Choosing Wisely: Five Things Physicians and Patients Should Question Related to Pediatric Neurosurgery and Treatment

The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, has released a list of common medical therapies and practices related to children’s neurosurgery and treatment that may be unnecessary and should be considered carefully by physicians and parents.

The AAP Section on Neurological Surgery Executive Committee has compiled the list of common issues and treatments encountered in pediatric settings and emergency departments by pediatricians, pediatric medical subspecialists and surgical specialists.

“Pediatric neurosurgery is an imaging intensive and reliant specialty,” said Andrew Jea, MD, MHA, FACS, FAAP, chair of the AAP Section on Neurosurgery. “However, we recognize the importance of limiting or even eliminating unnecessary and non-value-added tests and procedures for our patients, specifically those that involve radiation and need for general anesthesia.  Our Choosing Wisely list is just a start; we hope to add and refine this list with other organizations and societies that share our same concerns and love for children.”

The Section recognizes there are unique considerations and options as it concerns children. The list is available here and includes:

• Do not perform routine imaging for evaluation of infant head shape.  
• Do not obtain imaging of the cervical spine following trauma in an awake and alert patient without considering the use of clinical decision-making tools for cervical spine clearance. 
• Do not routinely perform imaging or routine elective procedures requiring sedation or general anesthesia for very young children with low-risk asymptomatic lesions. 
• Do not perform routine imaging for evaluation of VP shunt function in a patient without signs or symptoms of shunt malfunction. 
• Do not routinely obtain a CT or MRI scan for developmentally normal, clinically asymptomatic infants with macrocephaly. 

The list, Five Things Physicians and Patients Should Question, is available through the Choosing Wisely website.  Choosing Wisely® is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary.

At least 80 medical specialty societies have published more than 500 recommendations of overused tests and treatments as a result of the initiative, launched in 2012.

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The American Academy of Pediatrics is an organization of 67,000 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. For more information, visit www.aap.org.