Résumé
BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 "gray zone" practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 "gray zone" practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.
Langue d'origine | English |
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Pages (de-à) | 983-993 |
Nombre de pages | 11 |
Journal | Journal of Trauma and Acute Care Surgery |
Volume | 86 |
Numéro de publication | 6 |
DOI | |
Statut de publication | Published - juin 1 2019 |
Note bibliographique
Funding Information:Conflict of interest and source of funding: This research is funded by the Canadian Institutes of Health Research (Foundation grant, 353374) and the Fonds de Recherche du Québec – Santé (career award, L.M., F.Lau, F.Lam, M.C.). Patrick Archambault is supported by a Clinical-Embedded Scientist Award from the CIHR. Dr Turgeon is the Canada Research Chair in Critical Care Neurology and Trauma. For the remaining authors, no conflicts were declared.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
ASJC Scopus Subject Areas
- Surgery
- Critical Care and Intensive Care Medicine
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Review