Considerations for Ordering Tests

In addition to diagnostic accuracy, the other important consideration in test ordering is the ultimate effect on the patient. What actions will be taken, based on the test results? What are the expected benefits or harms that might occur, based on a positive or a negative result? Will ordering a particular test be more likely to help than harm the patient? Unfortunately, at present, randomized controlled trials (RCTs) that examine the outcomes of test-and-treatment strategies are not available for most clinical situations. Thoughtful systematic reviews of diagnostic test accuracy, linked with clinical evidence examining treatment options, may be the best available evidence to help guide decisions on diagnostic testing (Cornell et al., 2008).

The following section presents an overview of 40 commonly ordered tests. Each section discusses the physiologic significance of the test, a typical range of reference values, and a listing of some common disease states that might explain an abnormal result. The reference ranges for each

Table 15-4 Causes of Decreased Albumin Levels test are intended as guides and may differ from the reference ranges used by different laboratories, depending on the reference population and the test methodology.

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