Can't Stop The (Pediatric) Waste

1 in 5 visits for selected conditions received unnecessary tests.

[ed. you may also have noticed the branding on this e-mail has changed – it turns out “Medicine Minute” is already used in several other established sites, so I’ve had to come up with a new name]

This is one of those “Choosing Wisely” posts – and, as is typical of these posts, it again has that same negative “I’m not angry, I’m just disappointed” tone you get from your parents.

These authors used a healthcare utilization database to pull pediatric visits for respiratory illnesses, mental health, seizure, and constipation. To “choose wisely", as it were, there ought to be uncommon viral panel testing and chest radiography for respiratory illness, blood tests for mental health, blood tests or neuroimaging for seizure, and abdominal radiography for constipation.

How are we doing?

Anywhere from “not good” to “absurdly bad”. A 66% rate of abdominal radiography for constipation! Nearly half of patients with blood tests following a seizure. These are tests in which rarely will they provide an answer that will guide management, or may even be more likely to mislead clinicians into layering on additional unnecessary care – such as chest radiography in the context of viral lower respiratory tract infections. These were all children who were discharged from the ED, as well, so even further excluding the ones who “looked sick” or had other indications for testing as part of their pathway towards hospital admission.

Don’t do these things.