Low-Value Clinical Practices in Pediatric Trauma Care.

Autor:	Deshommes T; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.; Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island., Freire G; Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences Program, Peter Gilgan Institute for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada., Yanchar N; Department of Surgery, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada., Zemek R; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada., Beaudin M; Department of Pediatric Surgery, CHU Sainte-Justine, University of Montreal, Québec, Canada., Stang A; Department of Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada., Weiss MJ; Department of Pediatrics, School of Medicine, Laval University, Québec City, Québec, Canada.; Division of Pediatric Critical Care Medicine, Mère-Enfant Soleil hospital, Québec City, Québec, Canada., Carsen S; Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada., Gagnon IJ; Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal Children's Hospital, Montreal, Québec, Canada.; School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada., Gabbe BJ; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Bérubé M; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.; Faculty of Nursing, Université Laval, Québec City, Québec, Canada., Stelfox HT; Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Alberta, Canada., Beno S; Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Labrosse M; Department of Pediatrics, Division of Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada., Beaulieu E; Department of Pediatrics, Université Laval, Québec City, Québec, Canada., Berthelot S; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.; Department of Pediatrics, Université Laval, Québec City, Québec, Canada., Klassen T; George & Fay Yee Centre for Health Care Innovation, Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada., Turgeon AF; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.; Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada., Lauzier F; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.; Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada., Neveu X; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada., Belcaid A; Institut National d'Excellence en Santé et Services Sociaux, Québec City, Québec, Canada., Ben Abdeljelil A; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada., Tardif PA; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada., Giroux M; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada., Moore L; Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.; Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Oct 01; Vol. 7 (10), pp. e2440983. Date of Electronic Publication: 2024 Oct 01.
DOI:	10.1001/jamanetworkopen.2024.40983
Abstrakt:	Importance: Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking. Objective: To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation. Design, Setting, and Participants: A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included. Main Outcomes and Measures: Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%). Results: A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%). Conclusions and Relevance: In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu