Choosing Wisely - avoiding medical overuse: evidence assessment of recommendations on laboratory parameters

Launched in 2012, the Choosing Wisely initiative promotes evidence-based recommendations to reduce unnecessary tests and treatments. This study reviewed laboratory-related recommendations from five countries (USA, UK, Germany, Switzerland, and Austria) to assess their scientific validity.

Choosing Wisely websites were searched for laboratory-related recommendations. After removing duplicates, 49 randomly selected unique recommendations remained for this study. They were categorized by specialty and assessed for evidence quality using the Oxford 2009 system based on the sources cited by the original authors. Guidelines were rated by the study types supporting the recommendation, while narrative reviews and expert opinions received a lower level of evidence due to their weaker methodology, even if higher-quality studies were cited. The highest possible level of evidence was assigned from the sources provided.

Of 49 Choosing Wisely recommendations 58 % were based on high evidence (levels I-II), 14 % on moderate evidence (level III), 18 % on low evidence (level IV-V) and 10 % could not be classified. Hematology, transfusion/coagulation medicine, and oncology had the most level I evidence (75 %), while infectiology, pediatrics, and reproductive medicine relied more on level V sources (each 29 %). Cross-country comparison showed notable differences in the recommendations for laboratory medicine, reflecting national priorities in healthcare.

Some of Choosing Wisely's laboratory-related recommendations are based on a high level of evidence, while others lack strong empirical support. Regular updates with high-quality research, international collaboration, and greater transparency are needed to improve the evidence base and patient care.