Wednesday, April 18, 2007

April JMLA case posted: diagnosing acute pancreatitis

The April issue of the Journal of the Medical Library Association is now available in PubMed Central and it includes the latest installment in our case study series, "Using the literature to evaluate diagnostic tests: amylase or lipase for diagnosing acute pancreatitis?"

The case:
Your hospital's Emergency Department (ED) holds weekly teaching conferences for its residents. These sessions are composed of didactic lectures and oral case reports in which one resident presents a challenging patient case and another resident works through the process of evaluating and managing the situation. These sessions are a key part of the residents' training and present opportunities to evaluate current medical practices and determine the best methods of care based on the evidence.

During a particular case conference, a resident is managing a practice case that is clinically suspicious for pancreatitis. The two most common tests for diagnosing acute pancreatitis are serum amylase and serum lipase levels, and the resident requests both tests as part of the laboratory work-up of the case. The attending physician interrupts and queries the resident regarding his rationale for ordering both tests and whether one of the tests may be sufficient. An animated discussion ensues, with opinions voiced by several attending physicians and residents, about whether it is necessary to order both tests in this kind of case and, if not, which one should be used. During this debate, the lead attending turns to you as the group's consulting librarian and asks you to search and report on the literature surrounding the issue.

The question:
Which diagnostic test, serum amylase or serum lipase, is the best for making an accurate diagnosis of acute pancreatitis in the adult ED setting?

See the full case write-up for more details. Feel free to post your thoughts and questions about the case in the comments, and stay tuned for follow-up posts on sensitivity and specificity, the pancrease, physician diagnostic test ordering practices, and more...

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