Pediatric Emergencies Associated With Unnecessary Testing: AAP

Eliza Partika

December 02, 2022

The American Academy of Pediatrics (AAP) is cautioning physicians and parents to be on the lookout for unnecessary diagnostic testing associated with several common pediatric conditions

Children seen for the conditions in emergency settings and even in primary care offices could experience avoidable pain, exposure to harmful radiation, and other harms, according to the group.

"The emergency department has the ability to rapidly perform myriad diagnostic tests and receive results quickly," said Paul Mullan, MD, MPH, chair of the AAP's Section of Emergency Medicine's Choosing Wisely taskforce. The guidance was released week. "However, this comes with the danger of diagnostic over-testing."

The five recommendations are as follows:

  • Radiographs should not be obtained for children with bronchiolitis, croup, asthma, or first-time wheezing.

  • Laboratory tests for screening should not be undertaken in the medical clearance process of children who require inpatient psychiatric admission unless clinically indicated.

  • Laboratory testing or a CT scan of the head should not be ordered for a child with an unprovoked, generalized seizure or a simple febrile seizure whose mental status has returned to baseline.

  • Abdominal radiographs should not be obtained for suspected constipation.

  • Comprehensive viral panel testing should not be undertaken for children who are suspected of having respiratory viral illnesses.

The AAP taskforce partnered with Choosing Wisely Canada to create the recommendations. The list is the first of its kind to be published jointly by two countries, according to the release.

"We hope this Choosing Wisely list will encourage clinicians to rely on their clinical skills and avoid unnecessary tests," said Mullan, who is also a physician at Children's Hospital of the King's Daughters and professor of pediatrics at Eastern Virginia Medical School in Norfolk, Virginia.

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