This article touches in a topic that we encounter all the time in Emergency Medicine – testing with the intent of “reassurance”. The assumption is, wouldn’t a patient with symptom concerns be less anxious regarding their illness if they received a favorable negative test result?
That assumption, according to this meta-analysis and systematic review, is wrong. These authors gathered together 14 trials evaluating the effect of non-diagnostic testing on downstream patient outcomes. These tests included endoscopy for mild dyspepsia, radiography for low back pain, and cardiac event recording for palpitations. This is a difficult article to interpret, particularly because there’s so much heterogeneity between the included studies, but the general conclusion is that tests performed in the setting of low pretest probability do not decrease subsequent primary care utilization, symptom recurrence, or anxiety regarding illness.
It’s rarely easy to tell a patient no testing is indicated – but this is yet another example illustrating the minimal benefits to over-testing.
“Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease”
http://www.ncbi.nlm.nih.gov/pubmed/23440131