When a test is too good

Authors’ reply to Quantrill, Benger, Ripley and colleagues, Roach, Rogers, and Haldar and colleagues

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5131 (Published 20 August 2013)
Cite this as: BMJ 2013;347:f5131

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  1. Renda Soylemez Wiener, assistant professor1,
  2. Lisa M Schwartz, professor2,
  3. Steven Woloshin, professor2
  1. 1Pulmonary Center, Boston University School of Medicine, Boston, MA, USA and Center for Health Quality, Outcomes and Economic Research, ENRM VA Hospital, Bedford, MA, USA
  2. 2Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA and VA Outcomes Group, VA Medical Center, White River Junction, VT, USA
  1. rwiener{at}bu.edu

Quantrill’s concern underscores the tension between doing too much versus too little.1 2 Substantial evidence shows, however, that selective imaging based on diagnostic algorithms is not only safe,3 4 but preferable, because it reduces overtesting and overtreatment. Even Anderson and colleagues’ study, where all patients had a moderate to high pretest probability of pulmonary embolism, showed no difference between computed tomography …

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