When considering diagnosis or screening investigations, consider all available tests. It is prudent to consider the least invasive option that will have similar sensitivity and specificity to guide clinical decision making to minimize the potential for harm to the patient. For example, when diagnosing acute appendicitis in children, ultrasound should be considered before computed tomography (CT) scanning. Not only is ultrasound radiation- and contrast-free, but it has been shown to be equivalent to CT scanning in the diagnosis and management of acute appendicitis across several clinically-relevant endpoints, including time to antibiotic delivery, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay. Another example is conducting a non-invasive urea breath test rather than invasive endoscopy to prove H. pylori eradication. The sensitivity and specificity of the urea breath test are superior compared to other diagnostic tests and the risk of patient harm is minimal compared to endoscopy.
Sources:
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Mathews JD, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013 May 21;346:f2360. PMID: 23694687.
Mitchell H, et al. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection. 2016 Jun 6;204(10):376-80. PMID: 27256648.
Mostbeck G, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2016 Apr;7(2):255-63. PMID: 26883138.
Perri F, et al. Helicobacter pylori antigen stool test and 13C-urea breath test in patients after eradication treatments. Am J Gastroenterol. 2002 Nov;97(11):2756-62. PMID: 12425544.
Shogilev DJ, et al. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014 Nov;15(7):859-71. PMID: 25493136.