Unnecessary diagnostic tests and treatments in children cared for in emergency departments (EDs) do not benefit patients, increase costs, and may result in harm. To address this low-value care, a taskforce of pediatric emergency medicine (PEM) physicians was formed to create the first PEM Choosing Wisely recommendations. Using a systematic, iterative process, the taskforce collected suggested items from an interprofessional group of 33 ED clinicians from 6 academic pediatric EDs. An initial review of 219 suggested items yielded 72 unique items. Taskforce members independently scored each item for its extent of overuse, strength of evidence, and potential for harm. The 25 highest-rated items were sent in an electronic survey to all 89 members of the American Academy of Pediatrics PEM Committee on Quality Transformation (AAP COQT) to select their top ten recommendations. The AAP COQT survey had a 63% response rate. The five most selected items were circulated to over 100 stakeholder and specialty groups (within the AAP, CW Canada, and CW USA organizations) for review, iterative feedback, and approval. The final 5 items were simultaneously published by Choosing Wisely United States and Choosing Wisely Canada on December 1, 2022. All recommendations focused on decreasing diagnostic testing related to respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral respiratory tract infections. A multinational PEM taskforce developed the first Choosing Wisely recommendation list for pediatric patients in the ED setting. Future activities will include dissemination efforts and interventions to improve the quality and value of care specific to recommendations.

中文翻译：

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儿科急诊医学明智选择的建议：提高价值的五个机会


对急诊室 (ED) 接受治疗的儿童进行不必要的诊断测试和治疗不会使患者受益，还会增加成本，并可能造成伤害。为了解决这种低价值护理问题，成立了一个由儿科急诊医学 (PEM) 医生组成的工作组，以制定第一个 PEM 明智选择建议。通过系统化、迭代的流程，工作组从来自 6 个学术儿科急诊室的 33 名急诊科临床医生组成的跨专业小组中收集了建议项目。对 219 个建议项目的初步审查产生了 72 个独特项目。工作组成员对每个项目的过度使用程度、证据强度和潜在危害进行独立评分。评分最高的 25 个项目通过电子调查发送给美国儿科学会 PEM 质量转型委员会 (AAP COQT) 的所有 89 名成员，以选出他们的十大建议。 AAP COQT 调查的回复率为 63%。选出的五个项目被分发给 100 多个利益相关者和专业团体（在 AAP、CW 加拿大和 CW 美国组织内）进行审查、迭代反馈和批准。最后 5 项由“选择明智美国”和“选择明智加拿大”于 2022 年 12 月 1 日同时发布。所有建议都集中在减少与呼吸系统疾病、精神疾病、癫痫、便秘和病毒性呼吸道感染相关的诊断测试。一个跨国 PEM 工作组为急诊室的儿科患者制定了第一份明智选择推荐清单。未来的活动将包括传播工作和干预措施，以提高具体建议的护理质量和价值。