Efficacy of a "standard" XXXX workup in the emergency department.

@entity1 @entity410 @entity3439 @entity542 @entity4053 @entity51 @entity2613 @entity460 @entity1011 @entity4854 @entity413 @entity1760
In many institutions it is the "standard of care" to obtain serum chemistries and anticonvulsant levels as part of the emergency department evaluation of @entity410 @entity1 . To determine the efficacy of such a workup in the @entity2613 , 163 @entity410 @entity1 presenting to an inner-city teaching hospital were studied in a standardized, prospective manner. After the clinical examination all @entity1 had CBC, serum electrolyte, BUN, @entity1011 , @entity413 , @entity460 , @entity1760 , and if indicated, anticonvulsant drug level determinations performed. Any @entity1 presenting with a first-time @entity410 (in @entity1 greater than 6 years old), recent @entity542 , focal @entity51 , or focal @entity410 activity had cranial computerized tomography (CCT). After obtaining historical and physical examination and before receiving laboratory results, as many as five likely etiologies were listed and assigned probability ratings. After review of the laboratory data (and CCT scan, if obtained), final etiologies again were listed and assigned percentages of likelihood. Significant abnormalities (ie, those that changed diagnosis, management, or disposition) were found in 104 @entity1 ; 96 had subtherapeutic anticonvulsant levels, five had abnormal CCT scans, two had @entity4053 , and one had @entity4854 as the cause of @entity410 . The clinical examination successfully predicted those abnormalities in all but two cases (one each of @entity4854 and @entity3439 ). We contend tha routine serum chemistries in @entity1 presenting to the @entity2613 are of extremely low yield, and that the clinical examination can predict accurately the need to obtain these studies. CCT scanning is useful in selected @entity1 , and was found to be abnormal in five of 19 (25%) @entity1 .(ABSTRACT TRUNCATED AT 250 WORDS)
