Voor de dokter

Primum non nocere et in dubio abstine

Evidence based informatie ter ondersteuning van het spreekuur van de huisarts is ruim voor handen, maar niet altijd snel en overzichtelijk te vinden. Deze website probeert een hulp te zijn voor de huisarts die betrouwbare kennis snel en overzichtelijk wil kunnen inzetten tijdens het spreekuur.

Interpretatie laboratorium-uitslagen

Uitgegaan wordt van voorkansen gebaseerd op klinische verdenking zoals in de literatuur gevonden en deze kunnen dus anders zijn dan in uw praktijk. De afkapwaarden kunnen licht verschillen tussen verschillende laboratoria en tussen verschillende studies. Hierin differentiëren in deze rekenmodule is daardoor onmogelijk. Om deze reden zal er altijd een discrepantie zijn tussen wetenschap en praktijk.

Stap 1: Selecteer de uitslagen

 GestegenNormaalOnbekend
Bezinking
Leucocyten
Atypische lymfocyten
CRP
EBV-antilichamen
Troponine I
ALAT
Bilirubine
BNP
Ureum ademtest
Histologie scopie-biopt
Calprotectine
Phadiatop
RAST
Urinezuur
Reuma-factor
anti-CCP
Kristallen in punctaat
D-dimeer

