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 synthesize the evidence on these
practices.
Methods. We searched four databases for systematic
reviews, randomized 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-randomized studies of interventions tool for observational studies.
We summarized 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 immobilization 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 orthopedic 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.
Key words. Low value care, orthopaedics, trauma,
imaging, systematic review