Introduction
Close to 90% of adult trauma patients present with orthopeadic injury.1 These injuries represent the most expensive nonfatal injury with costs totaling $456 billion per year in the US.2,3 These high costs are due to multiple radiologic imaging for initial and follow-up management, consultations and interventions performed by specialized human resources, and the loss of productivity associated with treatments.4-8
Alarmingly, up to 30% of healthcare budgets are estimated to be spent on low value care.9 Low value practices are defined as “the common use of a particular intervention when the benefits don’t justify the potential harm or cost”.10 Organizations such as Choosing Wisely emit recommendations on clinical practices that should be questioned.11 However, to date, no recommendations have been made by Choosing Wisely nor by professional societies regarding low value practices for the adult orthopeadic trauma population. In a recent scoping review and survey, 15 potentially low value practices in adult orthopedic trauma care were identified (Table 1); practices were considered low-value if they were identified as such in at least one observational study and at least 75% of experts rated them as clearly or potentially low value.12,13 Experts were 36 clinicians from Canada, the UK, the US and Australia specialized in trauma care and actively involved in injury research including 8 orthopedic or spine surgeons; the response rate was 92%. No attempt to summarize the benefits & harms of practices was made at this stage.12 Given the high volume of patients hospitalized following orthopaedic injury annually, reducing low value practices in this population may free up considerable resources and to optimize the quality and efficiency of health care services. However, we need to appraise available evidence for these practices before recommendations can be made. The aim of this study was therefore to synthesize evidence on clinical practices in orthopaedic injury care that were previously identified as potentially low value.