The Top Ten pediatric overuse articles from 2017

By Judith Garber | February 20, 2019

Each year, JAMA Pediatrics publishes an update on overuse, featuring the highest-quality and highest-impact articles on pediatric overuse from the previous year. Medical overuse is just as much a problem in children’s health care as it is for adults, but the pediatric field has been slower to recognize this issue, in part because there is less evidence available on overused services. This review seeks to highlight studies that are filling these gaps in the research on pediatric overuse.

Below are some highlights from this year’s update, from researchers Eric R. Coon, Ricardo A. Quinonez, Daniel J. Morgan, Sanket S. Dhruva, Timmy Ho, Nathan Money, and Alan R. Schroeder.

Two meta-analyses found that for children with uncomplicated appendicitis, treatment with antibiotics instead of appendectomy was successful in over 90% of cases. Starting with antibiotics instead of appendectomy could reduce the risks of surgery and anesthesia for patients.
On the other hand, studies also found cases in which antibiotics are commonly used but not always necessary or beneficial. For children with recurrent urinary tract infections, a research review found that providing antibiotic treatment did not prevent renal scarring compared to a placebo. Another study found that broad-spectrum antibiotics did not have a benefit compared to narrow-spectrum antibiotics when treating respiratory tract infections, and actually led to more adverse events.
Are there ways we could lessen the potential for harm in infant care? Several studies provided important information on treatment for infants, including the benefits of using a laryngeal mask for anesthesia; providing less invasive treatment for respiratory distress; and the need to further evaluate the benefits of giving high doses of Docosahexaenoic acid (DHA) to preterm infants.
When childrens’ lives and health are on the line, our instinct may be to take the most aggressive approach. But this may not be better for the patient in the long run. For patients being treated for childhood cancer, a large cohort study found that reducing the intensity of radiation therapy decreased the risk in secondary malignancies without lowering cure rates.

What’s the big takeaway? “This is a generalizable lesson for all pediatricians: efforts should be made to limit medical harms, even among effective, life-saving interventions,” the authors write.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.