Mélanie Bérubé1,2, Lynne Moore1,3, Pierre-Alexandre Tardif1, Gregory Berry4, Étienne Belzile5, Martin Lesieur5, Jérôme Paquet6. 1. Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada. 2. Faculty of Nursing, Université Laval, Québec City, Québec, Canada. 3. Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada. 4. Division of Orthopaedic Surgery, McGill University Health Center, Montréal, Québec, Canada. 5. Division of Orthopaedic Surgery, CHU de Québec-Université Laval, Québec City, Québec, Canada. 6. Division of Neurosurgery, CHU de Québec-Université Laval, Québec City, Québec, Canada.
Abstract
OBJECTIVES: Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the evidence on these practices. METHODS: We searched four databases for systematic reviews, randomised controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomised studies of interventions tool for observational studies. We summarised findings with measures of frequency and association for primary outcomes. RESULTS: Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients <60 years of age, cast or splint immobilisation for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. CONCLUSION: In this review, we identified clinical practices in orthopaedic injury care which are not supported by current evidence and whose use may be questioned. In future research, we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.
OBJECTIVES: Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the evidence on these practices. METHODS: We searched four databases for systematic reviews, randomised controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomised studies of interventions tool for observational studies. We summarised findings with measures of frequency and association for primary outcomes. RESULTS: Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients <60 years of age, cast or splint immobilisation for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. CONCLUSION: In this review, we identified clinical practices in orthopaedic injury care which are not supported by current evidence and whose use may be questioned. In future research, we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.
Authors: Lynne Moore; Mélanie Bérubé; Pier-Alexandre Tardif; François Lauzier; Alexis Turgeon; Peter Cameron; Howard Champion; Natalie Yanchar; Fiona Lecky; John Kortbeek; David Evans; Éric Mercier; Patrick Archambault; François Lamontagne; Belinda Gabbe; Jérôme Paquet; Tarek Razek; Amina Belcaid; Simon Berthelot; Christian Malo; Eddy Lang; Henry Thomas Stelfox Journal: JAMA Surg Date: 2022-09-14 Impact factor: 16.681