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Update on Pediatric Overuse.

Eric R Coon1, Paul C Young2, Ricardo A Quinonez3

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Pediatric medical overuse, including overdiagnosis and overtreatment, harms children and increases healthcare costs. Identifying and reducing these practices is crucial for improving child health outcomes and resource allocation.

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Area of Science:

  • Pediatric Medicine
  • Health Services Research
  • Medical Overuse

Background:

  • Growing concerns about healthcare-related harms and costs necessitate action against medical overuse.
  • While adult medical overuse receives attention, children are also significantly affected.

Purpose of the Study:

  • To identify and evaluate key articles on pediatric medical overuse published in 2015.
  • To categorize findings into overdiagnosis, overtreatment, and overutilization in pediatric care.

Main Methods:

  • Structured PubMed search and manual review of tables of contents for 2015 publications.
  • Evaluation of identified articles based on methodological quality, clinical effect magnitude, and patient population size.

Main Results:

  • Overdiagnosis: Identified in pediatric hypoxemia (bronchiolitis) and skull fractures (minor head injuries).
  • Overtreatment: Ineffective treatments noted for adolescent antidepressants and bronchiolitis; potential overuse of antibiotics for pneumonia and prolonged IV therapy for osteomyelitis; possibly low thresholds for hyperbilirubinemia treatment.
  • Overutilization: Suggested relaxation of head circumference screening frequency; safe reduction in abdominal CT scans for appendicitis; overreliance on C-reactive protein in neonatal sepsis potentially increasing hospital stays.

Conclusions:

  • Pediatric medical overuse is a significant issue across overdiagnosis, overtreatment, and overutilization.
  • Evidence suggests specific areas where interventions can reduce harm and improve efficiency in children's healthcare.