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Low-value injury care in the adult orthopaedic trauma population: a protocol for a rapid review
  1. Mélanie Bérubé1,2,
  2. Lynne Moore1,3,
  3. Stéphane Leduc4,
  4. Imen Farhat1,
  5. Martin Lesieur5,
  6. Jean Lamontagne5,
  7. Stéphane Pelet5,
  8. Gregory Berry6,
  9. Pier-Alexandre Tardif1,
  10. Caroline Côté2,
  11. Jérôme Paquet7
  1. 1Population Health and Optimal Health Practices Research Unit, Trauma – Emergency – Critical Care Medicine, Centre de Recherche du CHU de Québec – Université Laval (Hôpital de l’Enfant-Jésus), Québec City, Québec, Canada
  2. 2Faculty of Nursing, Université Laval, Québec City, Québec, Canada
  3. 3Department of Social and Preventive Medicine, Université Laval, Québec City, Québec, Canada
  4. 4Division of Orthopaedic Surgery, CIUSSS du Nord-de-l’île-de-Montréal (Hôpital du Sacré-Coeur de Montréal), Montréal, Québec, Canada
  5. 5Division of Orthopaedic Surgery, CHU de Québec-Université Laval, Québec City, Québec, Canada
  6. 6Division of Orthopaedic Surgery, McGill University Health Center, Montréal, Québec, Canada
  7. 7Division of Neurosurgery, CHU de Québec - Université Laval, Québec City, Québec, Canada
  1. Correspondence to Professor Mélanie Bérubé; melanie.berube{at}fsi.ulaval.ca

Abstract

Introduction Orthopaedic injuries affect almost 90% of trauma patients. A previous scoping review and expert consultation survey identified 15 potential low-value intra-hospital practices in the adult orthopaedic trauma population. Limiting the frequency of such practices could reduce adverse events, improve clinical outcomes and free up resources. The aim of this study is to synthesise the evidence on intra-hospital practices for orthopaedic injuries, previously identified as potentially of low value.

Methods and analysis We will search Medline, Excerpta Medica Database (EMBASE), the Cochrane Central Register of Controlled Trials and Epistemonikos to identify systematic reviews, randomised controlled trials (RCTs), quasi-RCTs, cohort studies and case–control studies that evaluate selected practices according to a priori PICOS statements (Population–Intervention–Comparator–Outcome–Study design) . We will evaluate the methodological quality for systematic reviews using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2). Risk of bias in original studies will be evaluated with the Cochrane revised tool for RCTs (RoB2) and with the risk of bias in non-randomised studies of interventions (ROBINS-I) tool. If for a given practice, more than two original studies on our primary outcome are identified, we will conduct meta-analysis using a random effects model and assess heterogeneity using the I2 index. We will assess credibility of evidence (I–IV) based on statistical significance, sample size, heterogeneity and bias as per published criteria.

Ethics and dissemination Ethics approval is not required as original data will not be collected. Knowledge users from three level I trauma centres are involved in the design and conduct of the study in accordance with an integrated knowledge translation approach. Findings related to the rapid review will be available in May 2020. They will be presented to key stakeholders to inform discussions and raise awareness on low-value injury care. In addition, results will be disseminated in a peer-reviewed journal, at national and international scientific meetings and to healthcare associations.

  • orthopaedic injuries
  • wound and injuries
  • trauma
  • low-value practices
  • rapid review
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @BrubMlanie1, @Moore

  • Contributors MB contributed to the elaboration of keywords and the search strategy, drafted the manuscript and approved the final version of the manuscript. LM led the development of the protocol and drafted the manuscript with the first author. She acts as guarantor for the rapid review. SL contributed to the development of PICOS questions, revised the manuscript and approved the final version. IF contributed to the elaboration of keywords, the search strategy and the data extraction form, revised the manuscript and approved the final version. ML and JP contributed to the identification of low-value injury care, development of PICOS questions, critically revised the manuscript and approved the manuscript. JL contributed to the identification of low-value injury care, revised the manuscript and approved the final version. SP and GB contributed to the identification of low-value injury care, critically revised the manuscript and approved the final version. PAT and CC contributed to the data extraction form development, critically revised the manuscript and approved the manuscript.

  • Funding This research was supported by the Canadian Institutes of Health Research (Foundation grant, #353374).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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