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BACKGROUND: Over the last few decades, there has been a surge in the use of laboratory testing during patient encounters. Many suggest that laboratory investigations for psychiatric inpatient units are unnecessary, thus warranting further research and support. Furthermore, though the results of completed investigations may fall out of normal range, they are most often deemed not clinically significant and do not affect patient management. OBJECTIVES: Determine the clinical relevance of routine bloodwork completed upon patient admission to a pediatric psychiatric inpatient unitIdentify which blood tests fell most often outside the range of normal and whether they resulted in follow-up. Recommend a more streamlined and cost-efficient approach towards ordering admission bloodwork. DESIGN/METHODS: Through a retrospective chart review, 485 patient admissions to the pediatric inpatient unit at a tertiary care teaching hospital between January 1st and December 31st, 2016 were reviewed and analyzed. Demographics (age, sex) were collected along with results and clinical significance of 17 routinely ordered laboratory tests (CBC and differential, serum glucose, sodium, potassium, chloride, urea, creatinine, bilirubin, ALP, AST, ALT, LDH, GGT, TSH, ferritin, folate and B12 levels). RESULTS: Routine bloodwork was completed for 79.8% (n=387) of patient admissions. However, no more than 1.7% of the completed bloodwork led to changes in patient management. Tests which were most frequently clinically significant included Ferritin (6.1%), TSH (4.7%), and B12 (3.2%). The remaining 14 routine laboratory tests were each clinically significant less than 2.5% of the time. CONCLUSION: The results of this study suggest that not all routine laboratory investigations are useful on admission given few led to changes in patient management. Our study proposes that physicians admitting pediatric patients to the inpatient psychiatry ward order a subset of routine blood work including Ferritin, TSH, B12, and others only when deemed necessary by the attending physician and based on patient presentation.

Il est demontre que le traitement pharmacologique par des stimulants reduit les symptomes associes au trouble de deficit de l’attention avec hyperactivite (TDAH), et ce traitement fait partie des recommandations therapeutiques de l’American Academy of Pediatrics pour les enfants presentant ce trouble (1,2). Cependant, de recentes decisions en matiere de reglementation sur l’homologation et l’etiquetage des medicaments contre le TDAH (3,4), ainsi qu’un recent document de principes de l’American Heart Association (5), une correction et une reponse (clarification) de l’American Academy of Pediatrics (6,7), ont souleve des questions sur l’evaluation et la therapie du TDAH que preconisent les praticiens canadiens. La pratique canadienne actuelle dans le domaine de la pharmacotherapie du TDAH et du depistage cardiovasculaire est mixte, et il y a peu de consensus quant a l’evaluation pertinente des enfants avant d’instaurer la pharmacotherapie du TDAH (8). Les avis sont encore plus partages au sujet de l’innocuite du traitement des enfants ayant subi une refection ou une palliation de leur cardiopathie congenitale (CPC) et qui prennent des medicaments contre le TDAH (8). Afin d’orienter les medecins canadiens qui soignent les enfants ayant un TDAH et de clarifier la situation, la Societe canadienne de pediatrie, la Societe canadienne de cardiologie et l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent ont prepare conjointement le present document de principes. Il contient des recommandations consensuelles sur l’evaluation du risque cardiaque chez les enfants ayant un TDAH a qui on envisage d’administrer des stimulants. Il ne s’attarde pas au diagnostic de TDAH, ni aux bienfaits therapeutiques des stimulants. De meme, il n’aborde pas le bien-fonde ou les risques relatifs d’un medicament par rapport a un autre au sein de cette population de patients. Enfin, les medicaments non stimulants utilises dans le traitement du TDAH, y compris l’atomoxetine, les antidepresseurs et les agonistes alpha-adrenergiques, ne font pas l’objet d’une analyse particuliere.