Tests and procedures on hospitalized kids: first, do no harm
There are ample data in adult medicine than up to a third of the treatments and interventions we do in adults are useless at best, maybe harmful. Nobody knows if a similar percentage applies to children, but it is certainly true we do too many tests on kids in the hospital. I have to say that intensivists like me are frequent offenders with all the “routine” blood tests and chest x-rays we do. It is true intensive care requires more intensive testing, but every time I order a test these days I’m much more aware of these questions when I do so than I was in the past: Do I really need it? What will I do differently depending upon the test result? Now a new initiative from the professional organization of pediatric hospital doctors addresses this problem directly. It’s called Choosing Wisely. It’s patterned after a similar program by pediatric radiologists aimed at reducing radiation exposure, the Image Gently program.
The program recommendations starts small with 5 simple, concrete guidelines. All of these have been or are common practices of dubious or no benefit.
- Do not order chest x-rays on children with straightforward asthma or bronchiolitis.
- Do not use steroids in children less than 2 years of age with pneumonia
- Do not use bronchodilators (like albuterol) in children with bronchiolitis
- Do not routinely treat gastro-esophageal reflux in infants with acid suppression therapy (like Zantac or Prilosec)
- Do not use a pulse oximeter machine on children who are not receiving oxygen therapy. (This is a device that goes on a finger or a toe and measures oxygen in the blood continuously.)
These are all very sensible guidelines, but they’re only a beginning. The idea is not to forbid doctors from doing these things, but rather to make us think twice about ordering them to make sure they make sense for a particular patient. We don’t want to add cost, and certainly not risk, without adding any benefit.