Update on Medical Overuse

Use of advanced imaging and specialty referrals in ambulatory patients with uncomplicated headache nearly doubled over a decade, from 6.7% to 13.9% for imaging (P<0.001) and 6.9% to 13.2% for referral

Effect: adverse; Advanced imaging doubled from 6.7% in 1999-2000 to 13.9% in 2009-10; specialty referrals rose from 6.9% to 13.2%

Hospitalization of low-risk syncope patients led to a mean of 10.8 diagnostic tests per patient and a 13% adverse event rate, with nearly one-third of patients having incidental findings prompting fur

Effect: adverse; 13% adverse event rate during hospitalization; 34% of syncope admissions were low-risk

One-third (34%) of patients who underwent colonoscopy received follow-up interval recommendations shorter than multispecialty guidelines, while only 2% had longer intervals, with hyperplastic polyps (

Effect: adverse; 34% of patients had shorter-than-recommended follow-up intervals

Among atrial fibrillation patients under 60 with no structural heart disease and stroke risk scores of zero, approximately one in four (23.3-26.6%) were prescribed oral anticoagulants despite guidelin

Effect: adverse; 23.3% (CHADS2 cohort) and 26.6% (CHA2DS2-VASc cohort) prescribed oral anticoagulants

Among 111,631 men receiving new testosterone prescriptions, only 5.4% had androgen deficiency properly diagnosed by two low morning testosterone levels, 16.5% had no testosterone levels checked, nearl

Effect: adverse; Only 5.4% had proper diagnosis; 16.5% had no testosterone levels checked; ~13% had relative contraindications; 1.4% had absolute contraindica

Within 10 months of a nonfatal opioid overdose, 91% of patients again received opioid prescriptions, one-third received high-dose opioids, 58% received a benzodiazepine, and 7% had a repeat overdose,

Effect: adverse; 91% received opioid prescriptions again within 10 months; 7% had repeat overdose

Among 1,288 adults aged 65+ with diabetes, 61.5% had HbA1c less than 7% and 54.9% of these were treated with insulin or sulfonylureas; among patients with very complex/poor health, 56.4% had HbA1c <7%

Effect: adverse; 61.5% had HbA1c <7%; among complex/poor health patients, 56.4% had HbA1c <7% and 37.9% had HbA1c <6.5%

Adding oxycodone/acetaminophen or cyclobenzaprine to naproxen for acute low back pain provided no benefit beyond naproxen alone for functional status, pain, or return to work at 1 week, while causing

Effect: null; No difference in functional status, pain, healthcare resource use, or return to work at 1 week; adverse events NNH 5 for oxycodone/acetaminophen

PCR testing for C. difficile detected more than twice as many positive cases as the toxin test (293 vs 131), but toxin-negative/PCR-positive patients had lower bacterial loads, less inflammation, and

Effect: adverse; PCR detected 2x more C. difficile than toxin test; only 44.7% of PCR-positive were toxin-positive; toxin-/PCR+ patients had outcomes similar

Over 5 years of surveillance of 992 patients with benign thyroid nodules, 88.3% had no change in nodule number and 69.0% had no change in size; only 0.7% (7 patients) were diagnosed with thyroid cance

Effect: null; 88.3% no change in nodule number, 69.0% no change in size, 0.7% diagnosed with thyroid cancer