This article is more than 5 years old. Information may no longer be current.
AAP publishes Choosing Wisely list of overused procedures for pediatric surgery
The AAP published a new list of medical treatments, tests and procedures related to pediatric surgery that may be overused.
The list is part of the Choosing Wisely initiative, a national campaign aimed at helping patients and providers choose only care that is necessary, free from harm, supported by evidence and not duplicative of tests or procedures already received.
Specific to pediatric surgery, the goal of the latest list developed by the AAP is to “lead to an appropriate discussion between families, their physicians or referring practitioners to a pediatric surgeon about appropriate care,” Alan P. Ladd, MD, professor of surgery at the Indiana University School of Medicine, told Infectious Diseases in Children.
“We wanted to provide guidelines from the surgical perspective on the five most relevant issues encountered by pediatric surgeons from referring physicians,” Ladd said. “Our hope is that these statements regarding conditions treated by pediatric surgeons would raise awareness by families with children, and by pediatric physicians to appropriately discuss the guidelines in relation to the specific children under their care.”
Major suggestions from the new list are as follows:
- Avoid routine use of whole-body CT scanning for pediatric trauma patients;
- Use ultrasound instead of CT scans as the initial method for evaluating appendicitis;
- Avoid antireflux operations during gastrostomy insertion for children who are otherwise thriving with gastric feedings;
- Avoid referring children with umbilical hernias to a pediatric surgeon until 4 to 5 years of age; and
- Reduce postoperative opioid use by administering acetaminophen or nonsteroidal anti-inflammatory medications.
“There's a recognition that harm can be done by ordering too many tests and procedures,” Paul Kaplowitz, MD, professor emeritus at Children’s National Health System in Washington, D.C., and the AAP’s physician champion for Choosing Wisely, told Infectious Diseases in Children. “The point is not just to avoid costs but to give the right level of care and to not create other problems, like ordering unnecessary CT scans for minor head trauma and discovering minor findings which are unrelated to the trauma but which increase anxiety and result in further imaging studies.”
Previous Choosing Wisely recommendations developed by AAP specialty groups included a list of common procedures for pediatric orthopedics patients that are not always necessary. Two items on the new list are related to the overuse of CT scans, a topic particularly relevant to ER situations for pediatric trauma, according to Kaplowitz.
“There's a great deal of temptation to do a procedure that will provide the best picture of the effective structures,” Kaplowitz said. “And yet the evidence is now pretty clear that CT scans involve a lot of radiation, and radiation to young children can increase the risk of cancer later in life.”
“Reducing tests can avoid a spiral of more and more testing, and unhappier and more anxious patients and parents,” Kaplowitz added. – by Eamon Dreisbach
Reference:
Choosing Wisely. American Academy of Pediatrics – Section on Surgery. http://www.choosingwisely.org/societies/american-academy-of-pediatrics-section-on-surgery/. Accessed November 18, 2019.
Disclosures: Kaplowitz and Ladd report no relevant financial disclosures.