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Four imaging tests made a JAMA Internal Medicine top-five list of emergency department procedures to avoid.

A JAMA Internal Medicine article published online Monday says a panel of seven emergency physicians in eastern Massachusetts developed “a ‘top-five’ list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians.”

Lead author Jeremiah Schuur, MD, said the panel took into consideration worries that not ordering the procedures might leave doctors vulnerable to lawsuits:

I understand physicians fear malpractice, but our recommendations are structured such that you can avoid doing those things safely. The best way to avoid medical liability is to practice high-quality medicine, and the top five items we chose are strongly supported by clinical evidence.

Dr. Schuur is an emergency physician at Brigham and Women’s Hospital in Boston. He was quoted in a JAMA news release.

Here’s the top five—or, depending on how you look at it, bottom five—list:

  • Don’t order cervical spine CT for trauma patients who do not meet high-risk criteria.
  • Don’t order CT to diagnose pulmonary embolism without first determining the patient’s risk for pulmonary embolism.
  • Don’t order lumbar spine MRI for patients with lower back pain who don’t have high-risk features.
  • Don’t order head CT for patients with mild traumatic head injury who don’t meet high-risk criteria.
  • Don’t order tests to assess blood clotting times for a patient who is not bleeding or unless you suspect the patient is on anticoagulation therapy or has a clotting disorder.

An accompanying editorial praised the methodological approach the panel took in creating its list. The editorial recommended that creators of similar lists, such as those inspired by the American Board of Internal Medicine’s Choosing Wisely campaign, adopt similarly rigorous methods and be transparent about the process.

“In some cases,” the editorial says, “it is clear that the lists were developed without much input from frontline practitioners, using a process that was not transparent and without clear criteria for inclusion on the list.”

* * *

Are most functional MRI brain studies junk? Probably, says a new study. For details, see our Facebook page.

Related CME seminar (up to 20 AMA PRA Category 1 credits™): Emergency Radiology (all new release; for details, see our Facebook page)


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