Choosing wisely: Unnecessary tests and treatments cost money and harm your patient financially (DO NO HARM)!

  1. Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a head injury clinical decision rule).
  2. Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis.
  3. Don’t order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators
  4. Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules.
  5. Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.

Necrotizing Fasciitis

Patients classically present with the triad of pain, swelling and erythema. The most consistent feature of early NF is that the pain is out of proportion to the swelling or erythema. Other important features that make NF likely are:

  • Tenderness extending beyond the apparent involved area
  • Indistinct margins of involvement
  • Absence of lymphangitis  (because the infection is in the deep fascia and not in the skin)
  • Rapidly progressive despite the use of antibiotics
  • If the patients looks too sick for cellulitis
  • Bleb/Bullae, Crepitus (Though you cannot not rule out NF in their absence)

Choosing Wisely

  1. Antibiotics should not be used to treat asymptomatic bacteriuria.
  2. Physicians should avoid prescribing antibiotics for upper respiratory infections since most are viral.
  3. Antibiotics should be avoided for stasis dermatitis of lower extremities. The standard of care is leg elevation plus compression.