Evaluating the Evidence for Choosing WiselyTM in Primary Care Using the Strength of Recommendation Taxonomy (SORT)

Article Figures & Data

Table 1.

Primary Care–Relevant Choosing Wisely^TM Recommendations Sorted by Evidence Rating and Body System

Table 2.

Selected Choosing Wisely^TM Recommendations with Strength of Recommendation Taxonomy Ratings and Rationale

Recommendation	Organization	SORT Rating	Rationale
Do not perform screening panels for food allergies without previous consideration of medical history.	AAP	C	AAP guideline based on disease-oriented evidence
Do not perform stress cardiac imaging or advanced noninvasive imaging during the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.	ACC	C	ACC/AHA guideline based on expert consensus
Do not medicate to achieve tight glycemic control in older adults.	American Geriatrics Society	A	Multiple RCTs show harms, including higher mortality, with tight glycemic control
Do not screen for ovarian cancer in asymptomatic women at average risk.	American College of Obstetricians and Gynecologists	B	Single RCT showing no benefit from screening, USPSTF grade D recommendation
Do not prescribe opioid analgesics as first-line therapy to treat chronic, noncancer pain.	American Society of Anesthesiologists-Pain Medicine	C	Expert consensus
Do not perform imaging for low-back pain within the first 6 weeks unless red flags are present.	American Academy of Family Physicians and American College of Physicians	A	Systematic review of multiple RCTs with consistent results
Do not continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.	Critical Care Societies Collaborative–Critical Care	C	Expert consensus, seems self-evident

AAP, American Academy of Pediatrics; ACC, American College of Cardiology; AHA, American Heart Association; RCT, randomized controlled trial; SORT, Strength of Recommendation Taxonomy; USPSTF, US Preventive Services Task Force.