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Help families make evidence-based pediatric surgery decisions :

December 4, 2019
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Decisions based on scientific evidence and in the child’s best interest are the focus of a Choosing Wisely List for Pediatric Surgery developed by the AAP Section on Surgery.

With waste accounting for an estimated 25% of total health care spending in the U.S., physicians, surgeons and patients are discussing ways to avoid overuse of health care resources. Being a member of the National Choosing Wisely Initiative enables the AAP to be part of the dialog on reducing unnecessary medical tests and procedures.

Many AAP medical and surgical sections are developing Choosing Wisely lists by identifying common clinical scenarios in which the use of specific tests or treatments may not be necessary based on the clinical evidence. These lists are vetted by relevant AAP expert groups, then reviewed and approved by the AAP Executive Committee. The National Choosing Wisely Initiative partners then follow a similar review process.

The latest AAP Choosing Wisely List for Pediatric Surgery resulted in these top five items:

  1. Avoid routine use of whole-body computed tomography (CT) scanning (pan-scanning) in pediatric trauma patients.
  2. Avoid using CT scanning as the first-line imaging modality in the evaluation of suspected appendicitis in children. Ultrasound should be done first with a CT scan or MRI considered in equivocal cases.
  3. Avoid performing anti-reflux operations (fundoplications) during gastrostomy insertion in most children who otherwise are growing and thriving with gastric feedings.
  4. Avoid referring most children with umbilical hernias to a pediatric surgeon until around age 4 to 5 years.
  5. Reduce post-operative opioid requirements by administering acetaminophen and/or nonsteroidal anti-inflammatory medications in the perioperative period.

Each item also includes rationale and references at http://www.choosingwisely.org/societies/american-academy-of-pediatrics-section-on-surgery/. Search Choosing Wisely clinician lists from all participating societies at http://www.choosingwisely.org/clinician-lists/.

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