Low-Value Clinical Practices in Pediatric Trauma Care.

Area of Science:

• Pediatric Trauma Care
• Health Services Research
• Quality Improvement

Background:

• Reducing low-value care can enhance patient experiences and optimize healthcare resource utilization.
• While frequent in adult trauma, evidence on low-value practices in pediatric trauma care is limited.

Purpose of the Study:

• To determine the incidence of low-value practices in pediatric trauma care.
• To assess the variation in these practices across different hospitals.

Main Methods:

• A retrospective cohort study analyzed data from 10,711 children under 16 in a Canadian provincial trauma system (2016-2022).
• Low-value practices were identified from systematic reviews and clinical guidelines.
• Incidence and interhospital variation (using ICCs) were evaluated for identified practices.

Main Results:

• Nineteen low-value practices were identified; 14 were evaluable via trauma registry data.
• Five practices showed moderate to high frequency and interhospital variation: head CT in low-risk children, pretransfer CT, neurosurgical consultation, and hospital admission for mild TBI or minor abdominal trauma.
• Specific examples include 38.8% hospital admissions for mild traumatic brain injury with high interhospital variation (ICC 12.4%).

Conclusions:

• Low-value practices are prevalent in pediatric trauma care and exhibit significant interhospital variability.
• These findings highlight opportunities for deimplementation interventions, especially for practices measurable with existing data.
• Targeting these practices can improve care quality and resource efficiency in pediatric trauma.