Walker Heidi, West Courtney, Lawton Luke, Emeto Theophilus I, Gangathimmaiah Vinay
Townsville University Hospital, Douglas, Queensland, Australia.
James Cook University, Townsville, Queensland, Australia.
Emerg Med Australas. 2025 Aug;37(4):e70100. doi: 10.1111/1742-6723.70100.
The study aimed to evaluate the prevalence and impact of low-value diagnostic tests at a regional, major-referral, mixed Emergency Department (ED).
A single-site, cross-sectional study was conducted at Townsville University Hospital in April 2022. Adult patients (aged 18 years and above) who underwent one of 10 specified diagnostic tests were included. The tests encompassed coagulation studies, urine cultures, blood cultures, cranial computed tomography (CT) in syncope, cranial CT in minor head injury, cervical spine CT in neck trauma, ankle X-ray in acute ankle trauma, duplex lower extremity ultrasound in suspected deep vein thrombosis, CT pulmonary angiography in suspected pulmonary embolism, and CT kidney ureter bladder in renal colic. Tests were classified as low-value based on Choosing Wisely recommendations, with their value determined by a research assistant using clinical documentation, prior to the availability of test results. Emergency clinicians were blinded to the study conduct.
Of all diagnostic tests performed, 48.2% (276/572) were deemed low-value, including 50.6% of laboratory tests (246/486) and 24.4% of imaging tests (21/86). The median ED length of stay was 6.1 h (IQR 3.9-8.5). Low-value imaging tests contributed to 152 lost bed-hours per 100 tests.
A substantial proportion of diagnostic tests were low-value, exacerbating access block and reducing the availability of ED beds, thereby delaying timely emergency care. The implementation of evidence-based, effective strategies is imperative to mitigate patient harm associated with low-value diagnostic tests.
本研究旨在评估在一家地区性、主要转诊型的综合性急诊科（ED）中低价值诊断检查的患病率及其影响。
2022年4月在汤斯维尔大学医院进行了一项单中心横断面研究。纳入了接受10种特定诊断检查之一的成年患者（年龄18岁及以上）。这些检查包括凝血研究、尿培养、血培养、晕厥时的头颅计算机断层扫描（CT）、轻度头部损伤时的头颅CT、颈部创伤时的颈椎CT、急性踝关节创伤时的踝关节X线检查、疑似深静脉血栓形成时的双下肢超声检查、疑似肺栓塞时的CT肺动脉造影以及肾绞痛时的CT肾脏输尿管膀胱检查。根据“明智选择”建议，将检查分类为低价值，在检查结果出来之前，由一名研究助理根据临床记录确定其价值。急诊临床医生对研究实施情况不知情。
在所有进行的诊断检查中，48.2%（276/572）被认为是低价值的，其中包括50.6%的实验室检查（246/486）和24.4%的影像学检查（21/86）。急诊患者的中位住院时间为6.1小时（四分位间距3.9 - 8.5）。每100次低价值影像学检查导致152个床位小时的损失。
相当一部分诊断检查是低价值的，加剧了就诊障碍并减少了急诊床位的可用性，从而延迟了及时的急诊护理。实施基于证据的有效策略对于减轻与低价值诊断检查相关的患者伤害至关重要。
