Evidence map›Paper›PMID 27377975›Full record

ArticleJournal of thrombosis and thrombolysis2016

A high-value cost conscious approach to minimize heparin induced thrombocytopenia antibody (HITAb) testing using the 4T score.

Mohanad Hasan, Pannaga Malalur, Manas Agastya, Ali O Malik, Yaser Dawod, Mohammad Jaradat, Ji-Won Yoo, Ranjit Makar

Registry-linked trialAbstract read
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In one paragraph

Article in Journal of thrombosis and thrombolysis, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05439265 (Effect of an Electronic Medical Record Tool on the Documentation and Management of Newly Suspected Heparin Induced Thrombocytopenia), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05439265 completednot on this map

Effect of an Electronic Medical Record Tool on the Documentation and Management of Newly Suspected Heparin Induced Thrombocytopenia

TypeobservationalSponsorRush University Medical CenterRan2014 to 2017Enrolled128ConditionsHeparin, Thrombocytopenia, Electronic Health RecordsArmsElectronic medical record order panel and resident involvement
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Mohanad HasanDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Pannaga MalalurDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA. pannaga.mg@gmail.com.
Manas AgastyaDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Ali O MalikDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Yaser DawodDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Mohammad JaradatDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Ji-Won YooDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.
Ranjit MakarDepartment of Internal Medicine, University of Nevada School of Medicine, 1701 W Charleston Blvd., #230, Las Vegas, NV, 89102, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Heparin Induced Thrombocytopenia (HIT) is a serious complication from administration of heparin products. The 4T score is a validated pre-test probability tool to screen for HIT in hospitalized patients. As the negative predictive value (NPV) is very high further testing for HIT in patients with a low score can be avoided. Our objective was to determine trends at our hospital with respect to utilization of HIT antibody (HITAb) testing and evaluate economic burden from unnecessary HIT testing. A retrospective cohort review was performed on patients age 18 and above admitted to a tertiary care center from February 2013 to December 2014 who underwent HITAb testing. Surgical ICU patients were excluded. Patients were stratified into low, intermediate, and high risk for HIT based on the 4T model. Statistical analysis was performed using Chi square and regression models. Of 150 patients that underwent HITAb testing, 134 met inclusion criteria. 73 were male (54.47 %) and mean age was 55.50 ± 17.27 years. 81 patients had a low 4T score 0-3. Analysis of testing trends showed 60.44 % of patients were tested for HITAb despite being low risk using the 4T model. Only three patients with low 4T score were positive on confirmatory SRA testing (NPV 96.29 % CI 95 = 89.56-99.23 %). Expenditure due to inappropriate testing and treatment was estimated at $103,348.13. The majority of HITAb testing was found unnecessary based on the investigator calculated 4T score. We propose implementation of an electronic medical record (EMR) based calculator in order to reduce unneeded tests and reduce use of costlier alternative anticoagulants.

Indexed as

Predictive Value of TestsAdultAgedAntibodiesCohort StudiesFemaleHealth ExpendituresHeparinHumansMaleMiddle AgedPlatelet Factor 4Retrospective StudiesThrombocytopeniaAntibodiesHeparinPlatelet Factor 44T scoreAntibodyAnticoagulationCost-effectiveHeparinHeparin induced thrombocytopeniaThrombosis

Identifiers

PMID27377975

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