Implementation of a Clinical Decision Support System for Children With Minor Blunt Head Trauma Who Are at Nonnegligible Risk for Traumatic Brain Injuries.

Autor: Ballard DW; Division of Research, Kaiser Permanente, Oakland, CA; San Rafael Medical Center, Kaiser Permanente, San Rafael, CA. Electronic address: dustin.ballard@kp.org., Kuppermann N; Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA., Vinson DR; Division of Research, Kaiser Permanente, Oakland, CA; Sacramento Medical Center, