Choosing Wisely: Practices to Question in Pediatric Cardiology

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Academy of Pediatrics has added a list of pediatric cardiology practices that clinicians should question as part of the Choosing Wisely campaign, which prioritizes high-value care and highlights unnecessary tests and treatments. They include:

• For a sports preparticipation exam, clinicians shouldn't routinely order a screening electrocardiogram (ECG) for healthy youths who are asymptomatic and don't have a personal or family history of cardiac disease.

• A screening ECG shouldn't be ordered before starting treatment for attention-deficit/hyperactivity disorder in healthy youths without a personal or family history of cardiac disease.

• An echocardiogram isn't necessary in evaluating pediatric patients with syncope or chest pain who don't have a concerning history or ECG abnormalities.

• Clinicians shouldn't order troponins when evaluating pediatric chest pain in patients without a concerning history or ECG abnormalities.