Using clinical notes provided on request forms to assess the risk associated with isolated ureamia

Aims Clinicians often give clinical information in the ‘notes’ field of the request form which can be helpful. We aimed to determine if these notes could be used to determine the clinical risks associated with uraemia. Method We reviewed 951 759 requests for UE 1391 with lower GI bleeding ‘LGB’ (PR bleed, colon carcinoma); 3753 with cardiac failure ‘CCF’. Of all U&Es, 22.5% had elevated urea (>8 mmol/L), of which 29.5% had acceptable renal function (eGFR ≥60 mL/min/1.73 m2). Results Elevated urea was more commonly found with clinical notes of UGB (1.9-fold risk) or CCF (2.8-fold risk), but not with LGB (0.9-fold risk). The relative likelihood was highest for a urea > 12 mmol/L for both UGB (2.8-fold risk) and CCF (3.8-fold risk). Urea >12 mmol/L with acceptable renal function had the highest association for the clinical notes of UGB (9.9-fold risk) and CCF (6.8-fold risk). Discussion Request form clinical notes are associated with urea abnormalities. This approach may provide useful information when trying to define risk levels such as those for critical result phoning.