ASH and the ASPHO Release List for Reducing Unnecessary Tests and Procedures in the Pediatric Population as Part of Choosing Wisely Campaign

Dec 9, 2019

(WASHINGTON D.C., Dec. 9, 2019) — The American Society of Hematology (ASH) and the American Society of Pediatric Hematology/Oncology (ASPHO) today released a list on reducing unnecessary tests and procedures in the pediatric population.

The new Choosing Wisely list was developed after ASH and ASPHO formed a task force to solicit, evaluate, and select list items for a pediatric focused Choosing Wisely list. The panel was composed of 13 members that consisted of two co-chairs, representing ASH and ASPHO, five members selected by each organization, and one member serving as an advisor on Choosing Wisely methodology. Suggestions were solicited from the membership of both societies.

Formal systematic reviews of the evidence were completed for eight semi-finalist items. The final item selections were made by the ASH-ASPHO Choosing Wisely task force with reference to the following six guiding principles: avoiding harm to patients, producing evidence-based recommendations, considering both the cost and frequency of tests and treatments, making recommendations in the clinical purview of the hematologist, and considering the potential impact of recommendations. Harm avoidance was established as the campaign’s preeminent guiding principle. 

The five evidence-based recommendations that hematologists and their patients should question are:

  • Don’t perform routine pre-operative hemostatic testing (PT, aPTT) in an otherwise healthy child with no prior personal or family history of bleeding.
  • Don’t transfuse platelets in an asymptomatic (i.e., non-bleeding) pediatric patient (e.g. aplastic anemia, leukemia, etc.), with a platelet count > 10,000/mcL unless other signs and/or symptoms for bleeding are present, or if the patient is to undergo an invasive procedure.
  • Don’t order thrombophilia testing on children with venous access (i.e., peripheral or central) associated thrombosis in the absence of a positive family history.
  • Don’t transfuse packed red blood cells (pRBC) for iron deficiency anemia in asymptomatic pediatric patients when there is no evidence of hemodynamic instability or active bleeding.
  • Don’t routinely administer granulocyte colony stimulating factor (G-CSF) for empiric treatment of pediatric patients with asymptomatic autoimmune neutropenia in the absence of recurrent or severe bacterial and/or fungal infections.

“I have been involved with ASH’s efforts within the Choosing Wisely campaign for several years, and as a pediatric hematologist it is very exciting to see a list focused on the unique needs of our patient population,” said ASH co-chair Sarah O’Brien of Nationwide Children’s Hospital. “The true excitement is to come, though, as this new list is disseminated among the pediatric hematology community. It is my hope that providers will pick an item that particularly resonates with them, and then teach this best practice to their colleagues not only within hematology, but also in other relevant specialties. It is through these ‘boots on the ground’ efforts in the Choosing Wisely campaign that we will truly make big strides in patient/family satisfaction, safety, and quality of care.”

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWisely.org.

About ASH:

The American Society of Hematology (ASH) (www.hematology.org) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 60 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH publishes Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field, and Blood Advances (www.bloodadvances.org), an online, peer-reviewed open-access journal.

About the American Society of Pediatric Hematology/Oncology

The American Society of Pediatric Hematology/Oncology (ASPHO) is the professional medical society of pediatric hematology/oncology subspecialists and other healthcare professionals dedicated to promoting the optimal care of children, adolescents and young adults with blood disorders and cancer. Founded in 1981, ASPHO serves over 2000 members including physicians, researchers, advanced practice providers, and fellows in training by sponsoring educational and professional development programs, promoting discovery, advocating on behalf of its patient base and members, advancing professional practice and supporting partnerships to further its goals.

For more information, visit www.aspho.org.

About Choosing Wisely®

First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.

Contact:
Sara Khalaf, American Society of Hematology
skhalaf@hematology.org; 202-552-4925