{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:36:35Z","timestamp":1788021395376,"version":"build-2784847793"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if \u226410% and \u226410 cases, moderate if &amp;gt;10% or &amp;gt;10 cases, and high if &amp;gt;10% and &amp;gt;10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if &amp;lt;5%, moderate if 5%-20%, and high if &amp;gt;20%).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 10\u202f711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital\/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.40983","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T15:30:40Z","timestamp":1730215840000},"page":"e2440983","source":"Crossref","is-referenced-by-count":6,"title":["Low-Value Clinical Practices in Pediatric Trauma Care"],"prefix":"10.1001","volume":"7","author":[{"given":"Theony","family":"Deshommes","sequence":"first","affiliation":[{"name":"Department of Social and Preventive Medicine, School of Medicine, Laval University, Qu\u00e9bec City, Qu\u00e9bec, Canada"},{"name":"Population Health and Optimal Health Practices Research Unit, Trauma\u2013Emergency\u2013Critical Care Medicine, Centre de Recherche du CHU de Qu\u00e9bec \u2013 Universit\u00e9 Laval (H\u00f4pital de l\u2019Enfant-J\u00e9sus), Qu\u00e9bec City, Qu\u00e9bec, 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