Medical testing is a wonderful thing, but not when it provides information that doesn’t make a difference in treatment and unnecessarily increases healthcare costs.
It’s a topic that Dr. Paul Mullan, a pediatric emergency physician and Director of Research and Quality Improvement at CHKD, has immersed himself in during the past year and a half as he chaired a American Academy of Pediatrics taskforce examining tests that medical staff and patients should be cautious of requesting or ordering.
CHKD team members Becky Roenker, RN; Lyndsey Clements, NP; and Drs. Joel Clingenpeel, Meg Eason, and Eliza Foley were the contributing members from CHKD that submitted many of the initial recommendations. Diverse groups of providers from five other U.S. children's hospitals submitted their own recommendations as well. All of their recommendations were then used in a rigorous process of scientific evidence review and expert consensus to arrive at the final list.
The results, based on feedback from pediatric hospitals across the United States and Canada, were released by the AAP early this month as part of the “Choosing Wisely” campaign. That campaign was launched in 2012 and seeks to help patients and medical staff avoid unnecessary medical tests, treatments, and procedures.
These tests are also ordered in urgent care and primary care settings, and can unnecessarily lengthen time spent in a medical facility and cost of care.
“Parents should recognize that certain tests are not necessary for the proper treatment of their children,” Mullan said. “We also hope the Choosing Wisely list will encourage clinicians to rely on their clinical judgment. These tests are important in many instances, and the Choosing Wisely list also provides indications and references to guide clinicians on when these diagnostic tests do add value.”
The five recommendations are as follows:
- Radiographs should not be obtained for children with bronchiolitis, croup, asthma, or first-time wheezing.
- Laboratory tests for screening should not be undertaken in the medical clearance process of children who require inpatient psychiatric admission unless clinically indicated.
- Laboratory testing or a CT scan of the head should not be ordered for a child with an unprovoked, generalized seizure or a simple febrile seizure whose mental status has returned to baseline.
- Abdominal radiographs should not be obtained for suspected constipation.
- Comprehensive viral panel testing should not be undertaken for children who are suspected of having respiratory viral illnesses.
