A second list of five tests and procedures that should be questioned before use has been issued by the American College of Emergency Physicians (ACEP) as part of the ABIM Foundation’s “Choosing Wisely” campaign.

The initiative is designed to reduce the use of medical testing in situations in which the harm of using these tests may outweigh the benefits. The first five procedures and practices flagged by ACEP in October 2013 are listed at choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians.


The evidence-based recommendations were approved by ACEP’s board of directors and are specific to patients in the emergency room (ER). The risks of these medical tests often cited by the group include radiation exposure, use of potentially harmful dyes, and cost. 


The new list includes the following five recommendations:


  1. Avoid computed tomography (CT) of the head in asymptomatic adult patients with syncope, insignificant trauma, and a normal neurologic evaluation.

  2. Avoid CT pulmonary angiography in patients with a low pretest probability of pulmonary embolism and either a negative assessment for Pulmonary Embolism Rule-Out Criteria (PERC) or D-dimer.

  3. Avoid lumbar spine imaging in adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition, such as vertebral infection or cancer with bony metastasis. 

  4. Avoid prescribing antibiotics for uncomplicated sinusitis. 

  5. Avoid CT of the abdomen and pelvis in young but otherwise healthy persons with known histories of ureterolithiasis presenting with symptoms of uncomplicated kidney stones.