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Choosing Wisely®

American Academy of Pediatrics

The association of lower urinary tract dysfunction and constipation is termed bladder-bowel dysfunction. From 25-30% of children with functional constipation have daytime urinary incontinence. Treatment of constipation alone can eliminate daytime urinary incontinence in many patients and also has been shown to reduce recurrent urinary tract infection. The clinical diagnosis of constipation can be made using the Rome IV criteria. Treatment strategies involve education, fecal disimpaction in ...

Choosing Wisely®

American Medical Society for Sports Medicine

Concussions represent 70–90% of all traumatic brain injuries. The historic standard for treatment of sport-related concussions consists of physical and cognitive rest until symptoms resolve, followed by a stepwise gradual return to activity. However, the current consensus among experts is that there is insufficient evidence for prescribing complete physical and cognitive rest until asymptomatic after acute SRC. Moreover, unnecessary delays in activity initiation for athletes may have ...

Choosing Wisely®

Society of Hospital Medicine

According to published guidelines, cardiac troponin is the lab test of choice to diagnose acute coronary syndrome or acute myocardial infarction. Troponin is highly sensitive for acute myocardial infarction and more specific than Creatine Kinase-Myocardial Band (CK-MB); CK-MB yields no incremental diagnostic value even in patients with chronic kidney disease. Guidelines also support the use of cardiac troponin over CK-MB for diagnosing reinfarction

Choosing Wisely®

American Medical Society for Sports Medicine

Distal radius buckle fractures are one of the most common wrist fractures in children. These fractures are inherently stable and have an excellent prognosis. As long as the following conditions are met, radius buckle fractures can be safely treated with a Velcro removable wrist splint for 3-4 weeks as long as: cortex is intact, there are no fracture lines extending to the physis on any view, there is no angulation/displacement of the fracture, there are 2 or 3 inflection points seen in the ...

Choosing Wisely®

American Academy of Pediatrics

Prospective studies of the use of a bag applied to the perineum for urine collection have shown a high incidence of false-positive culture results, ranging from 85 to 99%. In children under 2 years of age, urethral catheterization with sterile technique is recommended. Alternatively, suprapubic bladder aspiration has been shown to have the highest sensitivity, but requires trained providers, often with ultrasound guidance, and is thus often impractical. In older children with sphincter ...