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[Deviating from guideline-recommended diagnostic work-up in general practice: examples involving high-sensitivity
Ralf E Harskamp1,2, Pier Woudstra3, Ramon R Gorter4
1Amsterdam UMC, afd. Huisartsgeneeskunde, Amsterdam.
Insights
Clinical guidelines aid decision-making but aren't exhaustive. Deviating from diagnostic testing recommendations in primary care can lead to over- or under-testing, as illustrated by troponin and CRP testing scenarios.
Area of Science:
- Clinical Medicine
- Diagnostic Testing
- Evidence-Based Practice
Context:
- Clinical guidelines provide evidence-based recommendations but have limitations.
- Deviations from guidelines are common due to various factors (contextual, ethical, clinical, scientific).
- Diagnostic work-up deviations can result in over- or under-testing.
Purpose:
- To illustrate scenarios where deviating from diagnostic testing guidelines occurs in primary care.
- To highlight potential consequences of non-adherence to clinical guidelines in diagnostic testing.
- To discuss the nuances of applying clinical guidelines in real-world patient care.
Summary:
- Discusses two primary care cases: high-sensitivity troponin testing for chest discomfort and CRP testing for pediatric abdominal pain.
- Examines deviations from recommended diagnostic pathways in these specific clinical scenarios.
- Highlights the balance between guideline adherence and individualized patient care.
Impact:
- Provides practical insights for clinicians managing diagnostic testing in primary care.
- Emphasizes the importance of considering patient-specific factors beyond guideline recommendations.
- Contributes to the understanding of over- and under-testing in diagnostic work-ups.
Abstract:
While clinical guidelines are essential for decision-making based on the latest evidence, they are not all-encompassing for any given patient or context. As such, deviating from guideline recommendations is common practice and can be attributed to contextual, ethical, clinical, or scientific factors. In the setting of diagnostic testing deviating from recommended diagnostic work-up may result in both over- and under-testing. In this Clinical Lesson we discuss two scenarios in primary care, one involving high-sensitivity troponin testing in a patient with episodes of chest discomfort, and the other involving CRP testing in a pediatric patient with acute-onset abdominal pain.
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