Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston.
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
JAMA Pediatr. 2020 Apr 1;174(4):375-382. doi: 10.1001/jamapediatrics.2019.5849.
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.
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.
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.
医疗过度在儿科中很常见，可能导致不必要的护理、资源使用和患者伤害。及时审查既定和新兴实践可以确定过度使用的领域，并使临床医生能够重新考虑他们提供的医疗保健的危害和益处之间的平衡。进行了文献回顾，以确定 2018 年儿科医疗过度的最重要领域。
与之前的方法一致，对选定的儿科期刊进行了结构化的 MEDLINE 搜索和手动目录审查，以查找 2018 年文献中与儿科医疗过度相关的文章。结构化的 MEDLINE 搜索包括使用 PubMed 搜索包含医疗主题词“健康服务滥用”或“医疗过度”的文章，或包含“不必要”、“不适当”、“过度利用”或“过度使用”的文章标题。排除了包含术语“过度使用损伤”或“过度使用损伤”的文章，以及未以英文发表的文章和非原创研究的文章。使用 Embase 进行了相同的搜索，并使用额外的 Emtree 术语“不必要的程序”。每篇文章都由 3 名独立评估员根据方法的质量、潜在危害的大小以及可能受到伤害的患者数量进行评估。根据得分和整体潜在危害评估，确定了 10 篇文章。本年度的审查确定了一些可能需要取消实施的既定和新兴实践。例如，抗生素预防泌尿道感染、常规阿片类药物处方、潜伏性肺结核的延长抗生素疗程以及新生儿戒断综合征的常规重症监护入院和药物治疗等既定实践。需要更仔细检查和不鼓励广泛采用的新兴实践包括出院后护士主导的家访、胃肠炎的益生菌治疗以及运动员密集的心脏筛查计划。
本年度的审查突出了既定和新兴实践，这些实践代表了儿科医疗过度。取消已被证明无效的实践并仔细审查新兴实践对于防止不必要的资源使用和患者伤害至关重要。
