Chosing Wisely Master List

  1. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
  2. Don’t prescribe antibiotics for URTIs
  3. Don’t order antibiotics for adenoviral conjunctivitis (pink eye).
  4. CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
  5. Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.
  6. CT scans are not necessary in the routine evaluation of abdominal pain.
  7. In the evaluation of simple syncope and a normal neurological examination, don’t obtain brain-imaging studies (CT or MRI).
  8. Don’t do imaging for uncomplicated headache.
  9. Avoid imaging studies (MRI, CT, or X-rays) for acute low back pain without specific indications.
  10. Do not order CT of the cervical spine after trauma for patients who do not meet the National Emergency X-ray Utilization Study (NEXUS) low-risk criteria or the Canadian C-Spine Rule.
  11. Do not order CT to diagnose pulmonary embolism without first risk-stratifying for pulmonary embolism (pretest probability and D-dimer tests if low probability).
  12. Do not order magnetic resonance imaging of the lumbar spine for patients with lower back pain without high-risk features.
  13. Do not order CT of the head for patients with mild traumatic head injury who do not meet New Orleans Criteria or Canadian CT Head Rule.
  14. Do not order coagulation studies for patients without hemorrhage or suspected coagulopathy (eg, with anticoagulation therapy, clinical coagulopathy).

Emergency Medicine Kenya Foundation