Skip to main content

Pediatric Diagnostic Lab Tests: An Overview

Abstract

Diagnostic laboratory tests in children require specialized knowledge to collect specimens, interpret results, and make appropriate diagnoses. The knowledge of fundamentals central to diagnostic testing includes disease prevalence, pretest probability, and post-test probability.

The characteristics of diagnostic tests include sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. A negative result of a diagnostic laboratory test must be interpreted in the face of the patient’s history, physical and disease prevalence, and diagnostic test characteristics.

Keywords

  • Pediatric blood collection
  • Pretest probability
  • Post-test probability
  • Sensitivity
  • Specificity
  • Positive likelihood ratio
  • Negative likelihood ratio
  • Diagnostic stewardship

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-90642-9_1
  • Chapter length: 28 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   79.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-90642-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Picture 1.1
Fig. 1.1
Fig. 1.2
Fig. 1.3
Fig. 1.4

References

  • Akobeng A. Understanding diagnostic tests 2; likelihood ratios, pre-post-test probabilities and their use in clinical practice. Acta Paediatr. 2006;96(4):487–91.

    CrossRef  Google Scholar 

  • American Academy of Nurse Practitioners. NP fact sheet. Accessed on Aug 1, 2020., https://www.aanp.org/about/all-about-nps/np-fact-sheet

  • American Academy of Pediatrics. Committee on Infectious Diseases. Red Book: Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018.

    Google Scholar 

  • American Medical Association. Medical Liability Reform NOW! The facts you need to know to address the broken medical liability system. 2020; Accessed Aug 1, 2020, from https://www.ama-assn.org/system/files/2020-05/mlr-now.pdf

  • Baeyens JP, Serrien B, Goossens M, Clijsen R. Questioning the "SPIN and SNOUT" rule in clinical testing. Arch Physiother. 2019; Mar 7;9:4 Retrieved on November 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407254/

  • Baird G. The choosing wisely initiative and laboratory test stewardship. Diagnosi. 2019;6(1):15–23.

    Google Scholar 

  • Balogh EP, Miller BT, Ball JR, editors. Improving Diagnosis in Health Care. Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine. Washington, DC: National Academies Press; 2015. PMID: 26803862

    Google Scholar 

  • Bindraban RS, Ten Berg MJ, Naaklgeboren CA, Kramer MHH, Vansolinge WW, Nanayakkara PWB. Reducing test utilization in a hospital setting: a narrative review. Ann Lab Med. 2018;38:402–12.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Blankenstein O, Pedersen BT, Schlump M, Andreasen AH, Júlíusson PB. Management and interpretation of heterogeneous observational data: using insulin-like growth factor-1 data from the NordiNet International Outcome study. Growth Hormon IGF Res. 2015;25:41–6.

    CAS  CrossRef  Google Scholar 

  • Borysiak MD, Thompson MJ, Posner JD. Translating diagnostic assays from the laboratory to the clinic: analytical and clinical metrics for device development and evaluation. Lab Chip. 2016;16(8):1293–313.

    Google Scholar 

  • Boyd C, Wood K, Whitaker D, Ashorobi O, Harvey L, Oster R, et al. Accuracy in 24-hour urine collection at a tertiary center. Rev Urol. 2018;20(3):119–24.

    PubMed  PubMed Central  Google Scholar 

  • Bray C, Bell LN, Liang H, Haykal R, Kalksow F, Mazza JJ, Yale SH. Erythrocyte sedimentation rate and C-reactive protein measures and their relevance in clinical medicine. WMJ. 2016;115(6):317–21.

    PubMed  Google Scholar 

  • Brown JVE, Meader N, Wright K, Cleminson J, McGuire W. Assessment of C-reactive protein diagnostic test accuracy for late-onset infection in newborn infants: a systematic review and meta-analysis. JAMA Pediatr. 2020;174(3):260–8.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Buppert C. Nurse practitioner’s business practice and legal guide. 6th ed. Burlington, MA: Jones and Barlett; 2018.

    Google Scholar 

  • Burke MD. Clinical laboratory consultation: appropriateness to laboratory medicine. Clin Chim Acta. 2003;333:125–9.

