As many as 1 in 3 lab tests ordered for patients may be medically unnecessary — and an equal number of needed tests are going unordered — a new study finds.
The research, published in the Public Library of Science journal PLOS ONE, is based on a sweeping analysis of 15 years' worth of published studies, dating back to 1997. The 42 studies, analyzed by researchers from Beth Israel Deaconess Medical Center and Harvard Medical School, tracked the results of 1.6 million results from 46 of medicine's 50 most commonly ordered lab tests.
"Lab tests are used in all medical specialties, affecting virtually all patients," explained Ramy Arnaout, M.D., who helped conduct the review. "While working with my clinical colleagues around the hospital, I often found myself wondering about the appropriateness or inappropriateness of all of these tests. In developing this study, my coauthors and I wanted to learn more about overall lab test utilization so that we could better understand how and where errors were occurring in this extremely high-volume activity."
To conduct reach their conclusions, the authors reviewed reports on such common tests as the complete blood count, basic metabolic panel, D-dimer (for pulmonary embolism), and HIV-1 tests. They then estimated how often such tests were overused (ordered but not indicated) and underused (tests that are indicated but not ordered.)
"This paper explores many of the nuances surrounding exactly how, when and why lab tests are ordered and misordered," said Jeffrey Saffitz, M.D. "Many times, the reasons for ordering tests seems to be based on dogma, the way it's always been done. This comprehensive and meticulous analysis shows that there are patterns in laboratory test utilization that can reveal when we do a good job at ordering tests and where we need to do better."
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