Determining the utility of creatinine delta checks: A large retrospective analysis

Delta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their utility is unclear. The objective of this retrospective analysis was to determine whether establishment of a creatinine delta check would be an...

Full description

Saved in:
Bibliographic Details
Published inClinical biochemistry Vol. 53; pp. 139 - 142
Main Authors Gruenberg, Jessica M., Stein, Tracy A., Karger, Amy B.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.03.2018
Online AccessGet full text

Cover

Loading…
Abstract Delta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their utility is unclear. The objective of this retrospective analysis was to determine whether establishment of a creatinine delta check would be an effective means for capturing true laboratory error. All patients with a minimum of two creatinine results during March of 2015 were selected for review (n = 23,410 creatinine results). The lowest % change for a previously confirmed creatinine error in our laboratory was approximately 60%; therefore only results that changed by at least ±60% (n = 254) were reviewed. The etiology of creatinine value change was categorized as laboratory error, pathologic change, or non-pathologic change, based upon chart review. Results: 1.2% (3/254) of reviewed delta checks were determined to reflect 2 instances of true laboratory error that went unrecognized by laboratory staff. 91.3% (232/254) of the delta checks were determined to reflect a pathologic or dialysis-related change in creatinine levels. The remaining 7.5% of delta checks (19/234) were deemed to be non-pathologic changes in creatinine. This study identified two instances of laboratory error reflected by 3 delta checks (1.2%); the vast majority (91.3%) of creatinine results that changed by ±60% were pathologic or dialysis-related. Thus, establishment of a ±60% delta check for creatinine would overwhelmingly flag true biological change and would not be an efficient means for identifying rare laboratory errors. Clinical laboratories should perform similar retrospective analyses prior to enacting delta checks to determine whether they will effectively capture laboratory error. •With decreased specimen mix-ups due to lab automation and technology, the utility of delta checks has been questioned•Studies on delta checks are limited and data is needed to assess their effectiveness•Retrospective medical record review determined that a creatinine delta check would overwhelmingly flag pathologic change•Clinical laboratories can use retrospective analysis to assess the utility of potential or current delta checks
AbstractList INTRODUCTIONDelta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their utility is unclear. The objective of this retrospective analysis was to determine whether establishment of a creatinine delta check would be an effective means for capturing true laboratory error.METHODSAll patients with a minimum of two creatinine results during March of 2015 were selected for review (n = 23,410 creatinine results). The lowest % change for a previously confirmed creatinine error in our laboratory was approximately 60%; therefore only results that changed by at least ±60% (n = 254) were reviewed. The etiology of creatinine value change was categorized as laboratory error, pathologic change, or non-pathologic change, based upon chart review.RESULTS1.2% (3/254) of reviewed delta checks were determined to reflect 2 instances of true laboratory error that went unrecognized by laboratory staff. 91.3% (232/254) of the delta checks were determined to reflect a pathologic or dialysis-related change in creatinine levels. The remaining 7.5% of delta checks (19/234) were deemed to be non-pathologic changes in creatinine.DISCUSSIONThis study identified two instances of laboratory error reflected by 3 delta checks (1.2%); the vast majority (91.3%) of creatinine results that changed by ±60% were pathologic or dialysis-related. Thus, establishment of a ±60% delta check for creatinine would overwhelmingly flag true biological change and would not be an efficient means for identifying rare laboratory errors. Clinical laboratories should perform similar retrospective analyses prior to enacting delta checks to determine whether they will effectively capture laboratory error.
