Top 5 Tests to Avoid in Neurosurgery: Choosing Wisely

Megan Brooks

June 26, 2014

As part of the Choosing Wisely initiative, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) have released a list of the 5 tests or procedures that are commonly ordered, but not always necessary, in neurosurgery.

The following 5 "evidence-based recommendations" can support physicians in working with their patients to make wise choices about their care, the organizations say.

  1. Don't administer steroids after severe traumatic brain injury.

  2. Don't obtain imaging (plain radiography, MRI, computed tomography [CT], or other advanced imaging) of the spine in patients with nonspecific acute low back pain and without red flags.

  3. Don't routinely obtain CT scanning of children with mild head injuries.

  4. Don't routinely screen for brain aneurysms in asymptomatic patients without a family or personal history of brain aneurysms, subarachnoid hemorrhage (SAH), or genetic disorders that may predispose to aneurysm formation.

  5. Don't routinely use seizure prophylaxis in patients following ischemic stroke.

"Neurosurgeons are committed to identifying the right treatment, for the right patient, at the right time to help eliminate unnecessary procedures, optimize outcomes, and reduce healthcare costs," AANS President, Robert E. Harbaugh, MD, said in a statement. "Participating in the Choosing Wisely initiative is a key step in this process."

"I think most of the neurosurgeons in the country will recognize that the list is reasonable," Dr. Harbaugh said in an interview with Medscape Medical News. "There are always going to be some people that have a protocol that they've followed forever and have done well with it and it might be difficult to change. But I don't think we will get too much push-back on the list," Dr. Harbaugh said.

The AANS and CNS Choosing Wisely list was developed after careful consideration and review by the organizations' Joint Guidelines Committee, Quality Improvement Workgroup, and 7 clinical subspecialty sections. The recommendations reflect the most current evidence about management and treatment options for patients facing disorders of the brain and spine, they note.

"A broad range of neurosurgeons, from across the spectrum of our specialty, reviewed the evidence and contributed to these recommendations," CNS President, Daniel K. Resnick, MD, said in a statement.

"We anticipate that these will help neurosurgeons and their patients make informed decisions by promoting conversations about the most appropriate tests and treatments, and avoiding care whose potential harm may outweigh the benefits," he added.

"There is an awful lot of waste in the medical care system," Dr. Harbaugh said. "At least from my experience, much of that waste is treating things that don't need to be treated, screening examinations that are unlikely to give you any meaningful information, and just unnecessary testing. Some of it is driven by the concerns for medical liability and practicing defensive medicine," he noted.

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