    CAS  PubMed  CrossRef  Google Scholar 

  • Caraguel CGB, Vanderstichel R. The two-step Fagan’s nomogram: ad hoc interpretation of a diagnostic test result without calculation. Evid Based Med. 2013;18(4):125–8.

    PubMed  CrossRef  Google Scholar 

  • Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801–2.

    CAS  PubMed  CrossRef  Google Scholar 

  • Centers for Disease Control and Prevention. HIV Surveillance report. 2015. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf

  • Centers for Disease Control and Prevention (CDC). Diagnoses of HIV Infection in the United States and Dependent Areas, 2017. CDC website. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf. Published November 2018. Accessed Aug 1, 2020.

  • Centre for Evidence-Based Medicine. OCEBM levels of evidence. https://cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence. Accessed November 3, 2020.

  • Centre for Evidence-Based Medicine, Diagnostic Accuracy Studies. https://www.cebm.net/wecontent/uploads/2014/04/diagnostic-study-appraisal-worksheet.pdf. Accessed November 3, 2020.

  • Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic accuracy of rapid antigen detection test for respiratory syncytial virus infection: systematic review and meta-analysis. J Clin Microbiol. 2015;53(12):3738–49.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  • Crewe S, Rowe PC. Likelihood ratio in diagnosis. Pediatr Rev. 2011;22(7):296–9.

    CrossRef  Google Scholar 

  • Cui W, Liu H, Ni H, Qin X, Zhu L. Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children: a meta-analysis. Ital J Pediatr. 2019;45:78.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  • Dailey AF, Hoots BE, Hall HI, Song R, Hayes D, Fulton P, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays—United States. MMWR Morb Mortal Wkly Rep. 2017;66:1300–6.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Ebell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician. 2004;70(7):1279–87.

    PubMed  Google Scholar 

  • Fang C, Chien Y, Yang L, Lu W, Lin M. EDTA-dependent pseudothrombocytopenia. Formosan J Surg. 2015;48(3):107–9.

    CrossRef  Google Scholar 

  • Fierz W, Bossuyt X. Likelihood ratios as a value proposition for diagnostic laboratory tests. Am Ass Clin Chem. 2020:1–9.

    Google Scholar 

  • Gaglani A, Gross T. Pediatric pain management. Emerg Med Clin North Am. 2018;36(2):323–34.

    PubMed  CrossRef  Google Scholar 

  • Graf EH, Pancholi P. Appropriate use of future directions of molecular diagnostic testing. Curr Infect Dis Rep. 2020;22:5.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Hallworth MJ. The “70% claim”. Ann Clin Biochem. 2011;48:487–8.

    PubMed  CrossRef  Google Scholar 

  • Harb R, Hajdasz D, Landry M, Sussman LS. Improving laboratory test utilization at the multihospital Yale-New Haven Health System. BMJ Qual. 2019;8(3):e0000689.

    Google Scholar 

  • Holtman GA, Lisman-van Leeuwen Y, Reitsma JB, Berger MY. Noninvasive test for inflammatory bowel disease: a meta-analysis. Pediatrics. 2016;137(1):e20152026.

    CrossRef  Google Scholar 

  • Iams W, Heck J, Kapp M, Leverenz D, Velia M, Szentirmai E, et al. A multidisciplinary house staff lead initiative to safely reduce daily laboratory testing. Acad Med. 2016;91(6):813–20.

    PubMed  CrossRef  Google Scholar 

  • Jackson E. Urinary tract infections in children: knowledge updates and a salute to the future. Pediatr Rev. 2015;36(4):153–66.

    PubMed  CrossRef  Google Scholar 

  • Jackups R, Szymnaski JJ, Persaud SP. Clinical decision support for hematology laboratory test utilization. Int J Lab Hematol. 2017; Retrieved on November 30, 2020, https://onlinelibrary.wiley.com/doi/full/10.1111/ijlh.12679

  • Kaminska J, Dymicka-Perkarska V, Tomaszewska J, Matowicka-Karna J, Koper-Lenkiewicz O. Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice. Crit Rev Clin Lab Sci. 2020;57(5):345–64.