Delta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their utility is unclear. The objective of this retrospective analysis was to determine whether establishment of a creatinine delta check would be an effective means for capturing true laboratory error. All patients with a minimum of two creatinine results during March of 2015 were selected for review (n = 23,410 creatinine results). The lowest % change for a previously confirmed creatinine error in our laboratory was approximately 60%; therefore only results that changed by at least ±60% (n = 254) were reviewed. The etiology of creatinine value change was categorized as laboratory error, pathologic change, or non-pathologic change, based upon chart review. 1.2% (3/254) of reviewed delta checks were determined to reflect 2 instances of true laboratory error that went unrecognized by laboratory staff. 91.3% (232/254) of the delta checks were determined to reflect a pathologic or dialysis-related change in creatinine levels. The remaining 7.5% of delta checks (19/234) were deemed to be non-pathologic changes in creatinine. This study identified two instances of laboratory error reflected by 3 delta checks (1.2%); the vast majority (91.3%) of creatinine results that changed by ±60% were pathologic or dialysis-related. Thus, establishment of a ±60% delta check for creatinine would overwhelmingly flag true biological change and would not be an efficient means for identifying rare laboratory errors. Clinical laboratories should perform similar retrospective analyses prior to enacting delta checks to determine whether they will effectively capture laboratory error.
Delta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their utility is unclear. The objective of this retrospective analysis was to determine whether establishment of a creatinine delta check would be an effective means for capturing true laboratory error. All patients with a minimum of two creatinine results during March of 2015 were selected for review (n = 23,410 creatinine results). The lowest % change for a previously confirmed creatinine error in our laboratory was approximately 60%; therefore only results that changed by at least ±60% (n = 254) were reviewed. The etiology of creatinine value change was categorized as laboratory error, pathologic change, or non-pathologic change, based upon chart review. Results: 1.2% (3/254) of reviewed delta checks were determined to reflect 2 instances of true laboratory error that went unrecognized by laboratory staff. 91.3% (232/254) of the delta checks were determined to reflect a pathologic or dialysis-related change in creatinine levels. The remaining 7.5% of delta checks (19/234) were deemed to be non-pathologic changes in creatinine. This study identified two instances of laboratory error reflected by 3 delta checks (1.2%); the vast majority (91.3%) of creatinine results that changed by ±60% were pathologic or dialysis-related. Thus, establishment of a ±60% delta check for creatinine would overwhelmingly flag true biological change and would not be an efficient means for identifying rare laboratory errors. Clinical laboratories should perform similar retrospective analyses prior to enacting delta checks to determine whether they will effectively capture laboratory error. •With decreased specimen mix-ups due to lab automation and technology, the utility of delta checks has been questioned•Studies on delta checks are limited and data is needed to assess their effectiveness•Retrospective medical record review determined that a creatinine delta check would overwhelmingly flag pathologic change•Clinical laboratories can use retrospective analysis to assess the utility of potential or current delta checks
Author Gruenberg, Jessica M.
Karger, Amy B.
Stein, Tracy A.
Author_xml – sequence: 1
  givenname: Jessica M.
  surname: Gruenberg
  fullname: Gruenberg, Jessica M.
  email: grue0048@umn.edu
– sequence: 2
  givenname: Tracy A.
  surname: Stein
  fullname: Stein, Tracy A.
  email: stei1035@umn.edu
– sequence: 3
  givenname: Amy B.
  orcidid: 0000-0002-2781-3824
  surname: Karger
  fullname: Karger, Amy B.
