This led to a lively discussion regarding the reason for the rule requiring transport based on mechanism alone. Most agreed that trauma centers have a vested interest in maintaining the rule. “All of our trauma centers are guilty of this,” Dr. Hoffman said.

Several of the studies found that global rules regarding routine interventions, such as all patients who experience vertigo should get a CT scan, are often unnecessary and can be detrimental to patients who do not need the interventions.

One study, “Overdiagnosis of Pulmonary Embolism (PE) by Pulmonary CT Angiography (CTPA),” determined that PE is overdiagnosed on CTPA. The retrospective study, involving three experts, found that in 26 percent of the cases, all three agreed that the CTPA led to a false positive, subjecting these patients to unnecessary risk of bleeding from blood thinners. “The bigger problem is not the misread, but the dramatic increase in harm from overdiagnosing,” Dr. Hoffman said. “It’s easy to be fooled by one clot, but 13 percent of the misreads was for multiple clots. It’s clear how easy it is to see something we expect to see.”

Another study, “Using Venous Blood Gas Analysis in the Assessment of COPD Exacerbations: A prospective Cohort Study”, elicited a strong reaction from Dr. Bukata. “This should be the end of ABG [arterial blood gases] as we know it,” he said. “This is going the way of the dodo bird.”

The importance of the studies like the ones discussed is to debunk much of the medicine that is being practiced. “There is so much good that we do, but it gets lost in all the crap,” Dr. Hoffman said.

Dr. Bukata urged the audience to use these studies to update guidelines. “We are quick to accept positive research, but it’s very difficult for us to eliminate or change our practice when studies have a negative or neutral effect,” he said. However, it’s not impossible. “You are the influencers to change.”

Teresa McCallion is a freelance medical writer based in Washington State.