    Google Scholar 

  • Kazmierczak S. Statistical techniques for evaluating the diagnostic utility of laboratory tests. Clin Chem Lab Med. 1999;37(11-12):1001–9.

    CAS  PubMed  CrossRef  Google Scholar 

  • Kessler DP. Evaluating the medical malpractice system and options for reform. J Econ Perspect. 2011;25:93–110. PMID: 21595327

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Kobewska DM, Ronksley PE, Mckay JA, Forster AJ, Van Walraven C. Influence of educational, audit and feedback, system-based and incentive and penalty interventions to reduce laboratory test utilization: a systematic review. Clin Chem Lab Med. 2015;53:157–83.

    Google Scholar 

  • Laposata M. Obtaining a correct diagnosis rapidly in the United States in association with many barriers not present in other countries. Am J Clin Pathol. 2018;149:458–60.

    PubMed  CrossRef  Google Scholar 

  • Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics. 2014;134(4):771–81.

    PubMed  CrossRef  Google Scholar 

  • Lee SH, Yun SJ. Diagnostic performance of ultrasonography for detection of pediatric elbow fracture: a meta-analysis. Ann Emerg Med. 2019;74(4):493–502.

    PubMed  CrossRef  Google Scholar 

  • Lippi G, Brambilla M, Bonelli P, Aloe R, Balestrino A, Nardelli A, et al. Effectiveness of a computerized alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests. Clin Biochem. 2015;48:1174–6.

    PubMed  CrossRef  Google Scholar 

  • Marshall-Andon T, Heinz P. How to use ... the Monospot and other heterophile antibody tests. Archives of Disease in Childhood – Educaiton and Practice. 2017; 102:188–93.

    Google Scholar 

  • McGee S. Simpifying likelihood ratios. J Gen Intern Med. 2002;17:647–50.

    Google Scholar 

  • Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29:1569–77.

    CrossRef  Google Scholar 

  • Messacar K, Parker SK, Todd JK, Dominguez SR. Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship. J Clin Microbiol. 2017;55(3):715–23.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Morjaria S, Chapin KP. Who to test, when and for what. J Mol Diagn. 2020;22:9.

    CrossRef  CAS  Google Scholar 

  • Nagler M, Keller P, Siegrist D, Alberio L. A case of EDTA-dependent pseudothrombocytopenia: simple recognition of an underdiagnosed and misleading phenomenon. BMC Clin Pathol. 2014;14:article 19. Retrieved on August 2, 2020, https://bmcclinpathol.biomedcentral.com/articles/10.1186/1472-6890-14-19

  • Patel R, Fang FC. Diagnostic stewardship: opportunity for a laboratory-infectious diseases partnership. Clin Infect Dis. 2018;67(5):799–801.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015;135(4):714–22.

    PubMed  CrossRef  Google Scholar 

  • Quidel. QueVue Chlamydia Test. Retrieved August 20, 2020., https://www.quidel.com/sites/default/files/product/documents/EF0562610EN00_%2808_19%29_QuickVue_Chlamydia_Pkg_Insert.pdf

  • Rao A, Berg B, Quezada T, Fader R, Walker K, Tang S, et al. Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction. BMC Pediatr. 2019;19:24. Retrieved on August 2, 202. https://doi.org/10.1186/s12887-019-1393-y.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Ridefelt P, Gustafsson J, Aldrimer M, Hellberg D. Alkaline phosphatase in healthy children reference intervals and prevalence of elevated levels. Horm Res Paediatr. 2014;82:399–404.

    CAS  PubMed  CrossRef  Google Scholar 

  • Robinson JC, Whaley C, Brown TT. Association of reference pricing for diagnostic laboratory testing with changes in patient choices, prices and total spending for diagnostic tests. JAMA Intern Med. 2016;176(9):1353–9.

    PubMed  CrossRef  Google Scholar 

  • Rolfe A, Burton C. Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis. JAMA Intern Med. 2013;173:407–16.

    PubMed  CrossRef  Google Scholar 

  • Sackett D, Strauss S, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. Edinburgh: Churchill Livingstone; 2000.

