Choosing Wisely: the American College of Rheumatology's Top 5 for pediatric rheumatology.
OBJECTIVE
To create a pediatric rheumatology Top 5 list as part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.


METHODS
Delphi surveys of a core group of representative pediatric rheumatology providers from across North America generated candidate Top 5 items. Items with high content agreement and perceived to be of prevalent use and of high impact were included in a survey of all American College of Rheumatology (ACR) members who identified themselves as providing care to pediatric patients. Items with the highest ratings were subjected to literature review and further evaluation.


RESULTS
A total of 121 candidate items were proposed in the initial Delphi survey and were reduced to 28 items in subsequent surveys. These 28 items were sent to 1,198 rheumatology providers who care for pediatric patients, and 397 (33%) responded. Based upon survey data and literature review, the Top 5 items were identified. These items focused on testing for antinuclear antibodies, autoantibody panels, Lyme disease, methotrexate toxicity monitoring, and use of routine radiographs.


CONCLUSIONS
The ACR pediatric rheumatology Top 5 is one of the first pediatric subspecialty-specific Choosing Wisely Top 5 lists and provides an opportunity for patients and providers to discuss appropriate use of health care in pediatric rheumatology.
Emory University School of Medicine, Atlanta, Georgia.
Kelly A
KA
Rouster-Stevens
Stacy P
SP
Ardoin
Ashley M
AM
Cooper
Mara L
ML
Becker
Leonard L
LL
Dragone
Anna
A
Huttenlocher
Karla B
KB
Jones
Karen S
KS
Kolba
L Nandini
LN
Moorthy
Peter A
PA
Nigrovic
Jennifer N
JN
Stinson
Polly J
PJ
Ferguson
D018501:Antirheumatic Agents / Q000627:therapeutic use; D002648:Child; D002755:Choice Behavior; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D012219:Rheumatology / Q000379:methods / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*; D014481:United States
D018501:Antirheumatic Agents