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Choosing Wisely Canada: Pediatric Neurosurgery Recommendations.

Julia A E Radic1, D Douglas Cochrane2

  • 1Division of Neurosurgery, British Columbia Children's Hospital, Vancouver, British Columbia.

Paediatrics & Child Health
|November 21, 2018
PubMed
Summary

Canadian pediatric neurosurgeons developed five Choosing Wisely Canada recommendations to optimize care for children with neurosurgical conditions. These guidelines aim to reduce unnecessary imaging and interventions, improving patient outcomes and resource utilization.

Keywords:
CanadaChoosing WiselyGuidelinePaediatric neurosurgeryRecommendation

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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.