Radic Julia A E, Cochrane D Douglas
Division of Neurosurgery, British Columbia Children's Hospital, Vancouver, British Columbia.
Division of Neurosurgery, Hospital For Sick Children, Toronto, Ontario.
Paediatr Child Health. 2018 Sep;23(6):383-387. doi: 10.1093/pch/pxy012. Epub 2018 Mar 1.
Choosing Wisely Canada is an evidence-based, patient-focused, physician-led campaign to improve the delivery of medical care in Canada. The goal of this study was to produce Canadian recommendations for physicians treating patients with selected paediatric neurosurgery issues.
Paediatric neurosurgeons practicing in Canada were invited to participate. Suggestions were obtained using an anonymous questionnaire, and then ranked anonymously by the participating surgeons. Suggestions that received consensus from participants were discussed at the 2016 annual Canadian Pediatric Neurosurgery Study Group meeting. Suggestions that were not evidence based, or that would not have a substantive population impact were eliminated. All remaining suggestions were anonymously ranked by the group and the top five recommendations were submitted to Choosing Wisely Canada.
The final five recommendations include: 1) don't order a computed tomography scan to investigate macrocephaly (order an ultrasound or magnetic resonance imaging scan); 2) don't image a midline dimple related to the coccyx in an asymptomatic infant or child; 3) don't use computed tomography scans for routine imaging of children with hydrocephalus. Fast sequence nonsedated magnetic resonance imaging scans or ultrasounds provide adequate information to assess patients without exposing them to radiation or an anesthetic; 4) don't recommend helmets for mild to severe positional flattening; 5) don't do routine surveillance imaging for incidentally discovered Chiari I malformation.
Five Choosing Wisely Canada recommendations were produced to support care of patients with paediatric neurosurgical issues. While these recommendations will apply to the majority of children with the involved conditions, occasionally, deviation from these recommendations may be clinically indicated.
“明智选择加拿大”是一项基于证据、以患者为中心、由医生主导的活动，旨在改善加拿大的医疗服务。本研究的目的是为治疗特定小儿神经外科问题患者的医生制定加拿大的相关建议。
邀请在加拿大执业的小儿神经外科医生参与。通过匿名问卷获取建议，然后由参与的外科医生进行匿名排序。在2016年加拿大小儿神经外科研究组年度会议上讨论了获得参与者共识的建议。排除那些没有证据支持或不会对大量人群产生实质性影响的建议。小组对所有剩余建议进行匿名排序，并将前五项建议提交给“明智选择加拿大”。
最终的五项建议包括：1）不要为检查巨头症而开具计算机断层扫描（开具超声或磁共振成像扫描）；2）不要对无症状婴儿或儿童的与尾骨相关的中线酒窝进行成像；3）不要将计算机断层扫描用于脑积水儿童的常规成像。快速序列非镇静磁共振成像扫描或超声能提供足够信息来评估患者，而无需让他们接受辐射或麻醉；4）对于轻度至重度体位性扁头不建议使用头盔；5）对于偶然发现的Chiari I型畸形不要进行常规监测成像。
制定了五项“明智选择加拿大”建议，以支持小儿神经外科问题患者的护理。虽然这些建议适用于大多数患有相关疾病的儿童，但偶尔在临床上可能需要偏离这些建议。
