Overdiagnosis in the emergency department: a sharper focus.
Ethics
Low-value care
Overdiagnosis
Overtreatment
Overuse
Shared decision-making
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
29
11
2021
accepted:
17
02
2022
pubmed:
7
3
2022
medline:
22
4
2022
entrez:
6
3
2022
Statut:
ppublish
Résumé
Overdiagnosis occurs when a person's symptoms or life experiences are given a diagnostic label that ultimately causes them more harm than good. We describe the complex drivers of overdiagnosis spanning five interconnected domains, which can lead to numerous negative impacts on patients. Emergency physicians are often tasked with making timely clinical assessments, decisions, and diagnoses that can unintentionally result in overdiagnosis. Three pertinent areas related to overdiagnosis in Emergency Medicine: anaphylaxis, subsegmental pulmonary embolism, and low-risk chest pain are discussed. For a broader perspective, insight on overdiagnosis from medical students and a patient advisor are presented. The perspectives illustrated are meant to spark reflection on: the ethics of labeling a person with a diagnosis, current clinical practices, the limitations of medical education, and patient care and communication in the context of overdiagnosis in the Emergency Department.
Identifiants
pubmed: 35249191
doi: 10.1007/s11739-022-02952-8
pii: 10.1007/s11739-022-02952-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
629-633Informations de copyright
© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
Références
Woloshin S, Kramer B (2021) Overdiagnosis: it’s official. BMJ 375:n2854. https://doi.org/10.1136/bmj.n2854
doi: 10.1136/bmj.n2854
pubmed: 34799371
Jenniskens K, De Groot JA, Reitsma JB, Moons KG, Hooft L, Naaktgeboren CA (2017) Overdiagnosis across medical disciplines: a scoping review. BMJ Open 7(12):e018448. https://doi.org/10.1136/bmjopen-2017-018448
doi: 10.1136/bmjopen-2017-018448
pubmed: 29284720
pmcid: 5770894
Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A (2015) The challenge of overdiagnosis begins with its definition. BMJ 350:h869. https://doi.org/10.1136/bmj.h869
doi: 10.1136/bmj.h869
pubmed: 25740625
Pathirana T, Clark J, Moynihan R (2017) Mapping the drivers of overdiagnosis to potential solutions. BMJ 358:j3879. https://doi.org/10.1136/bmj.j3879
doi: 10.1136/bmj.j3879
pubmed: 28814436
Arkwright P, Tang AH (2019) Trends in dispensing of epinephrine auto-injector (EAI) in England over the last ten years. J Allergy Clin Immunol 143(2):149. https://doi.org/10.1016/j.jaci.2018.12.453
doi: 10.1016/j.jaci.2018.12.453
Abrams EM, Greenhawt M, Alqurashi W, Singer AG, Shaker M (2021) The revenge of unintended consequences of anaphylaxis-risk overdiagnosis: how far we’ve come and how far we have to go. J Allergy Clin Immunol Pract. https://doi.org/10.1016/j.jaip.2021.05.038
doi: 10.1016/j.jaip.2021.05.038
pubmed: 34954121
pmcid: 8770849
Campbell RL, Hagan JB, Manivannan V et al (2012) Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clin Immunol 129(3):748–752. https://doi.org/10.1016/j.jaci.2011.09.030
doi: 10.1016/j.jaci.2011.09.030
pubmed: 22051698
Tejedor Alonso MA, Moro Moro MM, Múgica García MV (2015) Epidemiology of anaphylaxis. Clin Exp Allergy 45(6):1027–1039. https://doi.org/10.1007/s12016-015-8503-x
doi: 10.1007/s12016-015-8503-x
pubmed: 25495512
Jha S (2015) The road to overdiagnosis: the case of subsegmental pulmonary embolism. Acad Radiol 22(8):985–987. https://doi.org/10.1016/j.acra.2015.05.001
doi: 10.1016/j.acra.2015.05.001
pubmed: 26100193
Wang RC, Miglioretti DL, Marlow EC et al (2020) Trends in imaging for suspected pulmonary embolism across US health care systems, 2004 to 2016. JAMA Netw Open 3(11):e2026930. https://doi.org/10.1001/jamanetworkopen.2020.26930
doi: 10.1001/jamanetworkopen.2020.26930
pubmed: 33216141
pmcid: 7679949
Bariteau A, Stewart LK, Emmett TW, Kline JA (2018) Systematic review and meta-analysis of outcomes of patients with subsegmental pulmonary embolism with and without anticoagulation treatment. Acad Emerg 25(7):828–835. https://doi.org/10.1111/acem.13399
doi: 10.1111/acem.13399
Hendley NW, Moskop J, Ashburn NP, Mahler SA, Stopyra JP (2021) The ethical dilemma of emergency department patients with low-risk chest pain. Emerg Med J 38:851–854. https://doi.org/10.1136/emermed-2020-209900
doi: 10.1136/emermed-2020-209900
pubmed: 33687992
Kawatkar AA, Sharp AL, Baecker AS et al (2020) Early noninvasive cardiac testing after emergency department evaluation for suspected acute coronary syndrome. JAMA Intern Med 180(12):1621–1629. https://doi.org/10.1001/jamainternmed.2020.4325
doi: 10.1001/jamainternmed.2020.4325
pubmed: 33031502
pmcid: 7536619
Natsui S, Sun BC, Shen E et al (2019) Evaluation of outpatient cardiac stress testing after emergency department encounters for suspected acute coronary syndrome. Ann Emerg Med 74(2):216–223. https://doi.org/10.1016/j.annemergmed.2019.01.027
doi: 10.1016/j.annemergmed.2019.01.027
pubmed: 30955986
pmcid: 6650312
Wade DT, Halligan PW (2017) The biopsychosocial model of illness: a model whose time has come. Clin Rehabil 31(8):995–1004. https://doi.org/10.1177/0269215517709890
doi: 10.1177/0269215517709890
pubmed: 28730890
Singh H, Dickinson JA, Thériault G et al (2018) Overdiagnosis: causes and consequences in primary health care. Can Fam Physician 64(9):654–659
pubmed: 30209095
pmcid: 6135119