The American College of Emergency Physicians (ACEP) has issued a new list of tests and procedures--including efforts to eliminate unnecessary CT scans--as part of the Choosing Wisely initiative.
The list of evidence-based recommendations was released at the recent ACEP Scientific Assembly in Chicago.
Among five recommendations are four related to imaging, including:
- Avoid ordering head CT in asymptomatic adults with syncope, insignificant trauma and normal results of a neurologic evaluation
- Avoid ordering lumbar spine imaging for adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition
- Avoid ordering CT pulmonary angiography in patients with a low probability of embolism who either meet the Pulmonary Embolism Rule-out Criteria or have a negative D-dimer test
- Avoid ordering CT of the abdomen and pelvis in young, otherwise healthy patients with known histories of ureterolithiasis who present with symptoms consistent with uncomplicated kidney stones
The recommendations must involve an action that a physician has control over and isn't dictated by a hospital or trauma system protocol, and must not expose the patient to any danger or the physician to any medical liability risk, according to a recent Medscape Medical News article. They come on the heels of a new study in the Journal of the American College of Radiology that finds that despite evidence of an overall downturn in imaging utilization over the last decade, emergency department utilization has steadily increased--at least among the Medicare population--over that time period.