rationalised.
ISSN:1742-6731
1742-6723
DOI:10.1111/1742-6723.13332