Presentation (CTI)

OBJECTIVES: Our study aimed to explore the clinical decision-making processes underlying laboratory test requests in diagnostic and therapeutic contexts, with a particular focus on adherence to or deviations from international protocols and guidelines. We investigated how financial structures and information gaps influence diagnostic practices, using deep vein thrombosis (DVT) diagnostics as a case study.
METHODS: We analyzed diagnostic test request patterns for suspected DVT cases at the University of Debrecen Clinical Center between 2007 and 2020. We reviewed diagnostic recommendations, financial reimbursement policies, and actual clinical practices. Additionally, we conducted an anonymous survey among emergency department physicians to assess factors influencing diagnostic decisions.
RESULTS: A total of 6,821 patients were investigated for suspected DVT during the study period. Between 2008 and 2013, the most common approach was the combined use of D-dimer testing and duplex ultrasound (64.5%), followed by ultrasound alone (20.5%) and D-dimer alone (15%). From 2014 onwards, a marked shift occurred: by 2018-2020, 88% of cases involved ultrasound only, while the combined and D-dimer-only approaches dropped to 7.9% and 4%, respectively. Survey responses indicated that 75% of physicians cited time efficiency as the main reason for omitting D-dimer tests. Additionally, 45% believed D-dimer costs equaled or exceeded those of ultrasound. Financial analysis revealed that the current performance-based reimbursement system is outdated and fails to reflect actual diagnostic costs, particularly underfunding duplex ultrasound services.
CONCLUSIONS: Our findings suggest that financial and logistical considerations significantly impact diagnostic behavior, often overriding protocol-based clinical reasoning. The increased reliance on ultrasound, driven partly by financial misalignment, leads to higher national healthcare costs and strain on radiology departments. A revision of the reimbursement system is essential to ensure cost-reflective funding and sustainable diagnostic practice.