Filtering clinically significant hypercalcaemia from non-significant hypercalcaemia at the laboratory level

Combined reports on serum calcium and discriminant functions increase the diagnostic rate of hypercalcaemia

Hypercalcaemia is a condition easily overlooked by the clinician. Prompted by the observation that computerized reminders could increase the awareness, we have examined whether the combined reporting of increased serum calcium results and the results from diagnostic discriminating calculations could increase the clinical awareness of hypercalcaemia. Albumin-corrected serum calcium was estimated in all 4500 patients admitted to the hospital during a period of 2 months. Eighty-seven patients were found with hypercalcaemia and were assigned randomly to 2 groups: A (40 patients) and B (47 patients). In group A, the increased serum calcium and the results of the discriminant functions were reported; in group B, the serum calcium was reported only if requested and the discrimination diagnosis withheld. The clinical records were examined 3 weeks after admission. At this time the records in group A contained a relevant clinical diagnosis explaining the hypercalcaemia in 81% of the cases. This was in contrast to only 31% of the records in group B. We conclude that this combined reporting leads to a considerable improvement in the clinical awareness of hypercalcaemia and results in a diagnosis explaining the condition in the majority of cases.