Emergency Medicine Clinicians Identify Top 5 Tests that Provide Little Value

February 19, 2014 | Strategic Insights for Health System


An article published in the February 2014 issue of JAMA Internal Medicine describes five tests, treatments, and disposition decisions that are “of little value, are amenable to standardization, and are actionable” for emergency medicine clinicians. The five items are: (1) computed tomography (CT) of the cervical spine for trauma patients who do not meet certain criteria (e.g., National Emergency X-Ray Utilization Study low risk criteria); (2) CT to diagnose pulmonary embolism without first risk stratifying for it (e.g., pretest probability, D-dimer tests for low probability); (3) magnetic resonance imaging (MRI) of the lumbar spine for patients with low back pain without high risk characteristics; (4) head CTs for patients with mild traumatic head injury who do not meet certain criteria (e.g., New Orleans criteria); (5) coagulation studies for patients without hemorrhage or suspected coagulopathy (e.g., with anticoagulation therapy, clinical coagulopathy). The list was developed after convening an expert technical panel and receiving feedback from 174 emergency medicine clinicians, including physicians, physician assistants, and nurse practitioners. The first item regarding cervical spine CT imaging received unanimous support from the panel and the other four items were supported by the majority.

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