TORONTO — In pediatric medicine, unnecessary testing can be eliminated without compromising outcomes if every physician simply asks how the test will benefit the patient, new data show.
Overtesting and overdiagnosis is prevalent in pediatrics, said Eric Coon, MD, from the University of Utah School of Medicine Primary Children’s Hospital in Salt Lake City.
And the increasing incidence of disease might be directly related to overdiagnosis, he said during a special session here at the Pediatric Academic Societies 2018 Meeting.
An increase in the incidence of a disease without any change in morbidity or mortality from that disease is a sign that the abnormalities being detected are not that severe because they are not affecting patient outcomes, he explained.
For example, Kawasaki disease has long been treated with intravenous immunoglobulin to prevent the development of coronary artery abnormalities that can progress to adverse outcomes, such as thrombosis.
The most recent guidelines on the management of Kawasaki disease call for early and repetitive echocardiography — at diagnosis and 2 and 8 weeks after diagnosis, or more frequently if a coronary artery abnormality is detected — and the use of the z-score to lower the threshold at which physicians label a coronary artery “abnormal”.
For their study, Coon and his colleagues set out to determine whether the practice of aggressively identifying coronary artery abnormalities has led to the overdiagnosis of those abnormalities in children with Kawasaki disease.
The team assessed 342 children with Kawasaki disease who experienced an adverse cardiac outcome. Over the 15-year study period, the rate of coronary artery abnormalities per 1000 Kawasaki patients doubled.
During the same period, “adverse outcomes related to coronary artery abnormalities remained very stable,” Coon reported. “Together, these two trends fit the pattern of overdiagnosis.”
This increase in the detection of coronary artery abnormalities was primarily driven by an increase in nonsevere coronary artery abnormalities, “further supporting the concept of overdiagnosis,” he said.
Reversing the trend toward overdiagnosis will reduce the need for more frequent follow-up and more testing — both of which can be costly — and will reduce the stress parents can feel when they are told that their child has an abnormality in a vessel that is critical to the heart.
“As providers, we may think the abnormality is fairly benign,” Coon explained. But studies have shown that parents can develop a persistent belief in their child’s vulnerability despite full recovery from an illness.
This belief — called the vulnerable child syndrome — often results in parents restricting children from participation in physical activities later in life because of a “heart problem,” he pointed out.
Reproduced From: Medscape Pediatrics
Author : Pam Harrison
Date : 15 May 2018