Overdiagnosis in paediatrics

WHY is the rate of admission for bronchiolitis skyrocketing?

HOW CAN we combat this clearly terrible condition?

Perhaps we can stop diagnosing it as worth of hospitalisation?

Overdiagnosis is a great phrase, one which was, I think, coined to annoy those opposed to it’s idea as much as it’s inherent wrongness. (If it’s the diagnosis, it’s the diagnosis, it can’t be ‘over’ diagnosed it’s ‘wrongly’ diagnosed!) Of course, it’s not intended to convey an only idea of people incorrectly diagnosing something that isn’t there, but the identification of sub-clinically-important states of not-quite-normality that don’t actually need the lump hammer approach to treatment that gets whipped about.

There have been a string of oxygen/bronchiolitis papers out & about recently, including a neat HTA funded trial looking at how safe it is to discharge at 90% sats and a paper from JAMA Pediatrics looking at the outcomes of little ones who had dipping sats (on body worn, not real-time-monitored monitors) and comparing those to the groups who didn’t dip.

Both of these publications suggest that we are seriously over-using and are over-worried about the reading from the sats monitor. The >90% group did as well as the comparator group (only discharging at >94%). The dippy babies did as well as those who were not deeply dippy.

How do we identify, and how do we address, potential issues of overdiagnosis though?

We can start by looking for patterns that look dodgy – like increasing admissions without increasing ICU rates, or more and more people diagnosed with a condition yet the same number of people dying from it. We can question the ‘accidental’ diagnoses that are suggested when looking for something else. We can consider if treatments have the same effect on mild, moderate and severe versions of a condition and weigh these against the (often) stable rate of adverse effects. We may want to think very carefully about offhandedly labelling a child with something that may be incorporated into their biography without fair reason.

In short, we can think “what are the harms and benefits” before we act

  • Archi

 

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