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Study places CT among 10 most over-utilized medical exams... twice

por Lauren Dubinsky, Senior Reporter | October 11, 2017
Cardiology CT Risk Management Ultrasound X-Ray
CT and ultrasound make it on the list
A new study revealed ten of the most overused medical tests and treatments and CT imaging made the list twice.

“CT is a reassuring test, in that doctors can see images which reduce the feeling of uncertainty, and CT has become more readily available for quick use,” Dr. Daniel Morgan of the University of Maryland School of Medicine, told HCB News. “The downside of CT is primarily that one sees minor abnormalities that prompt a cascade of tests or even procedures, which are sometimes harmful to investigate [as] false positive results.”

For the study, Morgan and his research team at the university evaluated over 2,200 journal articles. They then chose the ten most influential and relevant articles and composed a list for health care practitioners.
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They found that although CT imaging is increasingly being used to assess respiratory symptoms and diagnose pulmonary embolism, it’s not necessary. For patients with non-life-threatening respiratory symptoms, CT did not improve their outcomes and often led to false positive results.

CT pulmonary angiography is mostly overused in the emergency department, compared to less risky tests. This can result in delays in care, higher costs and patient harm from radiation exposure and contrast dye.

Ultrasound is another modality that’s often used unnecessarily. Over 90 percent of carotid ultrasonography exams performed on patients without symptoms lead to inappropriate stenting or surgery.

Transesophageal echocardiography is known for being a sensitive test for diagnosing heart defects that can lead to stroke, but a recent study found that it doesn’t improve outcomes compared to a simpler test. TEE is also an invasive procedure that requires sedation.

Advanced cardiac imaging for patients with chest pain has more than tripled over the last 10 years. But studies are now finding that many of the low-risk patients are undergoing unnecessary procedures as a result.

According to the study, other overused tests and treatments include blood tests for prostate cancer, supplemental oxygen for patients with chronic obstructive pulmonary disease, surgery for meniscal cartilage tears, nutritional support for inpatients and strategies to reduce inappropriate antibiotic use.

Although health care practitioners typically don’t rely on the latest evidence from studies that investigate these procedures, Morgan is optimistic that his study, which appears in the most recent issue of JAMA Internal Medicine, will change that.

“We hope doctors in practice will reconsider harmful practices and provide better care for patients,” he said.

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