    Google Scholar 

  • Seegmiller AC, Kim AS, Mosse CA, Levy MA, Thompson MA, Jagasia MH, et al. Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach. Am J Clin Pathol. 2013;140:643–50.

    PubMed  CrossRef  Google Scholar 

  • Segel GB, Halterman J. Neutropenia in pediatric practice. Pediatr Rev. 2008;29:12–25.

    PubMed  CrossRef  Google Scholar 

  • Smith B, Kamoun M, Hickner J. Laboratory Medicine Education at U.S. Medical Schools: a 2014 Status Report. Acad Med. 2014;91(1):107–12.

    CrossRef  Google Scholar 

  • Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM. Rapid antigen group a streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. PLoS One. 2014;9(11):e111727.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  • Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children: heterophile antibody and viral-specific responses. Pediatrics. 1985;75(6):1011–9.

    CAS  PubMed  CrossRef  Google Scholar 

  • Tan G, Stalling M, Dennis G, Nunez M, Kahwash SB. Pseudothrombocytopenia due to platelet clumping: a case report and brief review of the literature. Case Rep Hematol. 2016;3036476. Retrieved on August 2, 2020, https://www.hindawi.com/journals/crihem/2016/3036476/

  • The ABIM Foundation. Unnecessary tests and procedures in the health care system: what physicians say about the problem, the causes and the solutions. Results from a national survey of physicians. May 1, 2014. Accessed on July 30, 2020, at https://www.choosingwisely.org/wp-content/uploads/2015/04/Final-Choosing-Wisely-Survey-Report.pdf.

  • Trevethan R. Sensitivity, specificity and predictive values: foundations pliabilities, and pitfalls in research and practice. Front Public Health. 2017;5:307–13.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • US Preventive Services Task Force [USPSTF]. Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA 2019; Retrieved on November 30, 2020, from https://jamanetwork.com/journals/jama/fullarticle/2735345

  • Vegting L, Beneden M, Kramer H, Piet A, Prabath K, Nanayakkara WB. How to save costs by reducing unnecessary testing: lean thinking in clinical practice. Eur J Intern Med. 2012;23(1):70–5.

    PubMed  CrossRef  Google Scholar 

  • Verna R, Velazquez A, Laposata M. Reducing diagnostic errors worldwide through diagnostic management teams. Ann Lab Med. 2019;39:121–4.

    PubMed  CrossRef  Google Scholar 

  • Watson J, Whiting PF, Brush JE. Interpreting a COVID-19 test result. BMJ. 2020;369:m1808. Retrieved November 30, 2020 from https://www.bmj.com/content/369/bmj.m1808

    PubMed  CrossRef  Google Scholar 

  • Wilson JMG, Jungner G. Principles and practices of screening for disease. Geneva: World Health Organization; 1968. Report No.: Public Health Papers No. 34

    Google Scholar 

  • Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Yoon HM, Suh CH, Kim JR, Lee JS, Jung AY, Cho YA. Diagnostic performance of magnetic resonance enterography for detection of active inflammation in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Pediatr. 2017;171(12):1208–16.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Yuksel S, Yusel G, Oncel S, Divanli E. Osteomyelitis of the calcaneus in the newborn: an ongoing complication of the Guthrie test. Eur J Pediatr. 2007;166(1):503–4.

    PubMed  CrossRef  Google Scholar 

  • Zhao C, Yuan B. Evaluation of the accuracy of FeNO in pediatric asthma diagnosis: a meta-analysis. Int J Clin Exp Med. 2019;12(5):4517–27.

    CAS  Google Scholar 

  • Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013;8:e78962.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arlene Smaldone .

Editor information

Editors and Affiliations

Websites

Websites

https://arupconsult.com/

https://ebm-tools.knowledgetranslation.net/

https://labtestsonline.org/

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Smaldone, A., John, R.M. (2022). Pediatric Diagnostic Lab Tests: An Overview. In: John, R.M. (eds) Pediatric Diagnostic Labs for Primary Care: An Evidence-based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-90642-9_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-90642-9_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-90641-2

  • Online ISBN: 978-3-030-90642-9

  • eBook Packages: MedicineMedicine (R0)