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Improving Children's Health Through Better Pediatric Reference Intervals

Reference intervals are the range of normal test values appropriate for a healthy individual and are vital for the proper interpretation of medical test results and accurate diagnoses. Clinicians rely on them to inform their treatment decisions and more precise reference intervals mean better patient outcomes.

Laboratories establish reference intervals using patient samples collected for testing. Different intervals are developed for different ages, genders, ethnicities, and on the basis of other factors, which allows healthcare providers to determine what normal test results should be for a variety of demographics. For intervals to be accurate, enough samples need to be collected to be representative of these various demographics.

The wide availability of samples from adults makes it easy for laboratories to establish quality reference intervals for adult groups. However, the establishment of quality reference intervals for pediatric groups has been a major challenge. Many samples that laboratories have for the youngest demographics are taken from children who are being tested for a medical condition or illness. This means that while general reference ranges can be established using these samples, they are not representative of healthy populations.

Initiatives such as the Children’s Health Improvement through Laboratory Diagnostics (CHILDx) program initiated by ARUP Laboratories and the University of Utah Department of Pathology, as well as the Canadian Laboratory Initiative in Pediatric Reference Intervals (CALIPER) have made great strides improving children’s reference intervals. However, the large scope of the problem means much more work needs to be done.

AACC is leading an ad hoc coalition of major healthcare groups that includes several pediatric organizations and medical device manufacturers in an effort to address this issue. Together, the association and its partners are working with lawmakers, their staff, and other stakeholders to improve the quality of children’s healthcare. AACC also conducted a congressional briefing to educate congressional staffers on this topic.

AACC Position Statement on Pediatric Reference Intervals

In this position statement, AACC calls on Congress to fund efforts to obtain specimens from healthy children, which can be used to develop precise reference intervals.

Additional Resources

Policy Documents

Congressional Briefing

Left: Dr. Dennis Dietzen speaks about the importance of
improving pediatric reference intervals at AACC's
February 27, 2019 congressional briefing.

View the congressional briefing presentations:
Presentations on Improving Pediatric Reference Intervals



Letter to Congress

From Other Organizations

AACC's Pediatric Reference Interval Partners

AACC would like to thank the following organizations for their support of the association's efforts to improve children's reference intervals.

Academy of Clinical Laboratory Physicians and Scientists American Society of Pediatric Hematology/Oncology COLA Seattle Children’s Hospital
American Clinical Laboratory Association American Urological Association College of American Pathologists Siemens Healthcare Laboratory Diagnostics
American Medical Technologists ARUP Laboratories Laboratory Corporation of America Holdings The Association of Genetic Technologists
American Society for Clinical Laboratory Science Association of Pediatric Hematology/Oncology Nurses National Association of Pediatric Nurse Practitioners Thermo Fisher Scientific
American Society for Clinical Pathology Association of Public Health Laboratories Pediatric Endocrine Society    
American Society of Hematology Clinical Laboratory Management Association Quest Diagnostics