Welcome to the Choosing Wisely Campaign series! This is the fourth episode of a 5-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

Our third case-based episode presents a child with fever and cough. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely Hospital Medicine and Infectious Diseases lists to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.

Series Learning Objectives:

1. Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
2. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
3. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.

Modified rMETRIQ Score: 14/15

Competencies:

AACN Essentials:

• 1: 1.1 g; 1.2 f; 1.3 d, e
• 2: 2.1 d, e; 2.2 g; 2.4 f, g; 2.5 h, i, j, k
• 7: 7.2 g, h, k
• 9: 9.1i, j; 9.2 i, j; 9.3 i, k

NONPF NP Core Competencies:

• 1: NP 1.1h; NP 1.2 k, m; NP 1.3 f, j, h
• 2: NP 2.1 j, g; NP 2.2 k, n; NP 2.4 h, i; NP 2.5 k, l, m, n, o
• 7: NP 7.2 m
• 9: NP 9.1 m, n; NP 9.2 n; NP 9.3 p

References

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

American Academy of Pediatrics [AAP] Committee on Infectious Diseases & Pediatric Infectious Diseases Society. (2018). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWInfectiousDisease.pdf

de Benedictis, F. M., Kerem, E., Chang, A. B., Colin, A. A., Zar, H. J., & Bush, A. (2020). Complicated pneumonia in children. Lancet (London, England), 396(10253), 786–798. https://doi.org/10.1016/S0140-6736(20)31550-6

Kato, H. (2024) Antibiotic therapy for bacterial pneumonia. J Pharm Health Care Sci 10, 45. https://doi.org/10.1186/s40780-024-00367-5

Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., Inwald, D., … Society of Critical Care Medicine Pediatric Sepsis Definition Task Force (2024). International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA, 331(8), 665–674. https://doi.org/10.1001/jama.2024.0179

Smith, D. K., Kuckel, D. P., & Recidoro, A. M. (2021). Community-Acquired Pneumonia in Children: Rapid Evidence Review. American family physician, 104(6), 618–625.

Society of Hospital Medicine, AAP, & Academic Pediatric Association. (2021). Five things physicians and patients should question. Retrieved from https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWHospitalmedicine.pdf

Yun K. W. (2024). Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clinical and experimental pediatrics, 67(2), 80–89. https://doi.org/10.3345/cep.2022.01452