A review identifies and classifies reasons for ordering diagnostic tests

Whiting, Penny; Toerien, Merran; de Salis, Isabel; Sterne, Jonathan A C; Dieppe, Paul; Egger, Matthias; Fahey, Tom (2007). A review identifies and classifies reasons for ordering diagnostic tests. Journal of clinical epidemiology, 60(10), pp. 981-9. New York, N.Y.: Elsevier 10.1016/j.jclinepi.2007.01.012

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OBJECTIVE: To consider the reasons and context for test ordering by doctors when faced with an undiagnosed complaint in primary or secondary care. STUDY DESIGN AND SETTING: We reviewed any study of any design that discussed factors that may affect a doctor's decision to order a test. Articles were located through searches of electronic databases, authors' files on diagnostic methodology, and reference lists of relevant studies. We extracted data on: study design, type of analysis, setting, topic area, and any factors reported to influence test ordering. RESULTS: We included 37 studies. We carried out a thematic analysis to synthesize data. Five key groupings arose from this process: diagnostic factors, therapeutic and prognostic factors, patient-related factors, doctor-related factors, and policy and organization-related factors. To illustrate how the various factors identified may influence test ordering we considered the symptom low back pain and the diagnosis multiple sclerosis as examples. CONCLUSIONS: A wide variety of factors influence a doctor's decision to order a test. These are integral to understanding diagnosis in clinical practice. Traditional diagnostic accuracy studies should be supplemented with research into the broader context in which doctors perform their work.

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