{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:12:51Z","timestamp":1772169171827,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.19858.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000}}],"reference-count":17,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V015757\/1"],"award-info":[{"award-number":["MR\/V015757\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_PC-20059"],"award-info":[{"award-number":["MC_PC-20059"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W016729\/1"],"award-info":[{"award-number":["MR\/W016729\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023699","name":"Health Data Research UK","doi-asserted-by":"publisher","award":["HDRUK2021.000"],"award-info":[{"award-number":["HDRUK2021.000"]}],"id":[{"id":"10.13039\/501100023699","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023699","name":"Health Data Research UK","doi-asserted-by":"publisher","award":["2021.0157"],"award-info":[{"award-number":["2021.0157"]}],"id":[{"id":"10.13039\/501100023699","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["DataandConnectivityNationalCoreStudyMC_PC_20058"],"award-info":[{"award-number":["DataandConnectivityNationalCoreStudyMC_PC_20058"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Core Studies - Longitudinal Health and Wellbeing","award":["MC_PC_20030: MC_PC_20059"],"award-info":[{"award-number":["MC_PC_20030: MC_PC_20059"]}]},{"name":"NIHR CONVALESCENCE","award":["COV-LT-0009"],"award-info":[{"award-number":["COV-LT-0009"]}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR135559, COV-LT2-0073"],"award-info":[{"award-number":["NIHR135559, COV-LT2-0073"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["222097"],"award-info":[{"award-number":["222097"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p>Background Numeric results of pathology tests are sometimes returned as a range rather than a precise value, e.g. \u201c&lt;10\u201d. In health data research, test result values above or below clinical threshold values are often used to categorise patients into groups; however comparators (&lt;, &gt; etc) are typically stored separately to the numeric values and often ignored, but may influence interpretation. Methods With the approval of NHS England we used routine clinical data from 24 million patients in OpenSAFELY to identify pathology tests with comparators commonly attached to result values. For each test we report: the proportion returned with comparators present, split by comparator type and geographic region; the specific numeric result values returned with comparators, and the associated reference limits. Results We identified 11 common test codes where at least one in four results had comparators. Three codes related to glomerular filtration rate (GFR) tests\/calculations, with 31-45% of results returned with \u201c\u2265\u201d comparators. At least 90% of tests with numeric values 60 and 90 represented ranges (\u226560 and \u226590 respectively) rather than exact values. The other tests - four blood tests (Nucleated red blood cell count, Plasma C reactive protein, Tissue transglutaminase immunoglobulin A, and Rheumatoid factor), two urine tests (albumin\/microalbumin) and two faecal tests (calprotectin and quantitative faecal immunochemical test) - were returned with \u201c\u2264\u201d comparators (29-86%). Conclusions Comparators appear commonly in certain pathology tests in electronic health records. For most common affected tests, we expect there to be minimal implications for researchers for most use-cases. However, care should be taken around whether results falling exactly on clinical threshold values should be considered \u201cnormal\u201d or \u201cabnormal\u201d. Results from GFR tests\/calculations cannot reliably distinguish between mild kidney disease (stage G2, 60-&lt;90) versus healthy kidney function (90+). More broadly, health data researchers using numeric test result values should consider the impact of comparators.<\/ns4:p>","DOI":"10.12688\/wellcomeopenres.19858.2","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T10:43:09Z","timestamp":1720694589000},"page":"541","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Interpreting pathology test result values with comparators (&lt; , &gt;) in Electronic Health Records research: an OpenSAFELY short data report"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3429-9576","authenticated-orcid":false,"given":"Helen J","family":"Curtis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-079X","authenticated-orcid":false,"given":"David","family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"OpenSAFELY Collaborative","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Bacon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2098-1278","authenticated-orcid":false,"given":"Amir","family":"Mehrkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Goldacre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3786-9063","authenticated-orcid":false,"given":"Brian","family":"MacKenna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2024,7,2]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"430-436","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY.","volume":"584","author":"E Williamson","year":"2020","journal-title":"Nature."},{"key":"ref-2","article-title":"Chronic kidney disease.","year":"2023"},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"191","DOI":"10.12688\/wellcomeopenres.18010.1","article-title":"OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England [version 1; peer review: 2 approved].","volume":"7","author":"C Andrews","year":"2022","journal-title":"Wellcome Open Res."},{"key":"ref-4","article-title":"OpenPathology: fake seasonality in potassium results \u2014 dangerous and avoidable.","author":"H Curtis","year":"2019"},{"key":"ref-5","article-title":"OpenPathology: Seasonality in Haemoglobin test results.","author":"H Curtis","year":"2019"},{"key":"ref-6","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.13607","article-title":"An audit of the measurement and reporting of male testosterone levels in UK clinical biochemistry laboratories.","volume":"74","author":"M Livingston","year":"2020","journal-title":"Int J Clin Pract."},{"key":"ref-7","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad016","article-title":"Variation in the reference range limits of thyroid function tests and association with the prevalence of levothyroxine treatment.","volume":"188","author":"S Razvi","year":"2023","journal-title":"Eur J Endocrinol."},{"key":"ref-8","article-title":"What is HbA1c?","year":"2017"},{"key":"ref-9","article-title":"CKD Stages.","year":"2021"},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"820-834","DOI":"10.1053\/j.ajkd.2013.12.006","article-title":"GFR estimation: from physiology to public health.","volume":"63","author":"A Levey","year":"2014","journal-title":"Am J Kidney Dis."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"1231-1236","DOI":"10.1038\/s41416-020-01221-9","article-title":"Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England.","volume":"124","author":"S Bailey","year":"2021","journal-title":"Br J Cancer."},{"key":"ref-12","article-title":"The NHS England OpenSAFELY COVID-19 service - privacy notice."},{"key":"ref-13","article-title":"Data Security and Protection Toolkit"},{"key":"ref-14","article-title":"ISB1523: Anonymisation Standard for Publishing Health and Social Care Data"},{"key":"ref-15","article-title":"Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service (Control of Patient Information) Regulations 2002 - general.","year":"2022"},{"key":"ref-16","article-title":"Secretary of State for Health and Social Care - UK Government. COVID-19 Public Health Directions 2020: notification to NHS Digital."},{"key":"ref-17","article-title":"Confidentiality Advisory Group."}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T10:43:31Z","timestamp":1720694611000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,2]]},"references-count":17,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.19858.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.19858.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.25001.r106886","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.25001.r104602","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,2]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.21991.r70395, Tom Oates, Barts Health NHS Trust, London, 31 Jan 2024, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v1#referee-response-70395","order":0,"name":"referee-response-70395","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.21991.r71235, Jessica Watson, University of Bristol, Bristol, England, 26 Feb 2024, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-541\/v1#referee-response-71235","order":1,"name":"referee-response-71235","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The OpenSAFELY Platform is supported by grants from the Wellcome Trust (222097\/Z\/20\/Z) and MRC (MR\/V015737\/1, MC_PC-20059, MR\/W016729\/1). In addition, development of OpenSAFELY has been funded by the Longitudinal Health and Wellbeing strand of the National Core Studies programme (MC_PC_20030, MC_PC_20059), the NIHR funded CONVALESCENCE programme (COV-LT-0009), NIHR (NIHR135559, COV-LT2-0073), and the Data and Connectivity National Core Study funded by UK Research and Innovation (MC_PC_20058), and Health Data Research UK (HDRUK2021.000, 2021.0157). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}