Quality

Overdiagnosis in Pediatric Hospital Medicine Is Harming Children


 

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Key Takeaway

The bottom line for physicians to consider when ordering a test is not just ‘Does the patient benefit from detection or diagnosis?’ but also ‘What is the potential harm?’

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