The biochemical investigation of cases of hypoglycaemia: an assessment of the clinical effectiveness of analytical services.
OBJECTIVE
To assess the extent to which biochemical analytical services contribute to the diagnosis and management of clinical cases of hypoglycaemia.


METHODS
All cases of confirmed hypoglycaemia, referred during a six month period, were included in the survey. Questionnaires were sent to each referring laboratory requesting information on the clinical progress and current status of the patient.


RESULTS
The level of influence exerted by analytical data was assigned in each case and those with similar outcomes combined. Identifiable case groups were: (1) Results not recorded in the patients' notes (15.7%). (2) Inappropriate requesting of insulin and C peptide measurements in cases of diabetes (11.4%). (3) Patient died soon after investigation (20.0%). (4) Patient recovered spontaneously (17.1%). (5) Patient received effective medical or surgical treatment (12.9%). (6) Patient awaiting or not requiring pathology based treatment (31.4%). (7) Inconclusive outcome prompting further investigation (5.7%).


CONCLUSIONS
Within the timescale of the survey (approximately 12 months), positive progress had been made towards diagnosis and subsequent treatment in only 10% of cases. Another 30% were either awaiting some form of treatment or further diagnostic tests. The remaining 60% did not appear to benefit in any way from the biochemical investigations.
Teale
J D
JD
SAS Hormone Unit, Clinical Laboratory, Royal Surrey County Hospital, Guildford GU2 7XX, UK. dteale@royalsurrey.nhs.uk
Wark
G
G
Marks
V
V
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002096:C-Peptide / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003954:Diagnostic Services / Q000592:standards*; D004739:England; D004797:Enzyme-Linked Immunosorbent Assay; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood*; D007755:Laboratories, Hospital / Q000592:standards; D008875:Middle Aged; D016896:Treatment Outcome
D002096:C-Peptide; D007328:Insulin