  email: karge026@umn.edu
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29402415$$D View this record in MEDLINE/PubMed
BookMark eNqNkE1v2zAMhoWhxZJ0-wuDduvFnijbsdVbkH4CBQYU21mQaapV5o9MUgrk31dB0mHHnkiCL_mSz4KdjdNIjH0HkYOA5Y9Njr0bWzfhCw25FNDkAnIhi09sDk1dZFIVxRmbCyFUpkCKGVuEsEmlLJvlZzaTqkwpVHP2dE2R_OBGNz7z-EJ8F13v4p5PlqMnEw8d4h310fBkh3_CFV_x3vhn4p6in8KWMLpX4mY0_T648IWdW9MH-nqKF-z37c2v9X32-PPuYb16zLCo65gtWyTR1aYhSYUo1ZJAlRZKWVoqEBU2SpVYCUW1rG3XgRVoK7SqaVsFCooLdnncu_XT3x2FqAcXkPrejDTtggalKqjKum6SVB2lmO4NnqzeejcYv9cg9AGp3uj_kOoDUi1AJ6Rp9tvJZtcO1P2bfGeYBOujgNKzr468DuhoROqcT2h0N7kP2LwBz-GQbg
CitedBy_id crossref_primary_10_1515_cclm_2019_1131
crossref_primary_10_11613_BM_2022_030704
crossref_primary_10_1093_ndt_gfac051
crossref_primary_10_11613_BM_2019_020502
crossref_primary_10_1080_10408363_2018_1540536
crossref_primary_10_1515_cclm_2022_1098
Cites_doi 10.1258/acb.2011.011125
10.1631/jzus.B1500201
10.1016/j.clinbiochem.2016.05.003
10.4103/2153-3539.93402
10.5858/arpa.2016-0161-CP
10.1093/clinchem/21.11.1648
10.1093/clinchem/28.11.2244
10.1093/ajcp/62.5.707
ContentType Journal Article
Copyright 2018 The Canadian Society of Clinical Chemists
Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Copyright_xml – notice: 2018 The Canadian Society of Clinical Chemists
– notice: Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
DBID NPM
AAYXX
CITATION
7X8
DOI 10.1016/j.clinbiochem.2018.01.023
DatabaseName PubMed
CrossRef
MEDLINE - Academic
DatabaseTitle PubMed
CrossRef
MEDLINE - Academic
DatabaseTitleList MEDLINE - Academic
PubMed

Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
Chemistry
EISSN 1873-2933
EndPage 142
ExternalDocumentID 10_1016_j_clinbiochem_2018_01_023
29402415
S0009912017312547
Genre Journal Article
GroupedDBID ---
--K
--M
-~X
.55
.GJ
.~1
0R~
1B1
1RT
1~.
1~5
29B
4.4
457
4G.
4R4
53G
5GY
5VS
6J9
7-5
71M
8P~
9JM
AACTN
AAEDT
AAEDW
AAIAV
AAIKJ
AAKOC
AALRI
AAOAW
AAQFI
AAQXK
AAXUO
AAYJJ
ABBQC
ABFNM
ABFRF
ABGSF
ABJNI
ABLVK
ABMAC
ABMZM
ABOCM
ABUDA
ABXDB
ABYKQ
ACDAQ
ACGFO
ACGFS
ACIUM
ACRLP
ADBBV
ADEZE
ADMUD
ADUVX
AEBSH
AEFWE
AEHWI
AEKER
AENEX
AFKWA
AFTJW
AFXIZ
AGHFR
AGRDE
AGUBO
AGYEJ
AHHHB
AHPSJ
AIEXJ
AIKHN
AITUG
AJBFU
AJOXV
AJRQY
ALMA_UNASSIGNED_HOLDINGS
AMFUW
AMRAJ
ANZVX
ASPBG
AVWKF
AXJTR
AZFZN
BKOJK
BLXMC
BNPGV
CS3
DOVZS
DU5
EBS
EFJIC
EFLBG
EJD
EO8
EO9
EP2
EP3
F5P
FDB
FEDTE
FGOYB
FIRID
FNPLU
FYGXN
G-2
G-Q
G8K
GBLVA
HLW
HVGLF
HX~
HZ~
IHE
J1W
KOM
LCYCR
LX3
M41
MO0
N9A
O-L
O9-
OAUVE
OZT
P-8
P-9
P2P
PC.
