Choosing Wisely list reveals five unnecessary neurosurgical tests, procedures

The American Association of Neurological Surgeons and the Congress of Neurological Surgeons have released the Choosing Wisely list, a document that unveils specific tests and procedures that are commonly ordered but not always necessary in neurosurgery.

The Choosing Wisely list is part of the ABIM Foundation and includes five evidence-based recommendations aimed to support physicians as they work with patients to make wise choices about their care, according to a press release.

The five recommendations are:

• Don’t administer steroids after severe traumatic brain injury.

• Don’t obtain imaging (plain radiographs, magnetic resonance imaging, CT or other advanced imaging) of the spine in patients with non-specific acute low back pain and without red flags.

• Don’t routinely obtain CT scanning of children with mild head injuries.

• Don’t routinely screen for brain aneurysms in asymptomatic patients without a family or personal history of brain aneurysms, subarachnoid hemorrhage or genetic disorders that may predispose to aneurysm formation.

• Don’t routinely use seizure prophylaxis in patients following ischemic stroke.

“Neurosurgeons are committed to identifying the right treatment, for the right patient, at the right time to help eliminate unnecessary procedures, optimize outcomes and reduce health care costs,” American Association of Neurological Surgeons (AANS) president, Robert E. Harbaugh, MD, said in the press release. “Participating in the Choosing Wisely initiative is a key step in this process.”

The AANS and Congress of Neurological Surgeons (CNS) devised the list after months of consideration by the Joint Guidelines Committee, the Quality Improvement Workgroup and seven clinical subspecialty sections, according to the press release. The recommendations take into account the most current evidence about management and treatment options for patients with brain and spine disorders.

With this new list, the Choosing Wisely campaign will have more than 300 tests and practices that the specialty society partners say are overused and inappropriate. Choosing Wisely is intended for patients and their physicians to discuss the necessity of such testing, according to the press release.

“A broad range of neurosurgeons, from across the spectrum of our specialty, reviewed the evidence and contributed to these recommendations,” CNS president, Daniel K. Resnick, MD, said in the press release. “We anticipate that these will help neurosurgeons and their patients make informed decisions by promoting conversations about the most appropriate tests and treatments, and avoiding care whose potential harm may outweigh the benefits.”

Choosing Wisely was established in December 2011. It 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, the press release stated.

Reference: www.choosingwisely.com