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February 3, 2020

2019 Update on Pediatric Medical Overuse: A Systematic Review

Author Affiliations
  • 1Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston
  • 2Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
  • 3Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 4Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 5Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 6University of Maryland School of Medicine, Baltimore
  • 7VA Maryland Health Care System, Baltimore
  • 8University of California, San Francisco School of Medicine, San Francisco
  • 9San Francisco VA Medical Center, San Francisco, California
  • 10Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City
JAMA Pediatr. 2020;174(4):375-382. doi:10.1001/jamapediatrics.2019.5849

Importance  Medical overuse is common in pediatrics and may lead to unnecessary care, resource use, and patient harm. Timely scrutiny of established and emerging practices can identify areas of overuse and empower clinicians to reconsider the balance of harms and benefits of the medical care that they provide. A literature review was conducted to identify the most important areas of pediatric medical overuse in 2018.

Observations  Consistent with prior methods, a structured MEDLINE search and manual table of contents review of selected pediatric journals for the 2018 literature was conducted identifying articles pertaining to pediatric medical overuse. The structured MEDLINE search consisted of a PubMed search for articles with the Medical Subject Headings term health services misuse or medical overuse or article titles containing the term unnecessary, inappropriate, overutilization, or overuse. Articles containing the term overuse injury or overuse injuries were excluded, along with articles not published in English and those not constituting original research. The same search was performed using Embase with the additional Emtree term unnecessary procedure. Each article was evaluated by 3 independent raters for quality of methods, magnitude of potential harm, and number of patients potentially harmed. Ten articles were identified based on scores and appraisal of overall potential harm. This year’s review identified both established and emerging practices that may warrant deimplementation. Examples of such established practices include antibiotic prophylaxis for urinary tract infections, routine opioid prescriptions, prolonged antibiotic courses for latent tuberculosis, and routine intensive care admission and pharmacologic therapy for neonatal abstinence syndrome. Emerging practices that merit greater inspection and discouragement of widespread adoption include postdischarge nurse-led home visits, probiotics for gastroenteritis, and intensive cardiac screening programs for athletes.

Conclusions and Relevance  This year’s review highlights established and emerging practices that represent medical overuse in the pediatric setting. Deimplementation of disproven practices and careful examination of emerging practices are imperative to prevent unnecessary resource use and patient harm.

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