Bylapudisesh u Kumar
Introduction
Patients presented to surgical Same Day Emergency Care (SDEC)with epigastric and right upper abdominal pain undergo routine repeated blood tests including amylase to diagnose pancreatitis. Routine serum amylase testing costs a little off £1.8 to £4.5 per sample in the hospital and up to £45 in the primary care. This study reviewed whether routine repeated amylase was clinically required or an unnecessary expense.
Methods
Retrospective case note analysis of patients who had presented to surgical SDEC from April to June 2024 was performed. Data collected included timing of serum amylase test, how many times the test was performed and the final clinical value of testing.
Results
Of a total of 1058 patients, 323 patients presented with Epigastric pain and RUQ pain and 256(79.2%) had a repeated serum amylase testing. 178(55.1%) patients had amylase testing of more than 3 times within 5 days of initial Presentation.
Overall, Only 8(0.7%)patients presented to ambulatory care were diagnosed as mild acute pancreatitis based on amylase and admitted for further management.
The total cost of serum amylase testing was £4861 excluding the phlebotomy services for the given small cohort In the 3 months period.
Conclusions
It appears that routine repeated serum amylase testing is an unnecessary expenditure for patients presented with Right upper quadrant and epigastric pain within sort duration. Targeted testing of serum amylase should be reserved for patients with a high clinical suspicion of acute pancreatitis.
Authors
Seshu Kumar Bylapudi
University Hospitals leicester, leicester, United Kingdom
Sadhasivam Ramasamy
The roayl Wolverhampton NHS Trust, Wolverhampton, United Kingdom
Rafique Umer Harvitkar
Royal sussex county hospital, Brighton, United Kingdom
Syeda Rizvi
University Hospitals leicester, leicester, United Kingdom
Biraj Karmakar
Kettering General hospital, Kettering, United Kingdom