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Pediatrics. 2017 Feb;139(2). pii: e20162797. doi: 10.1542/peds.2016-2797. Epub 2017 Jan 3.

Update on Pediatric Overuse.

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Divisions of Pediatric Inpatient Medicine, Primary Children's Hospital, and
General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
VA Maryland Healthcare System, Baltimore, Maryland.
Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
VA Connecticut Healthcare System, West Haven, Connecticut; and.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.


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.

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