Coon Eric R, Young Paul C, Quinonez Ricardo A, Morgan Daniel J, Dhruva Sanket S, Schroeder Alan R
Divisions of Pediatric Inpatient Medicine, Primary Children's Hospital, and
General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Pediatrics. 2017 Feb;139(2). doi: 10.1542/peds.2016-2797. Epub 2017 Jan 3.
As concerns over health care-related harms and costs continue to mount, efforts to identify and combat medical overuse are needed. Although much of the recent attention has focused on health care for adults, children are also harmed by overuse. Using a structured PubMed search and manual tables of contents review, we identified important articles on pediatric overuse published in 2015. These articles were evaluated according to the quality of the methods, the magnitude of clinical effect, and the number of patients potentially affected and were categorized into overdiagnosis, overtreatment, and overutilization. Overdiagnosis: Findings included evidence for overdiagnosis of hypoxemia in children with bronchiolitis and skull fractures in children suffering minor head injuries. Overtreatment: Findings included evidence that up to 85% of hospitalized children with radiographic pneumonia may not have a bacterial etiology; many children are receiving prolonged intravenous antibiotic therapy for osteomyelitis although oral therapy is equally effective; antidepressant medication for adolescents and nebulized hypertonic saline for bronchiolitis appear to be ineffective; and thresholds for treatment of hyperbilirubinemia may be too low. Overutilization: Findings suggested that the frequency of head circumference screening could be relaxed; large reductions in abdominal computed tomography testing for appendicitis appear to have been safe and effective; and overreliance on C-reactive protein levels in neonatal early onset sepsis appears to extend hospital length-of-stay.
随着对医疗相关危害和成本的担忧不断加剧，识别和对抗医疗过度使用的努力是必要的。尽管近期的大部分关注都集中在成人医疗保健上，但儿童也会受到过度使用的伤害。通过结构化的PubMed搜索和手动目录审查，我们确定了2015年发表的关于儿科过度使用的重要文章。这些文章根据方法质量、临床效果大小以及可能受影响的患者数量进行评估，并分为过度诊断、过度治疗和过度利用。过度诊断：研究结果包括毛细支气管炎患儿低氧血症和轻度头部受伤患儿颅骨骨折存在过度诊断的证据。过度治疗：研究结果包括证据表明，高达85%的住院放射性肺炎患儿可能没有细菌病因；许多儿童因骨髓炎接受长时间静脉抗生素治疗，尽管口服治疗同样有效；青少年使用抗抑郁药物和毛细支气管炎使用雾化高渗盐水似乎无效；以及高胆红素血症的治疗阈值可能过低。过度利用：研究结果表明，头围筛查频率可以放宽；大幅减少阑尾炎的腹部计算机断层扫描检查似乎是安全有效的；新生儿早发性败血症中过度依赖C反应蛋白水平似乎会延长住院时间。