Stap 2: Selecteer de aandoening die klinisch verdacht is

 Klinische verdenkingVoorkansNakans
 
Infecties
 
Bacteriele BLW-infectie
Bacteriele sinusitis
Pneumonie
Mononucleosis infectiosa
 
Cardiovasculaire aandoeningen
 
Acuut coronair syndroom
Hartfalen
Diep veneuze trombose
 
Gastro-enterologie
 
Appendicitis
Cholecystitis
IBD
Helicobacter pylori
 
Allergologie
 
Hooikoorts
 
Reumatologie
 
Jicht
Septische artritis
Reumatoide artritis




Bronnen

  • Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest. 2004 Apr;125(4):1335-42
  • Lindbaek M, Hjortdahl P. The clinical diagnosis of acute purulent sinusitis in gen- eral practice-a review. Br J Gen Pract 2002;52(479):491-5.
  • C-Reactive Protein as an Indicator of Bacterial Infection of Adult Patients in the Emergency Department. Chang Gung Med J 2002;25:437-45
  • Hasse Melbye, Bjorn Straume & Jan Brox (1992) Laboratory Tests for Pneumonia in General Practice: The Diagnostic Values Depend on the Duration of Illness, Scandinavian Journal of Primary Health Care, 10:3, 234-240
  • White blood cells, C-reactive protein and erythrocyte sedi- mentation rate in pneumococcal pneumonia in children. Eur Respir J 1997; 10: 1125-1129
  • Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians. Open Forum Infect Dis. 2015 Sep; 2(3): ofv098
  • White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis. Ann R Coll Surg Engl. 2009 Mar; 91(2): 113-115
  • Marcelo A. Beltran. Predictive value of C-reactive protein in children with appendicitis. Acutecaretesting.org. April 2013
  • Rothrock SG, Pagane J. Acute appendicitis in children: Emergency department diagnosis and management. Ann Emerg Med 2000; 36: 39-51
  • Diagnosing ARI's. Canadian Family Physician. Vol 57: May 2011 565-567
  • Epstein-Barr Virus Infectious Mononucleosis. Am Fam Physician. 2004 Oct 1;70(7):1279-1287
  • Does This Patient Have Infectious Mononucleosis?: The Rational Clinical Examination Systematic Review. JAMA. 2016 Apr 12;315(14):1502-9
  • Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children. BMC Surg. 2006; 6: 15
  • Diagnostic value of inflammatory markers (complete blood count, erythrocyte sedimentation rate, and C-reactive protein) in children with acute appendicitis. Annals of Pediatric Surgery: April 2014 - Volume 10 - Issue 2 - p 39-41
  • The Epidemiology of Upper Respiratory Infections at a Tertiary Care Center: Prevalence, Seasonality, and Clinical Symptoms. Journal of Respiratory Medicine Volume 2014 (2014), Article ID 469393
  • Troponin I sensitivity and specificity for the diagnosis of acute myocardial infarction. J Am Osteopath Assoc. 2000 Jan;100(1):29-32
  • Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction. N Engl J Med 2009; 361:868-877
  • Puleo PR, Meyer D, Wathen C, Tawa CB, Wheeler S, Hamburg RJ, et al. Use of a rapid assay of subforms of creatine kinase-MB to diagnose or rule out acute myocardial infarction. N Engl J Med. 1994;331:561-6
  • Sensitive, Rapid Assay of Subforms of Creatine Kinase MB in Plasma Peter R. Puleo, PhilIp A. Guadagno,1 Robert Roberts, and M. Benjamin Perryman. Clin. chem. 35/7, 1452-1 455 (1989)
  • Laurino JP, Bender EW, Kessimian N, Chang J, Pelletier T, Usategui M. Comparative sensitivities and specificities of mass measurements of CK-MB2, CK MB, and myoglobin for diagnosing acute myocardial infarction. Clin Chem. 1996;42:1454-9
  • Early diagnosis of acute myocardial infarction based on assay for subforms of creatine kinase-MB. PR Puleo, PA Guadagno, R Roberts, MV Scheel, AJ Marian, D Churchill and MB Perryman Circulation. 1990;82:759-764, originally published September 1, 1990
  • The Role of BNP Testing in Heart Failure. Am Fam Physician. 2006 Dec 1;74(11):1893-1900.
  • Cowie MR, Struthers AD, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, et al. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet. 1997;350:1349–53
  • Lainchbury JG, Campbell E, Frampton CM. et al. Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol. 2003 Aug 20;42(4):728-35
  • Knudsen CW, Omland T, Clopton P. et al. Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med. 2004 Mar 15;116(6):363-8
  • Fonseca, C., Morais, H., Mota, T., Matias, F., Costa, C., Gouveia-Oliveira, A., Ceia, F. and on behalf of the EPICA Investigators (2004), The diagnosis of heart failure in primary care: value of symptoms and signs. European Journal of Heart Failure, 6: 795–800
  • Testing for BNP and NT-proBNP in the diagnosis and prognosis of heart failure. Evid Rep Technol Assess (Full Rep). 2006 Sep; (142): 1-147
  • American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007 Aug;102(8):1808-25
  • Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006 Apr;101(4):848-63
  • Shu et al. (2017), Investigation of Helicobacter pylori infection among symptomatic children in Hangzhou from 2007 to 2014: a retrospective study with 12,796 cases. PeerJ 5:e2937
  • Comparison of immunologic tests in the diagnosis of occupational asthma and rhinitis. Allergy. 1994 May;49(5):342-7
  • A practical guide for the diagnosis and treatment of acute sinusitis. Can Med Assoc J 1997;156(6 suppl):S1-S14
  • Crobach MJ, Hermans J, Kaptein AA, Ridderikhoff J, Petri H, Mulder JD. The diagnosis of allergic rhinitis: how to combine the medical history with the results of radioallergosorbent tests and skin prick tests. Scand J Prim Health Care. 1998;16(1):30-36
  • Evaluation of the phadiatop test in the diagnosis of allergic sensitization in a general adult population. J Investig Allergol Clin Immunol. 2005;15(2):124-30
  • Prediction of new-onset asthma and nasal allergy by skin prick test and RAST in a cohort of adults. Eur Respir J. 2014 Jan;43(1):92-102
  • C van Dijk, R Verheij, F Schellevis. Hooikoorts in de huisartsenpraktijk: kosten en verleende zorg. Utrecht: NIVEL 2010
  • Iskandar HN, Ciorba MA. Biomarkers in inflammatory bowel disease: current practices and recent advances. Transl Res. 2012;159:313-325.
  • Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006;55:426-431.
  • Langhorst J, Elsenbruch S, Koelzer J, et al. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103:162-169.
  • Relationship between fecal lactoferrin and inflammatory bowel disease. Scand J Gastroenterol. 2007 Dec;42(12):1440-4
  • Fecal lactoferrin in discriminating inflammatory bowel disease from Irritable bowel syndrome: a diagnostic meta-analysis. BMC Gastroenterol. 2014; 14: 121
  • Fecal lactoferrin, a marker of intestinal inflammation in children with inflammatory bowel disease. Acta Biochim Pol. 2015;62(3):541-5
  • EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006 Oct;65(10):1301-11
  • Review: sensitivities and specificities vary for different diagnostic tests of gout. Evid Based Med. 2007 Apr;12(2):56
  • Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007 Jun 5;146(11):797-808
  • Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis. Canadian Association of Emergency Physicians CJEM 2015:1-8
  • Centers for Disease Control and Protection. Prevalence of doctor-diagnosed arthritis-attributable activity information - United States, 2010-2012. MMWR. 2012;62(44); 869-873.
  • Diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis. Ann Rheum Dis. 2004 Sep;63(9):1079-84
  • Guidelines for the diagnosis of rheumatoid arthritis. Rev. Bras. Reumatol. vol.53 no.2 Sao Paulo Mar./Apr. 2013
  • The Sensitivity and Specificity of a Red Blood Cell Agglutination D-Dimer Assay for Venous Thromboembolism When Performed on Venous Blood. Arch Intern Med. 2002;162(2):217-220
  • D-dimeren en veneuze trombose: beperkingen en perspectieven. Ned Tijdschr Hematol 2005;2(1):8-14
  • De diagnostische waarde van de D-dimeerbepaling. Ned Tijdschr Klin Chem Labgeneesk 2007; 33: 232-238
  • Chunilal SD, Brill-Edwards PA, Stevens PB, Joval JP, McGinnis JA, Rupwate M, et al. The sensitivity and specificity of a red blood cell agglutination D-dimer assay for venous thromboembolism when performed on venous blood. Arch Intern Med 2002;162:217-20

Lab-calculators


Deze pagina is enigszins als een 'proof of concept'-project te beschouwen. De likelihood ratio's, sensitiviteiten en specificiteiten komen uit sterke studies, maar soms zijn er maar beperkte cijfers voor handen. Er is hevig geput uit bronnen als The Likelihood Database, die rekenwaarden verzamelt en categoriseert, maar ook uit zo sterk mogelijke bronnen uit PubMed. De voetnoten van de NHG-standaarden zijn als solide beschouwd en verder berusten de getallen op extensief zoekwerk in de beschikbare literatuur.

Bereken zelf likelihood ratio's!