Correspondence (letter to the editor): Economicalness of Outpatient Laboratory Diagnostics

The author, Professor Niehues, deserves thanks for this review article (1), which may be extremely useful for everyone working with children. For pediatricians, no change in their daily routine would be expected as identifying the cause of a fever in a child is clinical routine. For those doctors, however, who do treat children, but for whom pediatrics is not the core element of their training, the described algorithms may be useful.

It is of note that the author does not see laboratory diagnostic evaluation (blood count, C-reactive protein [CRP], and urine, Figure 2) as within the outpatient sector but sets it within the hospital. This gives rise to two conclusions: firstly, the author does not trust physicians in private practice to perform such diagnostic evaluations. Secondly, the author has realized that outpatient laboratory diagnostic evaluation—according to the guideline of the German Medical Association and within the context of EBM reimbursement, especially in relation to point of care testing—is in no way economically viable, and he therefore concludes that such diagnostic tests can be undertaken only in the inpatient setting.

In my experience with the authors, I can definitely rule out the first conclusion. The second one definitely applies, although, for consistency's sake, all children who meet the criteria will now need to be admitted as inpatients in order to undergo laboratory tests.