Q38
R2-
RIG
ROL
RPZ
SBG
SDF
SDG
SDP
SES
SEW
SPCBC
SSH
SSU
SSZ
T5K
UNMZH
WUQ
X7M
XPP
YYP
YYQ
ZGI
ZUP
~G-
AAXKI
ADVLN
AFJKZ
AKRWK
NPM
AAYXX
ABDPE
ACRPL
ADNMO
CITATION
7X8
ID FETCH-LOGICAL-c377t-6bce0d7a8e2e30496e194f1424fe3cc9c8994c509e727fdd1f0cf5cf98bb91913
IEDL.DBID AIKHN
ISSN 0009-9120
IngestDate Sun Sep 29 07:45:45 EDT 2024
Fri Dec 06 05:13:56 EST 2024
Wed Oct 16 00:58:28 EDT 2024
Fri Feb 23 02:33:46 EST 2024
IsPeerReviewed true
IsScholarly true
Language English
License Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c377t-6bce0d7a8e2e30496e194f1424fe3cc9c8994c509e727fdd1f0cf5cf98bb91913
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ORCID 0000-0002-2781-3824
PMID 29402415
PQID 1995154778
PQPubID 23479
PageCount 4
ParticipantIDs proquest_miscellaneous_1995154778
crossref_primary_10_1016_j_clinbiochem_2018_01_023
pubmed_primary_29402415
elsevier_sciencedirect_doi_10_1016_j_clinbiochem_2018_01_023
PublicationCentury 2000
PublicationDate March 2018
2018-Mar
2018-03-00
20180301
PublicationDateYYYYMMDD 2018-03-01
PublicationDate_xml – month: 03
  year: 2018
  text: March 2018
PublicationDecade 2010
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle Clinical biochemistry
PublicationTitleAlternate Clin Biochem
PublicationYear 2018
Publisher Elsevier Inc
Publisher_xml – name: Elsevier Inc
References Nosanchuk, Gottmann (bb0010) 1974; 62
Schifman, Talbert, Souers (bb0030) 2017; 141
Garner, Lewington, Barth (bb0045) 2012; 49
Ladenson (bb0020) 1975; 21
Ovens, Naugler (bb0005) 2012; 3
Karger, Senn, Skogseth, Floodman (bb0040) 2016; 49
Li, Sun, Yap, Chen, Qian (bb0025) 2016; 17
CLSI (bb0035) 2016
Iizuka, Kume, Multivariate (bb0015) 1982; 28
Iizuka (10.1016/j.clinbiochem.2018.01.023_bb0015) 1982; 28
Schifman (10.1016/j.clinbiochem.2018.01.023_bb0030) 2017; 141
CLSI (10.1016/j.clinbiochem.2018.01.023_bb0035) 2016
Nosanchuk (10.1016/j.clinbiochem.2018.01.023_bb0010) 1974; 62
Ovens (10.1016/j.clinbiochem.2018.01.023_bb0005) 2012; 3
Ladenson (10.1016/j.clinbiochem.2018.01.023_bb0020) 1975; 21
Karger (10.1016/j.clinbiochem.2018.01.023_bb0040) 2016; 49
Li (10.1016/j.clinbiochem.2018.01.023_bb0025) 2016; 17
Garner (10.1016/j.clinbiochem.2018.01.023_bb0045) 2012; 49
References_xml – volume: 17
  start-page: 181
  year: 2016
  end-page: 187
  ident: bb0025
  article-title: 0.9% saline is neither normal nor physiological
  publication-title: J Zhejiang Univ Sci B
  contributor:
    fullname: Qian
– volume: 49
  start-page: 737
  year: 2016
  end-page: 739
  ident: bb0040
  article-title: Rare erroneous results on the Siemens dimension vista® platform due to urine carryover: a warning to current users
  publication-title: Clin. Biochem.
  contributor:
    fullname: Floodman
– volume: 62
  start-page: 707
  year: 1974
  end-page: 712
  ident: bb0010
  article-title: CUMS and delta checks. A systematic approach to quality control
  publication-title: Am. J. Clin. Pathol.
  contributor:
    fullname: Gottmann
– volume: 28
  start-page: 2244
  year: 1982
  end-page: 2248
  ident: bb0015
  article-title: Delta check method for detecting specimen mix-up
  publication-title: Clin. Chem.
  contributor:
    fullname: Multivariate
– volume: 21
  start-page: 1648
  year: 1975
  end-page: 1653
  ident: bb0020
  article-title: Patients as their own controls: use of the computer to identify “laboratory error”
  publication-title: Clin. Chem.
