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It is uncertain to perform coagulation tests only in patients taking anticoagulant medication, massive bleeding, or a suspected bleeding disorder.
Choosing Wisely UK
NICE
There is no specific recommendation from NICE about this patient groups. Related guidance from NICE about preoperative testing before surgery advocates a similar targeted approach.
ver más ... 2018Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).
Choosing Wisely Australia
The Australia and New Zealand Child Neurology Society
The incidence of epileptiform discharges in patients with syncope is roughly similar to its incidence among healthy subjects, and that therefore EEG has very low diagnostic yield among these patients. Guidelines recommend that an EEG should not be performed if syncope is the most likely cause of the transient loss of consciousness.
ver más ... 2018It is not recommended to routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality in children.
Choosing Wisely Australia
The Australia and New Zealand Child Neurology Society
Studies suggest that the yield of neuroimaging findings in children with headache that actually change patient management is no higher than 2.5 per cent. This supports the practice of selective imaging of paediatric headache patients with clinical presentation suspicious for intracranial abnormality. Neuroimaging on a routine basis is therefore not indicated in children with new onset primary headaches and a normal neurological examination. It should be reserved for a selected group. An ...
ver más ... 2018It is not recommended to perform computed tomography children with new onset seizures
Choosing Wisely Australia
The Australia and New Zealand Child Neurology Society
The yield from neuroimaging of children presenting with new onset afebrile seizures is typically low, with one study finding that it led to a change in clinical management for only four percent of patients. As there are already a well-tested set of indicators for determining the likelihood of intracranial abnormalities in children with new onset unprovoked seizures, a combination of clinical history, examination, and electroencephalograph (where relevant) should first be used to determine ...
ver más ... 2018It is not recommended to undertake repeat blood level monitoring of antiepileptic drug (AED) treatments in epileptic patients.
Choosing Wisely Australia
The Australia and New Zealand Child Neurology Society
The serum concentration of an antiepileptic drug (AED) varies markedly between patients taking the same dosage because of differences in people’s ability to absorb, distribute, metabolise and excrete drugs. The utility of drug blood level monitoring assumes that plasma drug level correlates better with clinical response or side effects than with dosage. Evidence from a major randomised controlled trial suggests that repeat blood level monitoring of antiepileptic drug (AED) treatments has no ...
ver más ... 2018