Choosing Wisely Canada: Pediatric Neurosurgery Recommendations.

Area of Science:

• Paediatric Neurosurgery
• Evidence-Based Medicine
• Clinical Practice Guidelines

Background:

• Choosing Wisely Canada promotes evidence-based medical care.
• There was a need for specific recommendations in paediatric neurosurgery.
• The campaign aims to improve the delivery of medical care in Canada.

Purpose of the Study:

• To produce Canadian recommendations for physicians treating paediatric neurosurgery patients.
• To identify five key areas for improved care delivery in paediatric neurosurgery.

Main Methods:

• Canadian paediatric neurosurgeons participated via anonymous questionnaires.
• Suggestions were ranked, discussed at the Canadian Pediatric Neurosurgery Study Group meeting, and filtered for evidence base and population impact.
• The top five recommendations were submitted to Choosing Wisely Canada.

Main Results:

• Recommendation 1: Avoid computed tomography (CT) for macrocephaly; use ultrasound or magnetic resonance imaging (MRI).
• Recommendation 2: Do not image asymptomatic midline dimples in infants/children.
• Recommendation 3: Avoid routine CT for hydrocephalus; use fast-sequence MRI or ultrasound.
• Recommendation 4: Do not recommend helmets for positional flattening.
• Recommendation 5: Avoid routine surveillance imaging for incidental Chiari I malformation.

Conclusions:

• Five Choosing Wisely Canada recommendations were established for paediatric neurosurgical care.
• These guidelines aim to optimize treatment and reduce unnecessary procedures.
• Clinical judgment may necessitate deviation from recommendations in specific cases.