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Health VIEW

Value of Routine Hospital Tests Studied

July 16, 1987|ALLAN PARACHINI | Times Staff Writer

Critics of the health care system have long contended that many routine hospital procedures, like the chest X-ray automatically taken on admission, are of little apparent benefit.

This line of reasoning has been extended to include many of the now-routine blood tests done at the time a person checks into a hospital.

In a new study conducted by a team at the University of Western Ontario in Canada that was published in the journal Archives of Internal Medicine, researchers examined tests given 2,570 patients who checked into hospitals for routine gallbladder surgery. Of them, 1,010 were not known to have any other health problem other than the one for which they were admitted.

There were 5,003 routine tests done on blood from the 1,010 patients, showing abnormal results in 225 people, of which 104 were possibly important. But in just 17 cases was any treatment ordered as a result, and just four of the patients could be said to have received significant health care intervention on the strength of the tests alone.

A better method of detecting patients who may need care in addition to that for which they were admitted, the researchers concluded, is the traditional physician examination and taking of a health history.

"It appears that the value of the pre-operative history and physical examination has been de-emphasized," the researchers concluded in urging changes in existing procedures, "and that we have become unnecessarily dependent on laboratory techniques."

Body Clock and Births

Medical researchers have known for some time that there is an apparent relationship between the cycles of the so-called body clock and the onset of labor--with most studies indicating labor is most likely to begin from 1:30 to 3 a.m.

Now, a similar body-clock relationship has been discovered between the wee hours and the incidence of premature rupture of the fetal membranes--a complication that can lead to infection, premature birth or other problems. Both phenomena involve the body's circadian rhythm--the clocklike mechanism that regulates a wide variety of human functions.

Not surprisingly, the prevailing time for rupture of the membranes in full-term pregnancies is similar to earlier findings about the onset of labor: 2:15 to 4 a.m. The conclusion, published in the journal Obstetrics and Gynecology, was reached by a research team at the University of Missouri School of Medicine.

There seemed to be differences between the time of premature membrane rupture and whether a woman was delivering at term or early. A logical explanation, the researchers said, is that the circadian mechanism is responsible.

If that's true, they said, it should be possible to influence episodes of premature rupture by somehow interfering with the body clock.

"Because pre-term birth is a major national health problem," the researchers concluded, "it becomes particularly important to determine the identity of the circadian factor."

The new study was not able to do so, but the research team urged new attempts to classify the exact nature of body-clock childbirth influence.

Studies About Speed

Contradicting the rationale behind recent changes in speed limits that permit a 65 m.p.h. maximum on non-urban superhighways, two crash studies of motor vehicles have found that isolated rural roadways have the most dismal injury and fatality rates.

According to one research team, whose findings were reported last week, rural counties outstrip large, populous areas in terms of motor-vehicle death toll by factors of several hundred to one.

Esmeralda County in Nevada, for instance, had the equivalent death rate of 558 people killed per 100,000 population while Loving County, Tex., had a rate of 1,456. This contrasted with New York City (2.5 deaths per 100,000) and Philadelphia (4.1).

The study, published last week in the New England Journal of Medicine, was conducted by the Johns Hopkins School of Hygiene and Public Health and the Insurance Institute for Highway Safety. It came several weeks after a Metropolitan Life Insurance Co. evaluation of regional motor vehicle fatality differences found the safest regions of the country to be the South-Central and Mid-Atlantic states and the most dangerous the Mountain and West South-Central states.

The highest annual death rates for motor vehicle crashes were recorded, Metropolitan Life found, in New Mexico (80.8 deaths per 100,000 for all age groups), Wyoming (85.9), Arizona (60.6), Montana (61.2) and Nevada (66). Statewide in Wyoming, more than 134 of every 100,000 young men 15 to 24 died in car crashes. California's rate was 51.1 for all men. Rhode Island had the lowest rate: 25.7.

While small populations and possibly poor local conditions on rural streets and highways might explain some of the difference, both of the new studies found remarkable consistency among comparatively unpopulated counties and states. The Johns Hopkins study was the first ever to look at fatalities on a county-by-county basis.

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