{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:20:04Z","timestamp":1747196404763,"version":"3.40.5"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The correlation between hyperamylasemia and acute pancreatitis was discovered in 1929, yet another test, lipase, was shown to provide better diagnostic performance in the late 1980s and early 1990s. Subsequent studies demonstrated co-ordering amylase with lipase did not provide additional benefit, only added cost. We sought to investigate the impact of studies advocating for the obsolescence of amylase on its clinical demand. We reviewed 1.3 million reportable results for amylase over 14 years (2009\u20132022). The trend in utilization of amylase over this period declined by 66% along a linear trajectory (R2 = 0.97). Despite demand for amylase decreasing by an average of 17,003 tests per year, the last year of the study (2022) recorded over 100,000 results for amylase. By interpolating the decline of amylase until the utilization reached zero, we calculated amylase orders will continue for 6 more years until 2028. Tests for creatinine and lipase changed &lt;3% over the same period. Despite a multitude of studies advocating for the obsolescence of amylase, robust demand continues. Many important clinical guidelines, a source many practicing physicians rely on, have yet to acknowledge the preference for lipase over amylase. They frequently treat the two tests as equivalent, neglecting their head-to-head comparison studies and subsequent studies advocating against co-ordering both tests simultaneously. To expedite the obsolescence of amylase, which we anticipate lasting 46 years in our case study from its initial call for obsolescence to the last orders placed, metrics created specifically to monitor the utilization of unnecessary tests are also needed.<\/jats:p>","DOI":"10.1371\/journal.pone.0296180","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T18:28:06Z","timestamp":1703183286000},"page":"e0296180","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Crawling toward obsolescence: The extended lifespan of amylase for pancreatitis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-2412","authenticated-orcid":true,"given":"Naga Sasidhar","family":"Kanaparthy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Loza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7361-7162","authenticated-orcid":true,"given":"Ronald George","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"issue":"12","key":"pone.0296180.ref001","doi-asserted-by":"crossref","first-page":"e058191","DOI":"10.1136\/bmjopen-2021-058191","article-title":"Does NIH funding differ between medical specialties? A longitudinal analysis of NIH grant data by specialty and type of grant, 2011\u20132020","volume":"12","author":"A Schlafly","year":"2022","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0296180.ref002","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1309\/AJCPBIK3G4BWEJKO","article-title":"Creatine kinase-MB: the journey to obsolescence","volume":"141","author":"G Singh","year":"2014","journal-title":"Am J Clin Pathol"},{"key":"pone.0296180.ref003","unstructured":"Centers for Medicare & Medicaid Services. Obsolete or Unreliable Diagnostic Tests 2006. https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncd.aspx?NCDId=204&NCDver=2."},{"issue":"4","key":"pone.0296180.ref004","doi-asserted-by":"crossref","first-page":"283","DOI":"10.3109\/10408368509165786","article-title":"Biochemistry of human alpha amylase isoenzymes","volume":"21","author":"JJ Zakowski","year":"1985","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"4","key":"pone.0296180.ref005","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/00005792-197607000-00001","article-title":"Amylase\u2014its clinical significance: a review of the literature","volume":"55","author":"WB Salt","year":"1976","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"pone.0296180.ref006","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1001\/archsurg.1929.01150060005001","article-title":"Value of blood amylase estimations in the diagnosis of pancreatic disease: a clinical study","volume":"19","author":"R Elman","year":"1929","journal-title":"Archives of Surgery"},{"issue":"6","key":"pone.0296180.ref007","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1056\/NEJM197202102860605","article-title":"Testing pancreatic function","volume":"286","author":"FP Brooks","year":"1972","journal-title":"N Engl J Med"},{"key":"pone.0296180.ref008","unstructured":"Roche Diagnostic Systems Inc. 510(k) Summary\u2014Roche COBAS INTEGRA Reagent Cassettes 1998. https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf\/K981897.pdf."},{"key":"pone.0296180.ref009","unstructured":"Abbott Laboratories. 501(k) Summary\u2014Amylase 1998 [https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf\/K981216.pdf."},{"issue":"3","key":"pone.0296180.ref010","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/clinchem\/37.3.361","article-title":"Lipase isoforms and amylase isoenzymes: assays and application in the diagnosis of acute pancreatitis","volume":"37","author":"JA Lott","year":"1991","journal-title":"Clin Chem"},{"issue":"7","key":"pone.0296180.ref011","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1093\/clinchem\/32.7.1290","article-title":"Assays of serum lipase: analytical and clinical considerations","volume":"32","author":"JA Lott","year":"1986","journal-title":"Clin Chem"},{"issue":"3","key":"pone.0296180.ref012","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/0002-9343(92)90070-R","article-title":"Serum lipase: a better test to diagnose acute alcoholic pancreatitis","volume":"92","author":"V Gumaste","year":"1992","journal-title":"Am J Med"},{"issue":"1","key":"pone.0296180.ref013","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/00006676-199801000-00008","article-title":"A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain","volume":"16","author":"V Keim","year":"1998","journal-title":"Pancreas"},{"issue":"10","key":"pone.0296180.ref014","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1046\/j.1445-2197.2001.02220.x","article-title":"Evaluation of amylase and lipase in the diagnosis of acute pancreatitis","volume":"71","author":"J Treacy","year":"2001","journal-title":"ANZ J Surg"},{"issue":"2","key":"pone.0296180.ref015","first-page":"463","article-title":"Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature","volume":"94","author":"B Frank","year":"1999","journal-title":"Am J Gastroenterol"},{"issue":"Suppl 3","key":"pone.0296180.ref016","first-page":"iii1","article-title":"UK guidelines for the management of acute pancreatitis","volume":"54","author":"Working Party of the British Society of G, Association of Surgeons of Great B, Ireland, Pancreatic Society of Great B, Ireland, Association of Upper GISoGB, Ireland","year":"2005","journal-title":"Gut"},{"issue":"18","key":"pone.0296180.ref017","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.clinbiochem.2017.07.003","article-title":"Lipase or amylase for the diagnosis of acute pancreatitis?","volume":"50","author":"OZ Ismail","year":"2017","journal-title":"Clin Biochem"},{"issue":"1","key":"pone.0296180.ref018","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1515\/dx-2018-0045","article-title":"The Choosing Wisely initiative and laboratory test stewardship","volume":"6","author":"GS Baird","year":"2019","journal-title":"Diagnosis (Berl)"},{"issue":"3","key":"pone.0296180.ref019","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1093\/ajcp\/aqz170","article-title":"Cost of Unnecessary Amylase and Lipase Testing at Multiple Academic Health Systems","volume":"153","author":"JP Ritter","year":"2020","journal-title":"Am J Clin Pathol"},{"issue":"11","key":"pone.0296180.ref020","first-page":"742","article-title":"\"Lipase Only, Please\": Reducing Unnecessary Amylase Testing","volume":"45","author":"H Holzer","year":"2019","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"5","key":"pone.0296180.ref021","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1002\/jhm.2544","article-title":"Amylase testing for abdominal pain and suspected acute pancreatitis","volume":"11","author":"JS Barbieri","year":"2016","journal-title":"J Hosp Med"},{"issue":"5","key":"pone.0296180.ref022","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1001\/archsurg.1993.01420170122019","article-title":"A clinically based classification system for acute pancreatitis. 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