The American College of Emergency Physicians (ACEP) has released a second list of their Choosing Wisely recommendations.

The ACEP reviewed the work of the Cost Effective Care Task Force and the Technical Expert Panel that formed the group’s original list of recommendations. Criteria for inclusion were: existing research to demonstrate the cost effectiveness and improvement of patient care, consensus among clinicians and the College’s Medical Legal Committee that the proposed list of recommendations did not pose a significant risk of litigation if implemented with reason, caution and explanation to the patient.

The new list includes the following recommendations:

  • Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma, and a neurological evaluation.
  • Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer.
  • Avoid lumbar spine imaging in the emergency department for adults with non-traumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition (such as vertebral infection, cauda equine syndrome, or cancer with bony metastasis).
  • Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
  • Avoid ordering CT of the abdomen and pelvis in young otherwise healthy emergency department (ED) patients (age <50) with known histories of kidney stones, or ureterolithiasis, presenting with symptoms consistent with uncomplicated renal colic.

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