Acil Serviste Karın Ağrısı Olan Hastalarda Laboratuvar İncelemeleri ve Maliyet-Etkinlik Yaklaşımı
Özet
Karın ağrısı, acil servis başvurularının en sık nedenlerinden biridir ve tanısal yaklaşımda önemli klinik ve ekonomik zorluklar barındırır. Geniş ayırıcı tanı yelpazesi nedeniyle laboratuvar tetkikleri sıklıkla kullanılmakta; ancak bu testlerin uygunsuz ve aşırı kullanımı maliyet artışına, hasta bakımında gecikmelere ve klinik verimlilikte azalmaya yol açabilmektedir. Bu bölümde, acil serviste karın ağrısının değerlendirilmesinde kullanılan temel laboratuvar testleri, bu testlerin tanısal değerleri ve maliyet-etkinlikleri güncel literatür ışığında ele alınmıştır. Ayrıca klinik risk sınıflaması, algoritmik yaklaşımlar ve hasta başı testlerin (Point-of-Care, POC) acil servis pratiğine katkıları tartışılmıştır. Amaç, kanıta dayalı ve maliyet-etkin bir laboratuvar kullanım stratejisinin acil servis pratiğine entegrasyonunu desteklemektir.
Referanslar
Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003 Feb;21(1):61-72.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008 Apr 1;77(7):971-8.
Gill BD, Jenkins JR. Cost-effective evaluation and management of the acute abdomen. Surg Clin North Am. 1996 Feb;76(1):71-82.
Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995 May;13(3):301-3.
Vaghef-Davari F, Ahmadi-Amoli H, Sharifi A, Teymouri F, Paprouschi N. Approach to Acute Abdominal Pain: Practical Algorithms. Adv J Emerg Med. 2019 Nov 8;4(2):e29
Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci. 2021 Sep;58(6):430-446.
Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J, Wandell M. A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain. Am J Emerg Med. 2013 Sep;31(9):1368-75.
Bogavac-Stanojevic N, Jelic-Ivanovic Z. The Cost-effective Laboratory: Implementation of Economic Evaluation of Laboratory Testing. J Med Biochem. 2017 Jul 14;36(3):238-242
Larkins MC, Zubair M, Thombare A. Point-of-Care Testing. 2025 Dec 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan
Goldstein LN, Wells M, Vincent-Lambert C. The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial. Scand J Trauma Resusc Emerg Med. 2019;27:110.
Goldstein LN, Wells M, Vincent-Lambert C. The cost of time: EC economic impact of POC blood tests in emergency centre. Afr J Emerg Med. 2019;9(2):57–63.
Asha SE, Chan AC, Walter E, Kelly PJ, Morton RL, Ajami A, et al. Impact from point-of-care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis. Emerg Med J. 2014 Sep;31(9):714-9.
Durgun Y, Yurumez Y, Guner NG, Aslan N, Durmus E, Kahraman Y. Abdominal Pain Management and Point-of-care Ultrasound in the Emergency Department: A Randomised, Prospective, Controlled Study. J Coll Physicians Surg Pak. 2022 Oct;32(10):1260-1265.
Tsai MF, Huang FW, Chiu TF, Wong TC, Hung SY, Lin WJ, et al. Association Between Early Point-of-Care Ultrasound and Emergency Department Outcomes in Admitted Patients with Non-Traumatic Abdominal Pain: A Propensity Score-Weighted Cohort Analysis. Diagnostics. 2025; 15(24):3182.
Feretzakis G, Karlis G, Loupelis E, Kalles D, Chatzikyriakou R, Trakas N, et al. Using Machine Learning Techniques to Predict Hospital Admission at the Emergency Department. J Crit Care Med (Targu Mures). 2022 May 12;8(2):107-116.
Pan HM, Li HL, Shen ZS, Guo H, Zhao Q, Li JG. Observation of the Effectiveness of a Diagnostic Model for Acute Abdominal Pain Based on the Etiology Checklist and Process Thinking. Risk Manag Healthc Policy. 2021 Feb 26;14:835-845
Kleinpell RM, Farmer JC, Pastores SM. Reducing Unnecessary Testing in the Intensive Care Unit by Choosing Wisely. Acute Crit Care. 2018 Feb;33(1):1-6.
Referanslar
Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003 Feb;21(1):61-72.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008 Apr 1;77(7):971-8.
Gill BD, Jenkins JR. Cost-effective evaluation and management of the acute abdomen. Surg Clin North Am. 1996 Feb;76(1):71-82.
Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995 May;13(3):301-3.
Vaghef-Davari F, Ahmadi-Amoli H, Sharifi A, Teymouri F, Paprouschi N. Approach to Acute Abdominal Pain: Practical Algorithms. Adv J Emerg Med. 2019 Nov 8;4(2):e29
Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci. 2021 Sep;58(6):430-446.
Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J, Wandell M. A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain. Am J Emerg Med. 2013 Sep;31(9):1368-75.
Bogavac-Stanojevic N, Jelic-Ivanovic Z. The Cost-effective Laboratory: Implementation of Economic Evaluation of Laboratory Testing. J Med Biochem. 2017 Jul 14;36(3):238-242
Larkins MC, Zubair M, Thombare A. Point-of-Care Testing. 2025 Dec 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan
Goldstein LN, Wells M, Vincent-Lambert C. The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial. Scand J Trauma Resusc Emerg Med. 2019;27:110.
Goldstein LN, Wells M, Vincent-Lambert C. The cost of time: EC economic impact of POC blood tests in emergency centre. Afr J Emerg Med. 2019;9(2):57–63.
Asha SE, Chan AC, Walter E, Kelly PJ, Morton RL, Ajami A, et al. Impact from point-of-care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis. Emerg Med J. 2014 Sep;31(9):714-9.
Durgun Y, Yurumez Y, Guner NG, Aslan N, Durmus E, Kahraman Y. Abdominal Pain Management and Point-of-care Ultrasound in the Emergency Department: A Randomised, Prospective, Controlled Study. J Coll Physicians Surg Pak. 2022 Oct;32(10):1260-1265.
Tsai MF, Huang FW, Chiu TF, Wong TC, Hung SY, Lin WJ, et al. Association Between Early Point-of-Care Ultrasound and Emergency Department Outcomes in Admitted Patients with Non-Traumatic Abdominal Pain: A Propensity Score-Weighted Cohort Analysis. Diagnostics. 2025; 15(24):3182.
Feretzakis G, Karlis G, Loupelis E, Kalles D, Chatzikyriakou R, Trakas N, et al. Using Machine Learning Techniques to Predict Hospital Admission at the Emergency Department. J Crit Care Med (Targu Mures). 2022 May 12;8(2):107-116.
Pan HM, Li HL, Shen ZS, Guo H, Zhao Q, Li JG. Observation of the Effectiveness of a Diagnostic Model for Acute Abdominal Pain Based on the Etiology Checklist and Process Thinking. Risk Manag Healthc Policy. 2021 Feb 26;14:835-845
Kleinpell RM, Farmer JC, Pastores SM. Reducing Unnecessary Testing in the Intensive Care Unit by Choosing Wisely. Acute Crit Care. 2018 Feb;33(1):1-6.
