Establishment of paediatric biochemical reference intervals

Ann Clin Biochem 2004;41:321-329
doi:10.1258/0004563041201572
© 2004 Royal Society of Medicine

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Original Articles


Russell SA Brinkworth,
Elaine Whitham and
Homer Nazeran


School of Informatics and Engineering, Flinders University, 5042 Adelaide, Australia;
Chemical Pathology, Women’s and Children’s Hospital, 5006 North Adelaide, Australia;
School of Informatics and Engineering, Flinders University, 5042 Adelaide, Australia


Background: The standard method for the determination of referencevalues in a population by testing a number of healthy volunteersis difficult within the paediatric age group; this study exploresan alternative approach.

Methods: Biochemical blood test results collected by the Woman’sand Children’s Hospital over a 1 year period were used and thedata selected to ensure, as far as possible, that the resultswere from patients who were ‘healthy’. This was achieved usingvarious selection criteria, such as the exclusion of patientswith more than one test episode. Some of the data were skewed,making standard statistical approaches difficult. In such cases,transformations were used to ensure that the resulting informationhad a distribution that was approximately Gaussian.

Results: Data from different biochemical tests covering bothgenders and ages in the range 0-18 years were collected; thisincluded more than 250 000 laboratory test results. After eliminationof non-representative data and tests with insufficient results,there were approximately 23 500 results covering almost 3000individuals and 16 different biochemical tests. There were noresults from very young children (< 1 year) after the dataselection process; hence the derivation of reference valuesfrom that age group was not possible.

Conclusions: This approach permitted better delineation of referenceintervals for common biochemical tests performed on paediatricpatients than is currently readily available. In addition, someimportant benchmarks for transformation of medical data havebeen found.

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