Blog | Wednesday, April 4, 2012

QD: News Every Day--Medical societies release top-five lists of overused medical tests


Nine leading physician specialty societies including ACP have identified the top-five overused tests or procedures in their respective fields (45 in all).

ACP's lists includes:
1) No screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. In asymptomatic individuals with a less than 10% 10-year risk, it doesn't improve patient outcomes.
2) No imaging studies in patients with non-specific low back pain. It doesn't improve outcomes if a physical exam doesn't pick up on a reason.
3) No brain imaging studies (CT or MRI) when evaluating simple syncope and a normal neurological examination. The likelihood of a central nervous system cause is extremely low and patient outcomes are not improved with brain imaging studies.
4) In patients with low pretest probability of venous thromboembolism (VTE), obtain a high-sensitive D-dimer measurement as the initial diagnostic test; don't obtain imaging studies as the initial diagnostic test. As defined by the Wells prediction rules, a negative high-sensitivity D-dimer measurement effectively excludes VTE.
5) Don't obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology. In the absence of cardiopulmonary symptoms, preoperative chest radiography rarely provides any meaningful changes in management or improved patient outcomes.

The societies' lists are part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign, which highlights specific, evidence-based recommendations physicians and patients should discuss.

Some of the other groups' lists include:
American Academy of Allergy, Asthma & Immunology
1) No immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests to evaluate allergies.
2) No sinus computed tomography or indiscriminately prescribed antibiotics for uncomplicated acute rhinosinusitis.
3) No routine diagnostic testing in patients with chronic urticaria.
4) Don't recommend replacement immunoglobulin therapy for recurrent infections unless there's an impaired antibody responses to vaccines.
5) Don't diagnose or manage asthma without spirometry.

American Academy of Family Physicians
1) No imaging for low back pain within the first six weeks, unless red flags are present.
2) Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.
3) No dual-energy X-ray absorptiometry screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.
4) Don't order annual electrocardiograms or any other cardiac screening for low-risk patients without symptoms.
5) Don't perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.

American College of Cardiology
1) Don't perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
2) Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.
3) Don't perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.
4) Don't perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.
5) Don't perform stenting of non-culprit lesions during percutaneous coronary intervention for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction.

Besides these groups, other organizations include American College of Radiology (no imaging for uncomplicated headache), American Gastroenterological Association (give the lowest dose of long-term acid suppression therapy needed), American Society of Clinical Oncology (no cancer-directed therapy for solid tumor patients with certain characteristics), American Society of Nephrology (no routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms), and American Society of Nuclear Cardiology (no stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present).

Eight more specialty societies will release lists in fall 2012: American Academy of Hospice and Palliative Medicine, American Academy of Otolaryngology-Head and Neck Surgery, American College of Rheumatology, American Geriatrics Society, American Society for Clinical Pathology, American Society of Echocardiography, Society of Hospital Medicine, and Society of Nuclear Medicine.

11 consumer organizations will join Consumer Reports to help disseminate information and educate patients on making wise decisions, including AARP, Service Employees International Union and the Wikipedia community