Eliminating Unnecessary Lactate Dehydrogenase TestingA Utilization Review Study and National Survey
CPT Daniel C. Randall, MC;
LTC David L. Jones, MC
Arch Intern Med. 1997;157(13):1441-1444.
Abstract
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Background
Consensus recommendations call for the elimination of lactate dehydrogenase (LDH) tests from routine rule out myocardial infarction (ROMI) protocols.
Methods
We conducted a utilization review project in which we evaluated the institutional impact of removing LDH and LDH isoenzyme tests from our hospital diagnostic panel. We then conducted a scripted telephone survey of 100 US hospitals to assess the generalizability of this project.
Results
All our cardiology staff members supported this intervention. Lactate dehydrogenase isoenzyme test results did not add clinically useful data for any of 200 consecutive patients discharged with a diagnosis of acute myocardial infarction, and selective use of LDH isoenzyme testing in cases where it was clinically believed to be indicated cut costs 99% during the year after our intervention. Furthermore, our telephone survey demonstrated that 66% of US hospitals polled continue to test for LDH isoenzymes in every patient with possible myocardial infarction.
Conclusions
Our results corroborate prior recommendations for the removal of LDH testing from the routine ROMI protocol. Such an intervention may be accomplished easily, with excellent staff acceptance and considerable savings. Most US hospitals continue to include LDH testing in their ROMI panels despite national guidelines recommending otherwise.
Arch Intern Med. 1997;157:1441-1444
Author Affiliations
USA; USA
From the Walter Reed Army Medical Center, Washington, DC. Dr Randall is now with the Madigan Army Medical Center, Tacoma, Wash.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
The Obsolescence of Lactate Dehydrogenase Testing
Martin et al.
Arch Intern Med 1998;158:544-544.
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