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.