AAP: 5 conditions where testing may be unnecessary

The American Academy of Pediatrics (AAP) has released an evidence-based list of 5 conditions common in pediatric care settings which can be identified without the use of unnecessary testing.

This list was a contribution from the AAP to the Choosing Wisely campaign, an effort from the American Board of Internal Medicine Foundation, to encourage discussion between patients and providers that lets them choose care that is supported by evidence, is safe and necessary, and is not the same as treatment already received.

The conditions in the AAP’s list were chosen from the AAP Section of Emergency Medicine, which analyzed conditions common in emergency departments (EDs), urgent care centers, and primary care offices. These conditions have a high rate of unnecessary testing, leading to harmful radiation, prolonged ED stays, and unnecessary pain and expenses.

There is also a risk of further unnecessary treatment for these conditions, such as therapies and further testing because of false positives. According to Paul Mullan, MD, MPH, chair of the AAP Section of Emergency Medicine’s Choosing Wisely taskforce, the EDs ability to produce rapid results carries a risk of diagnostic over-testing.

Along with rigorous examination from experts to determine which conditions see over-testing, the taskforce received feedback from Choosing Wisely Canada and the Canadian Association of Emergency Physicians. This makes the latest Choosing Wisely list the first to be published by Choosing Wisely organizations from 2 separate countries at the same time.

“We encourage parents and providers to think again before asking for or ordering these blood tests, viral panels, X-rays, and CT scans,” said Shabnam Jain, MD, MPH, a professor of pediatrics and emergency medicine at Emory University School of Medicine and Children’s Healthcare of Atlanta. “The current crisis of emergency department overcrowding underscores more than ever the need to choose wisely and avoid tests that are not evidence-based and do not improve outcomes.”

In the list, it is recommended that providers avoid radiographs in pediatric patients present with asthma, croup, bronchitis, or first-time wheezing. Screening laboratory tests for patients needing inpatient psychiatric admission should also be avoided unless clinically indicated.

Additionally, abdominal radiographs for suspected constipation, comprehensive viral panel testing for suspected respiratory viral illnesses, and laboratory testing for unprovoked or simple febrile seizure in patients who have returned to baseline status should be avoided.

Evidence-based guidance on when these tests may be necessary is included in the list. The list was based on recommendations from a diverse selection of ED providers, then scored for frequency of inappropriate use, lack of evidence for use, and risk of harm from overuse. 

Reference

Choosing wisely: five thingsphysicians and patients should question in the practice of pediatric emergency medicine. American Academy of Pediatrics. December 1, 2022. Accessed December 1, 2022. https://www.aap.org/en/news-room/news-releases/aap/2022/choosing-wisely-five-things-physicians-and-patients-should-question-in-the-practice-of-pediatric-emergency-medicine/