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Diagnostic work-up prior to thyroid surgery: have clinical guidelines resulted in improvement in the choice of tests ordered?

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Author(s): Aufret B | Rochas M | Caron P | Salles C

Journal: Revue m├ędicale de l'assurance maladie
ISSN 0767-2004

Volume: 31;
Issue: 1;
Start page: 39;
Date: 2000;
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Keywords: thyroid | nodule | diagnostic work-up in thyroid disease | quality of care | costs

ABSTRACT
The National Agency for Medical Accreditation and Evaluation (ANAES) has published clinical guidelines for the diagnosis of thyroid nodules and the use of other non-laboratory thyroid tests. The authors studied ninety-six patients who had undergone thyroid surgery between September 1, 1997 and February 28, 1998 in order to determine if the guidelines were followed by healthcare professionals in the department of the Aveyron. All clinical and laboratory results were obtained from the concerned patients, physicians and hospitals. Laboratory tests, sonography and thyroid scan were systematically performed whatever the thyroid disorder, without taking into account the results of the initial work-up. The pre-operative work-up had no effect on the indication for surgery, whose goal was mainly diagnostic and not therapeutic. Thyroid needle biopsy, the best diagnostic procedure, was not performed and therefore was unable to contribute to a better surgical indication. In addition, this inappropriate diagnostic strategy significantly increases the cost of treating these disorders.
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Tango Jona
Tangokurs Rapperswil-Jona