{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:10:12Z","timestamp":1777435812262,"version":"3.51.4"},"reference-count":46,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,2,1]]},"abstract":"<jats:p>As concerns over health care\u2013related harms and costs continue to mount, efforts to identify and combat medical overuse are needed. Although much of the recent attention has focused on health care for adults, children are also harmed by overuse. Using a structured PubMed search and manual tables of contents review, we identified important articles on pediatric overuse published in 2015. These articles were evaluated according to the quality of the methods, the magnitude of clinical effect, and the number of patients potentially affected and were categorized into overdiagnosis, overtreatment, and overutilization. Overdiagnosis: Findings included evidence for overdiagnosis of hypoxemia in children with bronchiolitis and skull fractures in children suffering minor head injuries. Overtreatment: Findings included evidence that up to 85% of hospitalized children with radiographic pneumonia may not have a bacterial etiology; many children are receiving prolonged intravenous antibiotic therapy for osteomyelitis although oral therapy is equally effective; antidepressant medication for adolescents and nebulized hypertonic saline for bronchiolitis appear to be ineffective; and thresholds for treatment of hyperbilirubinemia may be too low. Overutilization: Findings suggested that the frequency of head circumference screening could be relaxed; large reductions in abdominal computed tomography testing for appendicitis appear to have been safe and effective; and overreliance on C-reactive protein levels in neonatal early onset sepsis appears to extend hospital length-of-stay.<\/jats:p>","DOI":"10.1542\/peds.2016-2797","type":"journal-article","created":{"date-parts":[[2017,1,3]],"date-time":"2017-01-03T10:10:13Z","timestamp":1483438213000},"source":"Crossref","is-referenced-by-count":40,"title":["Update on Pediatric Overuse"],"prefix":"10.1542","volume":"139","author":[{"given":"Eric R.","family":"Coon","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Inpatient Medicine, Primary Children\u2019s Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul C.","family":"Young","sequence":"additional","affiliation":[{"name":"General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo A.","family":"Quinonez","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland;"},{"name":"VA Maryland Healthcare System, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanket S.","family":"Dhruva","sequence":"additional","affiliation":[{"name":"Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut;"},{"name":"VA Connecticut Healthcare System, West Haven, Connecticut; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan R.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2017,2,1]]},"reference":[{"issue":"11","key":"2021120921113503900_B1","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/jama.280.11.1000","article-title":"The urgent need to improve health care quality.","volume":"280","author":"Chassin","year":"1998","journal-title":"JAMA"},{"key":"2021120921113503900_B2","unstructured":"Reuters\u2008T\n          . Where can $700 billion in waste be cut annually from the U.S. healthcare system? Available at: www.hcca-info.org\/Portals\/0\/PDFs\/Resources\/Conference_Handouts\/Compliance_Institute\/2010\/P8handout6.pdf. Accessed May 12, 2016"},{"issue":"14","key":"2021120921113503900_B3","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1001\/jama.2012.362","article-title":"Eliminating waste in US health care.","volume":"307","author":"Berwick","year":"2012","journal-title":"JAMA"},{"issue":"3","key":"2021120921113503900_B4","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women\u2019s Health Initiative randomized controlled trial.","volume":"288","author":"Rossouw","year":"2002","journal-title":"JAMA"},{"issue":"7","key":"2021120921113503900_B5","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1001\/jama.280.7.605","article-title":"Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen\/progestin Replacement Study (HERS) Research Group.","volume":"280","author":"Hulley","year":"1998","journal-title":"JAMA"},{"issue":"2","key":"2021120921113503900_B6","doi-asserted-by":"crossref","first-page":"120","DOI":"10.7326\/0003-4819-157-2-201207170-00459","article-title":"Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement.","volume":"157","author":"Moyer","year":"2012","journal-title":"Ann Intern Med"},{"issue":"5","key":"2021120921113503900_B7","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1542\/peds.2014-1778","article-title":"Overdiagnosis: how our compulsion for diagnosis may be harming children.","volume":"134","author":"Coon","year":"2014","journal-title":"Pediatrics"},{"issue":"10","key":"2021120921113503900_B8","first-page":"1219","article-title":"The incidence of tonsillectomy in school children: (Section of Epidemiology and State Medicine).","volume":"31","author":"Glover","year":"1938","journal-title":"Proc R Soc Med"},{"issue":"4117","key":"2021120921113503900_B9","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1126\/science.182.4117.1102","article-title":"Small area variations in health care delivery.","volume":"182","author":"Wennberg","year":"1973","journal-title":"Science"},{"issue":"3","key":"2021120921113503900_B10","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2008-1928","article-title":"Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months\u2019 adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants.","volume":"123","author":"Wilson-Costello","year":"2009","journal-title":"Pediatrics"},{"issue":"1","key":"2021120921113503900_B11","doi-asserted-by":"crossref","first-page":"e20153730","DOI":"10.1542\/peds.2015-3730","article-title":"Patent ductus arteriosus in preterm infants.","volume":"137","author":"Benitz","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"2021120921113503900_B12","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1001\/jamainternmed.2014.5444","article-title":"Update on medical overuse.","volume":"175","author":"Morgan","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"12","key":"2021120921113503900_B13","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1001\/jamainternmed.2015.5614","article-title":"Update on Medical Practices That Should Be Questioned in 2015.","volume":"175","author":"Morgan","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2021120921113503900_B14","doi-asserted-by":"crossref","first-page":"h869","DOI":"10.1136\/bmj.h869","article-title":"The challenge of overdiagnosis begins with its definition.","volume":"350","author":"Carter","year":"2015","journal-title":"BMJ"},{"key":"2021120921113503900_B15","unstructured":"Phillips\u2008B, Ball\u2008C, Sacket\u2008D; Centre for Evidence-Based Medicine, et al. Levels of evidence (March 2009). Available at: www.cebm.net\/oxford-centre-evidence-based-medicine-levels-evidence-march-2009\/. Accessed October 20, 2016"},{"issue":"6","key":"2021120921113503900_B16","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1542\/peds.2015-1037","article-title":"3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial.","volume":"136","author":"Silver","year":"2015","journal-title":"Pediatrics"},{"issue":"4","key":"2021120921113503900_B17","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-2858","article-title":"Isolated linear skull fractures in children with blunt head trauma.","volume":"135","author":"Powell","year":"2015","journal-title":"Pediatrics"},{"issue":"6","key":"2021120921113503900_B18","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-3172","article-title":"Head growth and neurocognitive outcomes.","volume":"135","author":"Wright","year":"2015","journal-title":"Pediatrics"},{"issue":"9998","key":"2021120921113503900_B19","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0140-6736(15)00163-4","article-title":"Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial.","volume":"386","author":"Cunningham","year":"2015","journal-title":"Lancet"},{"issue":"5","key":"2021120921113503900_B20","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics"},{"key":"2021120921113503900_B21","doi-asserted-by":"crossref","first-page":"h4320","DOI":"10.1136\/bmj.h4320","article-title":"Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence.","volume":"351","author":"Le Noury","year":"2015","journal-title":"BMJ"},{"issue":"7","key":"2021120921113503900_B22","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/00004583-200107000-00010","article-title":"Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial.","volume":"40","author":"Keller","year":"2001","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2021120921113503900_B23","doi-asserted-by":"crossref","first-page":"f2865","DOI":"10.1136\/bmj.f2865","article-title":"Restoring invisible and abandoned trials: a call for people to publish the findings.","volume":"346","author":"Doshi","year":"2013","journal-title":"BMJ"},{"issue":"9","key":"2021120921113503900_B24","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. children.","volume":"372","author":"Jain","year":"2015","journal-title":"N Engl J Med"},{"issue":"3","key":"2021120921113503900_B25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S1473-3099(14)71081-3","article-title":"Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.","volume":"15","author":"Moore","year":"2015","journal-title":"Lancet Infect Dis"},{"issue":"17","key":"2021120921113503900_B26","first-page":"2206","article-title":"From the Centers for Disease Control and Prevention. Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children-- United States, 1998-2000.","volume":"287","author":"From the Centers for Disease Control and Prevention","year":"2002","journal-title":"JAMA"},{"issue":"2","key":"2021120921113503900_B27","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1001\/jamapediatrics.2014.2822","article-title":"Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children.","volume":"169","author":"Keren","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"2","key":"2021120921113503900_B28","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1542\/peds.2008-0596","article-title":"Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children.","volume":"123","author":"Zaoutis","year":"2009","journal-title":"Pediatrics"},{"issue":"3","key":"2021120921113503900_B29","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1001\/jamapediatrics.2014.3036","article-title":"Risk for cerebral palsy in infants with total serum bilirubin levels at or above the exchange transfusion threshold: a population-based study.","volume":"169","author":"Wu","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"1","key":"2021120921113503900_B30","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1542\/peds.114.1.297","article-title":"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.","volume":"114","author":"American