To Test or not to Test: Choosing Wisely in Your Clinical Practice

Overtesting occurs when investigations are unlikely to find abnormalities relevant for the health. Overdiagnosis may be defined as finding abnormalities that do not give symptoms, and that will not change life expectancy. Inappropriate testing may impose a risk for children in Europe. When investigations are applied without proper history taking and clinical suspicion, the risk of false positive findings increases rapidly.
In an era of increasing availability of health services, paediatricians have an important role in balancing risks and benefits of available tests and investigations. Examples from the medical literature of overtesting challenge us to reconsider current practices. Non-indicated radiological procedures are found in common practice across Europe. Widespread use of laboratory tests with unclear purpose, such as measuring vitamin D in children without symptoms or risks of deficiency, has been deemed as “costly, confusing and without credibility”. The availability of SpO2 monitoring has increased, but has the potential to prolong hospital stay unnecessary in bronchiolitis.

Choosing Wisely is an initiative to improve the quality of care by reducing unnecessary testing and treatment. The European Academy of Pediatrics has recently launched a statement in support of the campaign. Web-resources are made available from the EAP website. Member organizations in EAP are encouraged to bring awareness among their members about overdiagnosis and overtreatment.