Study: More diagnostic tests don't necessarily improve outcomes

Emergency departments that ordered more diagnostic tests for children with possible community-acquired pneumonia also admitted more children to the hospital, according to a study published online Monday in the journal Pediatrics.

However, there was no appreciable difference in the number of ED revisits among those patients between hospitals with higher and lower admission rates. That suggests EDs could conduct fewer diagnostic tests without negatively affecting outcomes, researchers concluded.

The study looked at children and teens diagnosed with community-acquired pneumonia during ED visits between 2007 and 2010 at 36 hospitals. The study excluded children with complex chronic conditions or other major complications.

The most common diagnostic tests for the 100,615 ED visits analyzed were complete blood count, blood culture and chest radiograph. The EDs that ordered more tests had significantly increased odds of hospitalization, the researchers found, but experienced nearly as many revisits within three days as EDs that admitted fewer of the pediatric pneumonia cases.

Paired with other studies in the same issue of Pediatrics that produced similar findings, the study suggests that evidence-based "best-care strategies" for common causes of pediatric hospitalization can reduce costs while improving care, Mark Neuman, M.D., and Vincent Chiang, M.D., wrote in an accompanying commentary, as reported by MedPage Today.

Evidence-based treatment reduces unnecessary variations in care, they wrote, but are often rejected by clinicians who trust their experience over evidence-based literature, according to the MedPage Today article.

The guidelines shouldn't be the only factor driving treatment, researchers said, but hospitals shouldn't ignore them.  

For more:
- read the study abstract
-read the MedPage Today article
- here's the commentary (subscription required)

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