Low-value clinical practices in injury care: A scoping review and expert consultation survey

Lynne Moore, François Lauzier, Pier Alexandre Tardif, Khadidja Malloum Boukar, Imen Farhat, Patrick Archambault, Éric Mercier, François Lamontagne, Michael Chassé, Henry T. Stelfox, Simon Berthelot, Belinda Gabbe, Fiona Lecky, Natalie Yanchar, Howard Champion, John Kortbeek, Peter Cameron, Paule Lessard Bonaventure, Jérôme Paquet, Catherine TruchonAlexis F. Turgeon, on behalf of the Canadian Traumatic brain injury Research Consortium

Research output: Contribution to journalReview ArticleResearchpeer-review

10 Citations (Scopus)


BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 "gray zone" practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 "gray zone" practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.

Original languageEnglish
Pages (from-to)983-993
Number of pages11
JournalThe Journal of Trauma and Acute Care Surgery
Issue number6
Publication statusPublished - Jun 2019


  • expert survey
  • Low-value care
  • scoping review
  • trauma systems

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