PhD student Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada. Québec, Canada
Background: Low-value practices are tests and treatments that are not supported by evidence, and which may expose patients to unnecessary risk. Because of timely actions, multidisciplinary management, medications requiring special precautions, and frequent multi-organ failures, trauma is a fertile ground for low-value prescriptions. However, information on the incidence of these low value prescriptions and the impact on patient outcomes and resource use is scarce, mainly because of difficulties obtaining data on the intra-hospital use of drugs.
Objectives: We aimed to identify low-value prescriptions in trauma population and evaluate the adherence to clinical practice guidelines recommendations in a Canadian level I trauma center.
Methods: We used internationally recognized clinical practice guidelines and an expert consensus study to identify low-value prescriptions. We then conducted a retrospective cohort study among adults hospitalised for injury between April 2017 and March 2020 in the Hôpital de l’Enfant-Jésus (Québec). We developed algorithms to identify low-value prescriptions iteratively with content experts. To evaluate the adherence to recommendations, we calculated incidences using data on clinical diagnoses and outcomes from the Quebec trauma registry and data on intra-hospital drug prescriptions from a hospital information system.
Results: We developed algorithms for 10 low-value prescriptions including corticosteroids, antiseizure and analgesics, among specific populations such as trauma brain injury or spinal cord injury. We included a total of 5716 patients including 56% male, 48% under 65 years of age. The mechanism of the injury were mostly falls (65%) and motor vehicle collisions (19%). 735 patients sustained traumatic brain injuries and 173 had spinal cord injuries. 67% had major injuries (Injury severity score >12). Incidences of low-value prescriptions ranged from 0% (barbiturates for acute trauma brain injury) to 22% (seizure prophylaxis more than one week after a severe trauma brain injury).
Conclusions: We observed high variation in adherence to clinical practice guidelines recommendations. While some recommendations seem to be well implemented, others represent opportunities to improve the quality of care. Hereafter, we will evaluate the impact of these low-value prescriptions on patient outcomes and resource use.