Academy of Pediatrics Subcommittee on Hyperbilirubinemia","year":"2004","journal-title":"Pediatrics"},{"issue":"3","key":"2021120921113503900_B31","doi-asserted-by":"crossref","first-page":"F248","DOI":"10.1136\/archdischild-2014-306349","article-title":"NICE neonatal early onset sepsis guidance: greater consistency, but more investigations, and greater length of stay.","volume":"100","author":"Mukherjee","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"8","key":"2021120921113503900_B32","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamapediatrics.2015.0479","article-title":"Effect of Reduction in the Use of Computed Tomography on Clinical Outcomes of Appendicitis.","volume":"169","author":"Bachur","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"11","key":"2021120921113503900_B33","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1001\/jama.282.11.1041","article-title":"Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children.","volume":"282","author":"Garcia Pe\u00f1a","year":"1999","journal-title":"JAMA"},{"issue":"6","key":"2021120921113503900_B34","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.jpeds.2011.11.037","article-title":"Advanced radiologic imaging for pediatric appendicitis, 2005-2009: trends and outcomes.","volume":"160","author":"Bachur","year":"2012","journal-title":"J Pediatr"},{"issue":"4","key":"2021120921113503900_B35","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1542\/peds.2009-0128","article-title":"Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement.","volume":"124","author":"US Preventive Services Task Force","year":"2009","journal-title":"Pediatrics"},{"issue":"9840","key":"2021120921113503900_B36","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0140-6736(12)60815-0","article-title":"Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.","volume":"380","author":"Pearce","year":"2012","journal-title":"Lancet"},{"issue":"8","key":"2021120921113503900_B37","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.","volume":"167","author":"Miglioretti","year":"2013","journal-title":"JAMA Pediatr"},{"issue":"6","key":"2021120921113503900_B38","doi-asserted-by":"crossref","first-page":"e20151353","DOI":"10.1542\/peds.2015-1353","article-title":"Neonatal Phototherapy and Infantile Cancer.","volume":"137","author":"Wickremasinghe","year":"2016","journal-title":"Pediatrics"},{"issue":"6","key":"2021120921113503900_B39","doi-asserted-by":"crossref","first-page":"e20151354","DOI":"10.1542\/peds.2015-1354","article-title":"Retrospective cohort study of phototherapy and childhood cancer in northern California.","volume":"137","author":"Newman","year":"2016","journal-title":"Pediatrics"},{"issue":"4","key":"2021120921113503900_B40","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1542\/peds.2014-3407","article-title":"Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life.","volume":"135","author":"Saari","year":"2015","journal-title":"Pediatrics"},{"key":"2021120921113503900_B41","doi-asserted-by":"crossref","first-page":"S166","DOI":"10.1542\/peds.2014-1817DDD2","article-title":"Consequences of antibiotics and infections in infancy: bugs, drugs, and wheezing.","volume":"134","author":"Winterroth","year":"2014","journal-title":"Pediatrics"},{"issue":"2","key":"2021120921113503900_B42","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-0036","article-title":"Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case-Control Study.","volume":"136","author":"Horton","year":"2015","journal-title":"Pediatrics"},{"key":"2021120921113503900_B43","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/1471-230X-13-109","article-title":"Antibiotic exposure and the development of coeliac disease: a nationwide case-control study.","volume":"13","author":"M\u00e5rild","year":"2013","journal-title":"BMC Gastroenterol"},{"issue":"3","key":"2021120921113503900_B44","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1056\/NEJMsa065779","article-title":"Selective publication of antidepressant trials and its influence on apparent efficacy.","volume":"358","author":"Turner","year":"2008","journal-title":"N Engl J Med"},{"key":"2021120921113503900_B45","doi-asserted-by":"crossref","first-page":"g6501","DOI":"10.1136\/bmj.g6501","article-title":"Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews.","volume":"349","author":"Saini","year":"2014","journal-title":"BMJ"},{"key":"2021120921113503900_B46","doi-asserted-by":"crossref","first-page":"i65","DOI":"10.1136\/bmj.i65","article-title":"Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports.","volume":"352","author":"Sharma","year":"2016","journal-title":"BMJ"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2016-2797\/1061266\/peds_20162797.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2016-2797\/1061266\/peds_20162797.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T05:56:09Z","timestamp":1639115769000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/139\/2\/e20162797\/60308\/Update-on-Pediatric-Overuse"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,1]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,2,1]]},"published-print":{"date-parts":[[2017,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2016-2797","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,1]]},"article-number":"e20162797"}}