Utilization of Coagulation Studies in Emergency Department: A Chart Review

Abstract

Aim:This study aimed to determine the prevalence of abnormal coagulation studies in emergency department (ED) patients with and to investigate the relationship among chief complaints, past medical history or drug history, and abnormal results of coagulation studies.Materials and Methods:In this retrospective chart review study, ED records of patients who had undergone coagulation studies were obtained. Patient data, including demographics, chief complaints, past medical history, drug history, and clinical impression, were reviewed. Descriptive and statistical analyses were performed.Results:A total of 322 charts were reviewed. Thirteen patients (4.04%) had an abnormal international normalized ratio (INR), of which six (46.2%) were on warfarin therapy. Although chest pain was the most prevalent chief complaint (10.4%), no statistically significant relationship was found between chief complaints and INR levels. Patients with past medical history of thromboembolic risk were likely to have an abnormal INR [likelihood ratio (LR): 8.8]. Patients on warfarin therapy had a statistically significant likelihood of having abnormal INR (LR: 32.8) (p=0.000). Coagulation profiling was repeated in 4.35% of the patients, with a request gap mean of 6 days.Conclusion:Chief complaints upon presentation to the ED are not good predictors of INR abnormalities. However, warfarin therapy and past medical history of thromboembolic events demonstrated robust association with abnormal INR levels. Routine coagulation studies are not indicated in all patients presenting to the ED.

Keywords

• coagulation
• emergency department
• utilization