  contributor:
    fullname: Ladenson
– volume: 3
  start-page: 5
  year: 2012
  ident: bb0005
  article-title: How useful are delta checks in the 21 century? A stochastic-dynamic model of specimen mix-up and detection
  publication-title: J. Pathol. Inform.
  contributor:
    fullname: Naugler
– year: 2016
  ident: bb0035
  article-title: Use of Delta Checks in the Medical Laboratory. CLSI Document EP33
  contributor:
    fullname: CLSI
– volume: 141
  start-page: 813
  year: 2017
  end-page: 823
  ident: bb0030
  article-title: Delta check practices and outcomes: a Q-probes study involving 49 health care facilities and 6541 Delta check alerts
  publication-title: Arch. Pathol. Lab. Med.
  contributor:
    fullname: Souers
– volume: 49
  start-page: 59
  year: 2012
  end-page: 62
  ident: bb0045
  article-title: Detection of patients with acute kidney injury by the clinical laboratory using rises in serum creatinine: comparison of proposed definitions and a laboratory delta check
  publication-title: Ann. Clin. Biochem.
  contributor:
    fullname: Barth
– year: 2016
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0035
  contributor:
    fullname: CLSI
– volume: 49
  start-page: 59
  issue: Pt 1
  year: 2012
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0045
  article-title: Detection of patients with acute kidney injury by the clinical laboratory using rises in serum creatinine: comparison of proposed definitions and a laboratory delta check
  publication-title: Ann. Clin. Biochem.
  doi: 10.1258/acb.2011.011125
  contributor:
    fullname: Garner
– volume: 17
  start-page: 181
  issue: 3
  year: 2016
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0025
  article-title: 0.9% saline is neither normal nor physiological
  publication-title: J Zhejiang Univ Sci B
  doi: 10.1631/jzus.B1500201
  contributor:
    fullname: Li
– volume: 49
  start-page: 737
  issue: 10−11
  year: 2016
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0040
  article-title: Rare erroneous results on the Siemens dimension vista® platform due to urine carryover: a warning to current users
  publication-title: Clin. Biochem.
  doi: 10.1016/j.clinbiochem.2016.05.003
  contributor:
    fullname: Karger
– volume: 3
  start-page: 5
  year: 2012
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0005
  article-title: How useful are delta checks in the 21 century? A stochastic-dynamic model of specimen mix-up and detection
  publication-title: J. Pathol. Inform.
  doi: 10.4103/2153-3539.93402
  contributor:
    fullname: Ovens
– volume: 141
  start-page: 813
  issue: 6
  year: 2017
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0030
  article-title: Delta check practices and outcomes: a Q-probes study involving 49 health care facilities and 6541 Delta check alerts
  publication-title: Arch. Pathol. Lab. Med.
  doi: 10.5858/arpa.2016-0161-CP
  contributor:
    fullname: Schifman
– volume: 21
  start-page: 1648
  issue: 11
  year: 1975
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0020
  article-title: Patients as their own controls: use of the computer to identify “laboratory error”
  publication-title: Clin. Chem.
  doi: 10.1093/clinchem/21.11.1648
  contributor:
    fullname: Ladenson
– volume: 28
  start-page: 2244
  issue: 11
  year: 1982
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0015
  article-title: Delta check method for detecting specimen mix-up
  publication-title: Clin. Chem.
  doi: 10.1093/clinchem/28.11.2244
  contributor:
    fullname: Iizuka
– volume: 62
  start-page: 707
  issue: 5
  year: 1974
  ident: 10.1016/j.clinbiochem.2018.01.023_bb0010
  article-title: CUMS and delta checks. A systematic approach to quality control
  publication-title: Am. J. Clin. Pathol.
  doi: 10.1093/ajcp/62.5.707
  contributor:
    fullname: Nosanchuk
SSID ssj0002486
Score 2.3021476
Snippet Delta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory automation, their...
INTRODUCTIONDelta checks are a long-standing practice for identifying errors in the laboratory. However, with the decrease in errors due to laboratory...
