ArticleAnnals of emergency medicine2025
Adherence to "Choosing Wisely" Recommendations in Pediatric Emergency Medicine.
Article in Annals of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
Funding
Abstract
STUDY
objectiveIn 2022, Choosing Wisely released recommendations to decrease the frequency of low-value testing in pediatric emergency medicine. The extent to which low-value testing occurs in US emergency departments (EDs) may vary by ED experience. We compared the frequency of low-value testing with ED volume.
methodsWe conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project in all EDs in 8 states from January 1, 2014 to December 31, 2020. We included children aged below 18 years with one of the addressed diagnoses: respiratory tract illness, mental or behavioral health condition, seizure, constipation, or respiratory viral illness. ED volume was defined using National Pediatric Readiness Program categories of pediatric visits per year: less than 1,800 (low); 1,800 to 4,999 (low-medium); 5,000 to 9,999 (medium); or ≥10,000 (high) with an outcome of low-value testing, determined using procedure codes. We evaluated the adjusted association of volume with low-value testing using logistic regression with clustering by site.
resultsWe analyzed 5.6 million visits. Low-value tests were obtained in 19.3% of encounters. Low-value tests were obtained in 12.2% of visits to low-volume EDs, 20.5% for low-medium-volume EDs, 23.1% for medium-volume EDs, and 18.7% for high-volume EDs. Low-volume sites had the lowest rates of testing for mental or behavioral health conditions, constipation, and respiratory viral illness. High-volume sites had the lowest rates of testing for respiratory tract illness and seizure.
conclusionsLow-value testing occurred in one fifth of ED visits for children with a study condition. The relationship of ED volume to low-value testing was inconsistent across conditions.
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