10 key areas of pediatric medical overuse

  • Money NM & al.
  • JAMA Pediatr
  • 3 Feb 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • These authors review 10 key articles that highlight the dangers of pediatric medical overuse.
  • Areas include probiotics for gastroenteritis, ADHD overdiagnosis, and antibiotic prophylaxis for urinary tract infection (UTI).

Why this matters

  • The authors say that avoiding these practices is necessary to prevent avoidable negative sequelae.
  • They say that the 10 articles they review should “temper enthusiasm for these interventions.”

Key results

  • The authors identified 10 articles that reflected the greatest harm from established and emerging practices in pediatric medicine. These included:
    • ADHD diagnosis for what is “likely” normal developmental variation.
    • Nurse-led home visits posthospital discharge, which are tied to limited outcomes improvement.
    • Cardiac screening for athletic participation.
    • Probiotics for acute gastroenteritis, which offers no benefit and “may cause harm,” say the authors.
    • Antibiotic prophylaxis for UTI, which has modest benefit with risk for infection with multidrug-resistant organisms.
    • Pharmacological closure for patent ductus arteriosus in premature infants, which adds little benefit over watchful waiting.

Study design

  • Authors selected articles based on scores for quality and for magnitude of potential harm and number of patients potentially harmed.
  • Funding: Specific funding to authors.

Limitations

  • Based on selected studies.