The PEDREF study

Improving children’s health assessment using data-mining of laboratory information systems — the multi-center PEDREF study to create next-generation reference intervals for laboratory analytes in pediatrics

Access the web application accompanying our publication Next-generation reference intervals for pediatric hematology.

Laboratory tests are an important tool for health assessment and essential for the majority of diagnostic and therapeutic decisions in modern healthcare. To enable the interpretation of numerical laboratory test results, comparison to reference intervals is performed, i.e. values expected in a comparable group of healthy control persons. When evaluating children’s laboratory test results, complex dynamics due to extensive physiological change with age have to be considered – however, lack of comprehensive reference intervals reflecting these dynamics limits the usefulness of laboratory tests in children and negatively impacts pediatric healthcare.

In the PEDREF study, we have established an approach to create pediatric reference intervals using data-mining of laboratory information systems, which circumvents the ethical and practical challenges of conventional approaches and enables the interpretation of laboratory test results in children with unprecedented accuracy.

Figure 1: Accurate pediatric reference intervals are essential to guide clinical decisions using laboratory test results. However, ethical and practical restrictions limit the creation of accurate pediatric reference intervals using conventional approaches. Data-mining of laboratory information systems overcomes these restrictions and allows the construction of accurate pediatric reference intervals.

Who is behind PEDREF?

The PEDREF pediatric reference intervals initiative is a multi-center study led by Markus Metzler, Manfred Rauh and Jakob Zierk at the Department of Pediatrics, University Hospital Erlangen (Chair: Joachim Wölfle), funded by the Deutsche Forschungsgemeinschaft, and supported by the DGKL's Working Group on Guide Limits.

The dataset analyzed in the PEDREF study is a collaborative database from a large number of German tertiary care centers and laboratory service providers. In PEDREF 1.0, we have analyzed data from 15 German centers, containing > 20,000,000 samples from children aged 0 to 18 years. The ongoing PEDREF 2.0 study employs a distributed/federated approach using the infrastructure of the German Medical Informatics Initiative / The Network of University Medicine (NUM).

See the complete list of collaborators.

The quality of the created reference intervals increases with the number of samples available for analysis, and datasets from varying sources allow us to establish reference intervals for different analytical platforms and populations. Therefore, we are always looking for collaborators prepared to share anonymized data sets.