Sunday, March 23, 2014

Limit Food Allergy Panels, AAP Says in Choosing Wisely List

Larry Hand
March 18, 2014

The American Academy of Pediatrics (AAP) has released its second list of common tests and treatments to question as part of the Choosing Wisely initiative.
The AAP also announced on March 17 the launch of an online learning module pediatricians can use to help with 2 items on its first Choosing Wisely list, released in February 2013. The module is designed to avoid use of antibiotics for viral respiratory illnesses and the use of unnecessary computed tomography scans.
"The AAP strongly supports partnerships and tools that improve the quality of care for patients," AAP President James M. Perrin, MD, said in a news release. "Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately. This is particularly important when treating children, because they are still growing and developing."
The new evidence-based recommendations are:
  • "Don't prescribe high-dose dexamethasone (0.5mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in the pre-term infant.
  • Don't perform screening panels for food allergies without previous consideration of medical history.
  • Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux...that is effortless, painless, and not affecting growth. Do not use medication in the so-called 'happy-spitter.'
  • Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.
  • Infant home apnea monitors should not be routinely used to prevent Sudden Infant Death Syndrome."
The AAP's complete list of Choosing Wisely recommendations is available online. The first 5 recommendations are:
  • "Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
  • Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
  • Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
  • Neuroimaging (CT, [magnetic resonance imaging]) is not necessary in a child with simple febrile seizure.
  • [CT] scans are not necessary in the routine evaluation of abdominal pain."
Choosing Wisely was launched in 2012 by the American Board of Internal Medicine. A national campaign, Choosing Wisely involves more than 50 medical specialty societies identifying common medical tests and treatments that may not be necessary or of benefit to patients.

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