Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

Abstract

Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.

Infant Videofluoroscopic Swallow Study Testing, Swallowing Interventions, and Future Acute Respiratory Illness

“…For example, that 41% of infants with a normal VFSS received a feeding intervention suggests that the intervention may have been prescribed for indications besides an abnormal VFSS result, including the following: (1) diagnoses apart from 24 Infant aspiration has been previously hypothesized to be an example of overdiagnosis: the diagnosis is accurate, but the infant does not benefit from the diagnosis and may even be harmed. 25 Study limitations should be considered. This is a single-center study and the degree to which the present findings are generalizable is unknown.…”

Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency

“…Coon et al 21 noted that practice variation may be an important indicator for overdiagnosis, which can lead to a number of downstream effects that do not improve patient outcomes but can cause harm. In our current study, we took advantage of variation in practice at the local level to highlight outlier practice patterns in both directions of high and low resource use.…”

“…20 A lack of system incentives such as quality measures has been noted as one of the reasons for overdiagnosis that can result in a cascade of effects that do not always improve outcomes. 21 Audit and feedback of physician practice has been used as a tool to improve resource use and care efficiency; when physicians are provided with data on how they practice, they may be more likely to consider practice changes. [22][23][24] Although insurers have been profiling providers' resource use patterns, such data are often not available to individual clinicians, usually are not acuity-adjusted, and do not include a combination of metrics that balance resource use and outcome measures.…”

Mapping the drivers of overdiagnosis to potential solutions

“…Once considered unbiased, third party advocacy groups are often used to deliver the same message." 17 Commercial imperatives and conflicts of interest, including financial or reputational conflicts of interests of those involved in guideline panels that expand disease definition, are also cited as a concern.…”