Key to making the top five was the strength of evidence of specific patient groups who would very likely benefit versus those who almost certainly would not, Schuur says. For example, one of the practices that was on the list of 17 but didn't make the cut was the practice of admitting patients who come to the emergency department with a low-risk of fainting.
While there's general agreement that such patients do not require hospital admission, Schuur says, "there's not complete agreement on how to define a low-risk patient."
The Partners' Top Five list and the American College of Emergency Physician's Top Five list for the Choosing Wisely campaign share only one low-value procedure: head CT for patients with mild traumatic head injury who are at low risk of serious skull fracture or brain bleeding.
The Partners list is as follows:
1. Do not order computed tomography (CT) of the cervical spine for patients after trauma who do not meet the National Emergency X-ray Utilization Study (NEXUS) low risk criteria or the Canadian C-Spine Rule.
2. Do not order CT to diagnose pulmonary embolism without first risk stratifying for pulmonary embolism (pretest probability and D-dimer tests if low probability).
3. Do not order magnetic resonance imaging of the lumbar spine for patients with lower back pain without high-risk features.