AAP enumerates unnecessary Practices in Pediatric Cardiology
The American Academy of Pediatrics has added a list of pediatric cardiology practices that clinicians should question as part of the Choosing Wisely campaign, which prioritizes high-value care and highlights unnecessary tests and treatments.
The AAP Section on Cardiology and Cardiac Surgery includes over 800 pediatric cardiologists and their mission is to advance the treatment and education of pediatric cardiology diseases through advocacy, education and collaboration.
Therefore, they have formulated a few concerns that the physicians should raise doubts on. These are as follows-
a. Ordering troponins for pediatric chest pain routinely or in case of ECG abnormalities-
It is reported that troponin levels are not useful for the pediatric population, hence, do not order troponin levels for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities. Furthermore, troponin levels have not been shown to reliably correlate with disease severity or prognosis in many cardiac diseases known to cause chest pain in pediatric patients.
b. Ordering a screening preparticipation examination in asymptomatic healthy patients-
Routine ECG screening of healthy pediatric patients with no personal or family history of cardiac disease has demonstrated a high false-positive rate and has not been found to reduce mortality from sudden cardiac death. This has been seen to lead to unnecessary secondary evaluations. Therefore, it was reported that ECG screening should be performed in those patients with a strong family history of conditions likely to cause sudden cardiac arrest or death.
c. Ordering of an ECG for routine evaluation-
The authors noted that it is important to obtain a complete personal and family history, physical examination, and screening ECG, if the treating physician feels that the chest pain is cardiac in nature, prior to proceeding with cardiac consultation and echocardiography. As a result, a screening ECG shouldn't be ordered before starting treatment for attention-deficit/
d. Echocardiogram for the routine evaluation of pediatric syncope-
An echocardiogram isn't necessary in evaluating pediatric patients with syncope or chest pain who don't have a concerning history or ECG abnormalities. If the episode of syncope is caused by the heart, it generally is an issue with the heart rhythm. Therefore, an echocardiogram rarely adds diagnostic value and it increases the cost of care.
As a result, the authors reported that obtaining the ECG increases health care costs and can increase stress for both the patient and family. If there is a concern based on the history and physical examination, then a pediatric cardiology referral is a reasonable consideration.
