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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

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Interpreting clinical and laboratory tests: importance and implications of context

Alan N. Charney
  • Corresponding author
  • Clinical Professor, Department of Internal Medicine, NYU Langone Health, Division of Nephrology, 550 1st Avenue, New York, NY 10016, USA; and 47 Laura Lane, Morristown, NJ 07960, USA
  • Email
  • Other articles by this author:
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/ Jordan T. Dourmashkin
Published Online: 2019-08-17 | DOI: https://doi.org/10.1515/dx-2019-0009


Clinical and laboratory tests in clinical medicine include a range of measurements that may be categorized as “normal range” tests, positive or negative tests, or contextual tests. Normal range test results are quantitative and are compared to a reference interval or range provided by the laboratory. Positive or negative tests are also quantitative tests and characteristically have a cutoff value that specifies the result. Contextual tests require a context, a physiological condition, to correctly interpret the result. A closer examination of reference intervals suggests that these also are contextual. The fact that there is a range of apparently normal values indicates the presence of cultural, biological, physiological and behavioral diversity in the population sampled to determine normality. As such, the reference interval describes the population from which it was determined and may have utility in this regard.

Keywords: clinical decisions; context; contextual; laboratory tests; normal range; normality; reference interval


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About the article

Corresponding author: Alan N. Charney, MD, Clinical Professor, Department of Internal Medicine, NYU Langone Health, Division of Nephrology, 550 1st Avenue, New York, NY 10016, USA; and 47 Laura Lane, Morristown, NJ 07960, USA, E-mail: ancharney@gmail.com

Received: 2019-02-13

Accepted: 2019-07-31

Published Online: 2019-08-17

Author contributions: Alan N. Charney, MD, conceived, researched and wrote the submitted manuscript. Jordan T. Dourmashkin, PA-C researched and wrote the submitted manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, 20190009, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2019-0009.

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