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Choosing Wisely® Campaign - AAP Identifies List of Commonly Used Tests and Treatments to Question

  For Release: Feb. 21, 2013
CHICAGO – The American Academy of Pediatrics (AAP) today released a list of specific tests or treatments that are commonly given to children, but not always necessary, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.
 
The AAP list identified the following five recommendations:

  • Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
    Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health care costs and the risks of adverse events.
  • Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
    Research has shown these products offer little benefit to young children and can have potentially serious side effects. Many cough and cold products for children have more than one ingredient, increasing the chance of accidental overdose if combined with another product.
  • Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
    Minor head injuries occur commonly in children and adolescents. Approximately 50% of children who visit hospital emergency departments with a head injury are given a CT scan, many of which may be unnecessary. Unnecessary exposure to x-rays poses considerable danger to children including increasing the lifetime risk of cancer because a child’s brain tissue is more sensitive to ionizing radiation. Unnecessary CT scans impose undue costs to the health care system. Clinical observation prior to CT decision-making for children with minor head injuries is an effective approach.
  • Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.
    CT scanning is associated with radiation exposure that may escalate future cancer risk. MRI also is associated with risks from required sedation and high cost. The literature does not support the use of skull films in the evaluation of a child with a febrile seizure. Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child’s fever.
  • Computed tomography (CT) scans are not necessary in the routine evaluation of abdominal pain.
    Use of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk for cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs. There also is the potential for radiation overdose with inappropriate CT protocols.

    According to AAP President Thomas K. McInerny, MD, FAAP, "The AAP is a strong supporter of partnerships that improve the quality of care for patients. Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately. The Choosing Wisely campaign helps to raise awareness of the need to evaluate tests and treatments thoughtfully. This is particularly important when treating children, because they are still growing and developing.”

    All of the lists released today as part of the Choosing Wisely campaign were developed by individual specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the societies believe the recommendations can make a significant impact on patient care, safety and quality.

    Releasing lists along with the AAP today are 16 other organizations representing more than 350,000 physicians, nurses, pathologists, radiologists and other health care professionals. They are:
*Releasing a second list
 
Dr. McInerny said, “The AAP believes that healthcare for children, in addition to being delivered in a patient-centered medical home, should be evidence-based or informed, efficient and based on quality improvement measures relevant to the pediatric population. The AAP also encourages patient and family engagement in promoting their child's well-being. These hallmarks of the patient-centered medical home also are integral to the success of the Choosing Wisely campaign."

In April 2012, nine medical specialty societies each released lists as part of the Choosing Wisely campaign. To date more than 130 tests and procedures to question have been released as part of the campaign and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective membership of more than 725,000 physicians.
 
The campaign is also reaching millions of consumers nationwide through a stable of consumer partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:

*Releasing a second list
**Releasing a third list
 
To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWisely.org.
 
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About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. (www.aap.org)
 
About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, read our blog blog.abimfoundation.org, connect with us on Facebook or follow us on Twitter.
 
About Choosing Wisely
First announced in December 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org