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February 18, 2019

2018 Update on Pediatric Medical Overuse: A Review

Author Affiliations
  • 1Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City
  • 2Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
  • 3University of Maryland School of Medicine, Baltimore
  • 4Veterans Affairs Maryland Healthcare System, Baltimore
  • 5University of California, San Francisco, School of Medicine and San Francisco VA Healthcare System, San Francisco
  • 6Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 7Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
JAMA Pediatr. 2019;173(4):379-384. doi:10.1001/jamapediatrics.2018.5550

Importance  Efforts to combat medical overuse have gained traction in recent years, but success has been intermittent and shortcomings have been recognized. A commitment to a strong evidence base is needed to more broadly engage clinicians and reduce overuse.

Observations  A structured MEDLINE search and a manual review of tables of contents from selected high-impact journals was performed to identify original research published in 2017 relevant to pediatric overuse. Articles were scored from low to high for 3 categories: quality of methods, magnitude of potential harm, and number of patients potentially harmed. The top-scoring articles presented in this review highlight examples of safe reductions in treatment intensity, including in the setting of cancer, appendicitis, acute respiratory tract infection, and elective anesthesia. This year’s articles also provide cautionary examples of rational interventions adopted without a full understanding of potential harms, including pharmacologic migraine therapies, docosahexaenoic acid supplementation for preterm neonates, tight glycemic control for individuals with critically illness, and prophylactic antibiotics for children with vesicoureteral reflux.

Conclusions and Relevance  The articles represent high-quality, original research from 2017 that may help mitigate overuse. These works should be fundamental to the maturation of the pediatric overuse field.

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