Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City.
Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
JAMA Pediatr. 2019 Apr 1;173(4):379-384. doi: 10.1001/jamapediatrics.2018.5550.
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.
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.
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.
近年来，对抗医疗过度的努力已经引起了关注，但成功是间歇性的，缺点也已经被认识到。需要致力于建立一个强有力的证据基础，以便更广泛地让临床医生参与进来，减少过度医疗。
对 2017 年发表的与儿科过度医疗相关的原始研究进行了系统的 MEDLINE 搜索和选定高影响力期刊目录的手动审查。文章根据 3 个类别进行了从低到高的评分：方法质量、潜在危害程度和潜在受危害患者数量。本综述中介绍的评分最高的文章强调了安全减少治疗强度的例子，包括癌症、阑尾炎、急性呼吸道感染和择期麻醉的情况。今年的文章还提供了一些谨慎的例子，说明了在没有充分了解潜在危害的情况下采取的合理干预措施，包括药物治疗偏头痛、早产儿补充二十二碳六烯酸、危重病患者严格控制血糖和预防性抗生素治疗膀胱输尿管反流儿童。
这些文章代表了 2017 年高质量的原创研究，可能有助于减轻过度医疗。这些工作应该是儿科过度医疗领域成熟的基础。