SourceID proquest
crossref
pubmed
elsevier
SourceType Aggregation Database
Index Database
Publisher
StartPage 139
Title Determining the utility of creatinine delta checks: A large retrospective analysis
URI https://dx.doi.org/10.1016/j.clinbiochem.2018.01.023
https://www.ncbi.nlm.nih.gov/pubmed/29402415
https://search.proquest.com/docview/1995154778
Volume 53
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1La8JAEB58gO2ltPZlH7JCr6mJiSYpvYit2JZ6KBW8LclmFmxFReO1v70zZtPHQSj0mBdZZnfn-4aZbxbgqhMoFyOb97ftWZ5KlBVRBEYbL-HmH4R5etPtc9gZjLzHcXtcgF6uheGySuP7M5--8dbmTtNYs7mYTFjjS-zGIQDzXUJpzy9CmeCIc7Xl7sPTYPjlkFve5sBHft_iDyrQ-C7zYgFiPOHTqViX7gRZE093G0xto6EbOOrvw57hkaKbDfUACjirwk4vP76tCpVnkzU_hJc7U_NCMCWI8AlabMy-xVyLjDTSExQJTtNI0BDV--pGdMWUi8TFEtPlPNdjisj0MDmCUf_-tTewzFkKlnJ9P7U6sUI78aMAW8iZtQ46oadZ5qbRVSpUFHd5itgDEqHRSeJoW-m20mEQxyHFdO4xlGbzGZ6CIAKBgUocQlf0ItcNHfQpykqQdbZxpGvQyk0nF1nLDJnXkr3JH_aWbG9pO5LsXYPb3Mjy1_xLcu1_-byRT4wkO3PSI5rhfL2SLEEnmuj7QQ1Oshn7GlUrpOiZGMzZ_35-Drt8lVWmXUApXa7xkqhKGteheP3h1M2C_ATRIekp
link.rule.ids 314,780,784,4502,24116,27924,27925,45585,45679
linkProvider Elsevier
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8NAEB5qhdaL-LY-t-A1Nmm2TSJepFqqtj2Igrcl2cxCtTRS06u_3Zk8fBwKgtdsQpZvd2e-YeebATjr-trF0ObzbUtL6lhbIUVgdPBiLv5BPs9k1T7H3cGTvHvuPFegV2phOK2ysP25Tc-sdfGkVaDZeptMWONL7MYhB-a55KWltwKrskPslzb1-cd3nkdbZu0e-W2LX69B8zvJi-WH0YR7U7Eq3fHzEp7uMie1jIRmzqi_AesFixRX-UQ3oYKzLaj3yuZtW1AbFXfm2_BwXWS8kJMSRPcEbTXm3iIxIqeMNIIixmkaCpqifn2_EFdiyiniYo7pPCnVmCIsKpjswFP_5rE3sIpOCpZ2PS-1upFGO_ZCH9vI92pddAJpWORm0NU60BR1SU3cAYnOmDh2jK1NR5vAj6KAIjp3F6qzZIb7IIg-oK9jh3wrytB1Awc9irFiZJVtFJoGtEvo1FteMEOVmWQv6gfeivFWtqMI7wZcliCrX6uvyLD_5fNmuTCKcOYrj3CGyeJdsQCdSKLn-Q3Yy1fsa1btgGJn4i8H__v5KdQHj6OhGt6O7w9hjUfyHLUjqKbzBR4TaUmjk2xTfgLv1OoC
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Determining+the+utility+of+creatinine+delta+checks%3A+A+large+retrospective+analysis&rft.jtitle=Clinical+biochemistry&rft.au=Gruenberg%2C+Jessica+M&rft.au=Stein%2C+Tracy+A&rft.au=Karger%2C+Amy+B&rft.date=2018-03-01&rft.eissn=1873-2933&rft.volume=53&rft.spage=139&rft.epage=142&rft_id=info:doi/10.1016%2Fj.clinbiochem.2018.01.023&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0009-9120&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0009-9120&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0009-9120&client=summon