In order to nuture a meaningful two-way doctor-patient conversation about which treatments are appropriate and necessary for specific medical conditions (and which are not), the American Board of Internal Medicine Foundation teamed with national medical specialty organizations (like the AAP), Consumer Reports, and other consumer-focused entities to “‘choose wisely’ by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.” The AAP chose ten, including:
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.
Here is a nice resource explaining when children need antibiotics — and when they don’t. And here is another explaining the criteria we use to tell the difference between a cold and a bacterial sinus infection where antibiotics are prescribed. The PediaBlog also has these topics covered here and here.
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.
More PediaBlog on avoiding the use of cold meds here.
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.
The PediaBlog has tackled concussions here.
These, as well as the other seven areas of questioning presented by the AAP, are not new talking points for pediatricians. Most, if not all, of these points come up in our daily practice and into the conversations we have with each other and with families. Tomorrow, we’ll look at the list of other organizations and how they are “choosing wisely” for children.