title: Choosing Wisely Canada®: Five tests, procedures and treatments to question in Emergency Medicine.
abstract: OBJECTIVE
  Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them.
  
  
  METHODS
  The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned. This list was distributed to CAEP committee chairs, revised, and then divided and randomly allocated to 107 Canadian emergency physicians (EWG nominated) who voted on each item based on: action-ability, effectiveness, safety, economic burden, and frequency of use. The EWG discussed the items with the highest votes, and generated the recommendations by consensus.
  
  
  RESULTS
  The top five CAEP CWC recommendations are: 1) Don't order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule); 2) Don't prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis; 3) Don't order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators; 4) Don't order neck radiographs in patients who have a negative examination using the Canadian C-spine rules; and 5) Don't prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.
  
  
  CONCLUSIONS
  The CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.
authors.affiliation: *Division of Emergency Medicine,Department of Medicine,University of Toronto,Toronto,ON.
authors.forename: Amy H Y
authors.initials: AHY
authors.lastname: Cheng
authors.affiliation: †Department of Emergency Medicine,Dalhousie University,Halifax,NS.
authors.forename: Sam
authors.initials: S
authors.lastname: Campbell
authors.affiliation: ‡Department of Emergency Medicine,University Health Network,Toronto,ON.
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Chartier
authors.affiliation: †Department of Emergency Medicine,Dalhousie University,Halifax,NS.
authors.forename: Tom
authors.initials: T
authors.lastname: Goddard
authors.affiliation: †Department of Emergency Medicine,Dalhousie University,Halifax,NS.
authors.forename: Kirk
authors.initials: K
authors.lastname: Magee
authors.affiliation: §Department of Emergency Medicine,University of British Columbia,Vancouver,BC.
authors.forename: Jill
authors.initials: J
authors.lastname: McEwen
authors.affiliation: ¶Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Atul K
authors.initials: AK
authors.lastname: Kapur
authors.affiliation: ǁDepartment of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Holroyd
authors.affiliation: ‡‡Division of Emergency Medicine,Department of Medicine,McMaster University,Hamilton,ON.
authors.forename: Suneel
authors.initials: S
authors.lastname: Upadhye
authors.affiliation: ǁDepartment of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Couperthwaite
authors.affiliation: ǁDepartment of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002170:Canada; D002755:Choice Behavior; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004635:Emergency Medicine; D019317:Evidence-Based Medicine; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical
chemical_list: D000900:Anti-Bacterial Agents