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How to Choose Wisely in PEM

March 27, 2024

Written by Vivian Lei

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The 5 Choosing Wisely recommendations for pediatric emergency medicine (PEM) focus on decreasing diagnostic testing related to respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral respiratory tract infections.

Choosing wisely – PEM edition
This paper details the systematic process for creating the PEM list of Choosing Wisely guidelines to help clinicians avoid unnecessary testing and treatment for children in the ED. A total of 219 initial suggested items resulted in 72 unique recommendations. These were then rated by a taskforce by frequency of overuse, potential for harm, and strength of evidence basis. The top 25 were included in an electronic survey sent to members on the AAP Section of Emergency Medicine Committee on Quality Transformation resulting in the top 5 Choosing Wisely items:

  1. Do not obtain radiographs in children with bronchiolitis, croup, asthma, or first-time wheezing.
  2. Do not obtain screening laboratory tests in the medical clearance process of pediatric patients who require inpatient psychiatric admission unless clinically indicated.
  3. Do not order laboratory testing or a computed tomography (CT) scan of the head for pediatric patients with an unprovoked, generalized seizure or a simple febrile seizure who have returned to baseline mental status.
  4. Do not obtain abdominal radiographs for suspected constipation.
  5. Do not obtain comprehensive viral panel testing for patients who have suspected respiratory viral illness.

These recommendations are meant to aid clinicians in establishing best practices related to pediatric emergency care and support shared decision-making with parents and caregivers.

How will this change my practice?
These Choosing Wisely recommendations help guide my clinical practice and avoid tests that are not evidence-based and do not improve outcomes. It also provides a way to partner with parents and caregivers in establishing a shared understanding about their child’s condition in the ED to ease conflict related to diagnostic testing.

The list of recommendations is available for download here.

Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value. Ann Emerg Med. 2024 Feb 11:S0196-0644(24)00017-9. doi: 10.1016/j.annemergmed.2024.01.007. Epub ahead of print.

What are your thoughts?