CONTENTS
It starts with a
A letter from a fellow questioner at Children ’ s Hospital Colorado
Dear colleagues ,
When a child arrives at an emergency department with abdominal pain , providers often perform an X-ray , see stool in the intestines , blame the discomfort on constipation and send the patient home . While common , this approach is a leading reason why appendicitis — which isn ’ t detectable via plain radiography — gets misdiagnosed . There ’ s no doubt that diagnostics can be lifesaving in emergency care , but too much testing can also lead to unnecessary , inaccurate results that may do more harm than good .
How , as pediatric care providers , can we practice research-driven emergency medicine that improves diagnoses while minimizing risk ?
A new list , developed in partnership with an organization called Choosing Wisely , is the first of its kind to offer guidance on this everimportant question . Created by a multinational taskforce of emergency medicine professionals at the American Association of Pediatrics , these recommendations are also the first to be endorsed by organizations from both the U . S . and Canada . Our list is based on rigorous published scientific data . It highlights eight common pediatric conditions associated with high diagnostic rates in emergency departments and offers data to help providers avoid these tests .
Having spent the last two decades researching evidence-based emergency medicine , this collaboration leaves me with a great sense of encouragement for what lies ahead . Not only will this list support providers navigating emergency care , but it will also reduce patient harm caused by excess radiation , prolonged hospital stays and falsepositive test results in a world where families face crowded emergency rooms , skyrocketing costs and pervasive uncertainty .
As we prepare to share our methods with colleagues across North America , I ’ m hopeful that this list will help us all create a healthier and less burdensome future for every child .
Best regards ,
Contents
ON THE COVER
04
CARDIOLOGY
Why Hearts Fail
FEATURES
08
ORTHOPEDICS
A Joint Effort
12
CRANIOFACIAL SURGERY
Smarter Image
14
PRECISION MEDICINE
Closing the Precision Medicine Loop
18
GASTROENTEROLOGY / HEPATOLOGY
Less Sugar , Sweeter Futures
20
HEMATOLOGY / ONCOLOGY
A New Era for Vascular Anomalies
SHORT ANSWER
03
NEUROLOGY
Medicine for the Future
03
OPHTHALMOLOGY
Advancing a Vision
07
PULMONOLOGY
Clearing the Airways
11
NEPHROLOGY
Demystifying Acute Kidney Injury
ACCOLADES
23
A (:) List
LALIT BAJAJ , MD , MPH
Chief Quality , Equity and Outcomes Officer , Children ’ s Hospital Colorado
Professor of pediatrics and emergency medicine , University of Colorado School of Medicine
For a digital version of this publication visit : childrenscolorado . org / Qmagazine
Share articles with colleagues , discover related research and sign up for our specialty-specific email newsletters .