Reference range

In:In health-related fields, a reference range or reference interval is the range of values that is deemed normal for a physiologic measurement in healthy persons (for example, the amount of creatinine in the blood, or the partial pressure of oxygen). It is a basis for comparison (a frame of reference) for a physician or other health professional to interpret a set of test results for a particular patient. Some important reference ranges in medicine are reference ranges for blood tests and reference ranges for urine tests. In health-related fields, a reference range or reference interval is the range of values that is deemed normal for a physiologic measurement in healthy persons (for example, the amount of creatinine in the blood, or the partial pressure of oxygen). It is a basis for comparison (a frame of reference) for a physician or other health professional to interpret a set of test results for a particular patient. Some important reference ranges in medicine are reference ranges for blood tests and reference ranges for urine tests. The standard definition of a reference range (usually referred to if not otherwise specified) originates in what is most prevalent in a reference group taken from the general (i.e. total) population. This is the general reference range. However, there are also optimal health ranges (ranges that appear to have the optimal health impact) and ranges for particular conditions or statuses (such as pregnancy reference ranges for hormone levels). Values within the reference range (WRR) are those within the normal distribution and are thus often described as within normal limits (WNL). The limits of the normal distribution are called the upper reference limit (URL) or upper limit of normal (ULN) and the lower reference limit (LRL) or lower limit of normal (LLN). In health care–related publishing, style sheets sometimes prefer the word reference over the word normal to prevent the nontechnical senses of normal from being conflated with the statistical sense. Values outside a reference range are not necessarily pathologic, and they are not necessarily abnormal in any sense other than statistically. Nonetheless, they are indicators of probable pathosis. Sometimes the underlying cause is obvious; in other cases, challenging differential diagnosis is required to determine what is wrong and thus how to treat it. A cutoff or threshold is a limit used for binary classification, mainly between normal versus pathological (or probably pathological). Establishment methods for cutoffs include using an upper or a lower limit of a reference range. The standard definition of a reference range for a particular measurement is defined as the interval between which 95% of values of a reference population fall into, in such a way that 2.5% of the time a value will be less than the lower limit of this interval, and 2.5% of the time it will be larger than the upper limit of this interval, whatever the distribution of these values. Reference ranges that are given by this definition are sometimes referred as standard ranges. Regarding the target population, if not otherwise specified, a standard reference range generally denotes the one in healthy individuals, or without any known condition that directly affects the ranges being established. These are likewise established using reference groups from the healthy population, and are sometimes termed normal ranges or normal values (and sometimes 'usual' ranges/values). However, using the term normal may not be appropriate as not everyone outside the interval is abnormal, and people who have a particular condition may still fall within this interval. However, reference ranges may also be established by taking samples from the whole population, with or without diseases and conditions. In some cases, diseased individuals are taken as the population, establishing reference ranges among those having a disease or condition. Preferably, there should be specific reference ranges for each subgroup of the population that has any factor that affects the measurement, such as, for example, specific ranges for each sex, age group, race or any other general determinant. Methods for establishing reference ranges are mainly based on assuming a normal distribution or a log-normal distribution, or directly from percentages of interest, as detailed respectively in following sections.