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May 2018

2017 Update on Pediatric Medical Overuse: A Review

Author Affiliations
  • 1Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City
  • 2Division of General Pediatrics, University of Utah School of Medicine, Salt Lake City
  • 3Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
  • 4Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
  • 5Department of Epidemiology and Public Health, Veterans Affairs Maryland Healthcare System, Baltimore
  • 6Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
  • 7Department of Hospital Epidemiology, Veterans Affairs Connecticut Healthcare System, West Haven
  • 8Department of Pediatrics, Stanford University School of Medicine, Stanford, California
JAMA Pediatr. 2018;172(5):482-486. doi:10.1001/jamapediatrics.2017.5752

Importance  Medical overuse has historically focused on adult health care, but interest in how children are affected by medical overuse is increasing. This review examines important research articles published in 2016 that address pediatric overuse.

Observations  A structured search of PubMed and a manual review of the tables of contents of 10 journals identified 169 articles related to pediatric overuse published in 2016, from which 8 were selected based on the quality of methods and potential harm to patients in terms of prevalence and magnitude. Articles were categorized by overtreatment, overmedicalization, and overdiagnosis. Findings included evidence of overtreatment with commercial rehydration solution, antidepressants, and parenteral nutrition; overmedicalization with planned early deliveries, immobilization of ankle injuries, and use of hydrolyzed infant formula; and evidence of overdiagnosis of hypoxemia among children recovering from bronchiolitis.

Conclusions and Relevance  The articles were of high quality, with most based on randomized clinical trials. The potential harms associated with pediatric overuse were significant, including increased risk of infection, developmental disability, and suicidality.

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