Choosing Wisely: 5 More Practices to Question in the Emergency Department

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM

The American College of Emergency Physicians has highlighted another five tests and procedures physicians should question, as part of the Choosing Wisely campaign, which aims to reduce practices that are not truly necessary.

For those presenting to the emergency department, the ACEP recommends avoiding the following:

• computed tomography of the head in asymptomatic adults with syncope, insignificant trauma, and a normal neurologic exam;

• CT pulmonary angiography in those who have a low-pretest probability of pulmonary embolism plus either negative Pulmonary Embolism Rule-Out Criteria or a negative D-dimer result;

• lumbar spine imaging in adults with non-traumatic back pain, unless there are severe or progressive neurologic deficits or a suspected serious underlying condition (e.g., vertebral infection, cauda equina syndrome, cancer with bony metastasis);

• antibiotics for uncomplicated sinusitis;

• abdominal and pelvic CTs in healthy patients under age 50 with histories of kidney stones who present with symptoms of uncomplicated renal colic.