Vitamin D Testing Deviations in General Internal Medicine Inpatients

Abstract

Aims
To evaluate adherence to Health Service Executive (HSE) criteria, identify predictors of testing deviations, and assess the clinical management of vitamin D results in a general internal medicine (GIM) inpatient cohort.

Methods
A retrospective review of 408 GIM inpatients categorised into four groups based on HSE-defined testing appropriateness: (1) testing indicated and ordered, (2) indicated but not ordered, (3) not indicated but ordered, and (4) not indicated and not ordered. Testing appropriateness was assessed against HSE Lab criteria, and predictors of testing practices and vitamin D levels were analysed using logistic regression models in R statistical software (v4.1.2), adjusted for age, gender, ethnicity, and hospital length of stay.

Results
Of 408 patients, 143 (35%) deviated from guidelines: 91 (22.3%) lacked indicated testing, while 50 (12.3%) underwent unindicated tests. Older age (OR 1.08 per year, 95% CI 1.04–1.13; p<0.001) and prolonged hospitalisation (OR 1.01 per day, 95% CI 1.00–1.01; p=0.03) predicted testing regardless of indication. Of 77 tested patients, 48 (62.3%) had sufficient levels (≥50 nmol/L), 13 (16.9%) insufficient (30–49 nmol/L), and 16 (20.8%) deficient (<30 nmol/L).

Discussion
Deviations from HSE Lab criteria were frequently observed, with older patients overtested and high-risk populations undertested.