title: Thrombophilia testing in a tertiary paediatric hospital: Indications, outcomes and appropriateness.
abstract: OBJECTIVE
  The association between inherited thrombophilia and thrombotic disease in children is unclear. As a result, whether expensive thrombophilia tests are indicated in children is a contentious issue. This retrospective study aimed to assess the appropriateness of thrombophilia testing and the associated cost of inappropriate testing at a tertiary paediatric hospital.
  
  
  METHODS
  We conducted a search for thrombophilia tests ordered at the Royal Children's Hospital between 1 January 2011 and 31 December 2013. Using pathology and clinical records, we collected data relating to demographics, clinical data, indications, requesting departments and impact on patient management.
  
  
  RESULTS
  Over the 3-year period, 3867 tests were ordered for 613 patients costing the hospital $102 579. Tests were most commonly ordered by gastroenterology on patients receiving liver transplants, by neurology as part of the stroke protocol, and by cardiology and cardiac surgery for patients anticoagulated on heparin infusions. Testing for thrombosis-related indications was relatively uncommon. Thrombophilia testing only directly affected management in one-third of patients. Overall, 70% of thrombophilia tests ordered were considered appropriate. However, some departments were found to have rates of inappropriate testing in excess of 50%.
  
  
  CONCLUSIONS
  With improvements in thrombophilia testing practices at the Royal Children's Hospital AU$29 645.40 could be saved over 3 years. While there are improvements to be made in this area, in the overall context of the hospital's pathology testing budget, review of other areas such as inappropriate use of low-cost, high-volume tests may be of greater value in reducing the cost of pathology testing.
authors.affiliation: Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Aryanto
authors.initials: A
authors.lastname: Sudarmana
authors.affiliation: Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.|Haematology Research, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.|Department of Haematology, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019851:Thrombophilia / Q000175:diagnosis* / Q000191:economics; D013927:Thrombosis / Q000175:diagnosis* / Q000191:economics / Q000209:etiology
keywords: clinical enzyme tests; costs and cost analysis; haematology; paediatrics; thrombophilia