The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study

Chen, Jennwood; Majercik, Sarah; Bledsoe, Joseph; Connor, Karen I.; Morris, Bede; Gardner, Scott; Scully, C; Wilson, Emily L.; Dickerson, Justin B.; White, Tom; Dillon, Douglas

doi:10.1016/j.amjsurg.2015.03.016

Cited by 28 publications

(15 citation statements)

References 18 publications

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“…The included studies were five retrospective cohort studies, 13–17 two cross-sectional studies, 18,19 six surveys, 20–25 four prospective cohort studies, 26–29 two studies having both retrospective and prospective cohort components, 30,31 and one qualitative study. 32…”

Section: Resultsmentioning

confidence: 99%

Factors associated with imaging overuse in the emergency department: A systematic review

Tung

Sharma

Hinson

et al. 2018

The American Journal of Emergency Medicine

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Section: Resultsmentioning

confidence: 99%

Factors associated with imaging overuse in the emergency department: A systematic review

Tung

Sharma

Hinson

et al. 2018

The American Journal of Emergency Medicine

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“…While diagnostic testing has increased exponentially in recent years, disease prevalence and outcomes have remained relatively unchanged . Defensive diagnostic testing is a costly practice that can have potentially unnecessary and harmful side effects for patients . The ED has emerged as a focal point for quick access to diagnostic testing …”

mentioning

confidence: 99%

Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross‐sectional, Scenario‐based Study

Meka

Porath

Iyengar

et al. 2017

Academic Emergency Medicine

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“…The cost reduction from the smaller number of beds outweighed the higher costs for CT, but the radiation exposure to patients increased. In a similar study, Chen J et al report that at a level I trauma center 38 % of CT scans were ordered out of defensive purposes [2]. Remarkably, in that study the rate of significant findings among CT scans obtained defensively was 6 %.…”

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confidence: 73%

Defensive medicine and overutilization of imaging—an issue of radiation protection

Kainberger

2016

Wien Klin Wochenschr

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Defensive medicine is a serious and prevalent challenge in modern medicine and is a major cause of overutilization of imaging, i. e., its application with a low probability to improve patient outcome. The problems are concerns of missing unexpected or rare findings and fear from litigation; other reasons are avoidance of an inaccurate diagnosis or keeping costs low. Defensive ordering of diagnostic tests may additionally lead to overdiagnosis, which is the detection of new findings not associated with a substantial impact on health which in turn may cause further unnecessary actions.In this issue of the Wiener klinische Wochenschrift Lambert L et al. describe a significant increase of emergency cranial CTs in a trauma setting compared to CTs of other body regions. They conclude that this cannot be entirely justified by clinical need as they observed that the highest increase occurred when the number of beds in this hospital was reduced by 21 % [1]. The cost reduction from the smaller number of beds outweighed the higher costs for CT, but the radiation exposure to patients increased. In a similar study, Chen J et al. report that at a level I trauma center 38 % of CT scans were ordered out of defensive purposes [2]. Remarkably, in that study the rate of significant findings among CT scans obtained defensively was 6 %. Tong GE et al. calculated a doubling of CT scans from 3.51 % in 2005 to 7.17 % in 2013, observed in over 8.5 million Californian patients with minor trauma [3]. Based on a survey among orthopaedic surgeons, trauma surgeons and radiologists in Austria, Osti and Steyrer found that hospital admission with F. Kainberger ( ) Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro-and Muskuloskeletal Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, 1090 Vienna, Austria franz.kainberger@meduniwien.ac.at 65 % and CT examinations with 32 % were the most important consequences of defensive medicine, thus causing an enormous workload in hospital settings [4]. Taking these studies into consideration, aspects of dose reduction play an increasing role in defensive medicine and the question comes up what we can learn from the recent developments in radiation protection to optimize the process of ordering diagnostic tests.In Europe, referral guidelines for imaging are part of the continuously improving quality and safety framework of the EURATOM Basic Safety Standards (BSS) Directive [5]. These new standards reflect a holistic safety concept with the potential to change the "culture" of our clinical work substantially in the sense of predictive, personalized, preventive, and participatory (P4) medicine. Many measures developed to reduce patient dose may be applied for reducing the negative effects of defensive medicine. One is that the motivation for ordering a diagnostic test is differentiated into direct clinical need or a forensic, scientific, or other purpose. Labeling the imaging request in such a form might have the potential for gaining more transparency and optimiz...

show abstract

The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study

Cited by 28 publications

References 18 publications

Factors associated with imaging overuse in the emergency department: A systematic review

Factors associated with imaging overuse in the emergency department: A systematic review

Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross‐sectional, Scenario‐based Study

Defensive medicine and overutilization of imaging—an issue of radiation protection

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