Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.

BACKGROUND: Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS: A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS: A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS: A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42020208072.

Symptoms and function in patients with articular cartilage lesions in 1,000 knee arthroscopies.

PURPOSE: Focal chondral lesions of the knee are commonly occurring. A lot is known about their frequency, size and localisation in arthroscopic series, but less about the symptoms they elicit and little about how the arthroscopic findings and symptoms correlate. The purposes of the present study included to investigate the relationship between articular cartilage lesion factors and patient factors, and to compare the symptoms and function of cartilage lesion patients to those of patients with a deficient ACL. METHODS: A prospective registration was conducted of preoperative data including Lysholm knee score and perioperative findings in 1,000 consecutive patients undergoing an arthroscopic procedure of the knee-including microfracture of articular cartilage defects and ACL reconstructions. RESULTS: Chondral or osteochondral lesions were found in 57 % of the arthroscopies. The mean Lysholm score in this subgroup was 55. The mean Lysholm score was significantly lower in women (50, SD 19) compared to men (59, SD 18, p < 0.001). Among the chondral lesion factors, only kissing (vs. non-kissing) lesions and multiple (vs. single) lesions influenced symptoms and function to a more than negligible degree. Microfracture in one or two articular cartilage defects was performed in 187 patients. The microfracture group had a significant lower mean Lysholm score (54, SD 18) than a group of patients (N = 71) undergoing ACL reconstruction group (67, SD 17, p < 0.001). CONCLUSION: The study confirms that articular cartilage lesions are both common and cumbersome. Women seem to have more problems than men, whereas chondral lesion factors-such as localisation and size-seem to influence symptoms and function to a small degree. These aspects should be addressed when designing outcome studies, and should also be of interest to the orthopaedic surgeon-in the day-by-day clinical work. When treating these patients, our prime focus need to be on knee function rather than the cartilage defect as the relationship between the latter and the former is unclear. LEVEL OF EVIDENCE: Case-control study, Level III.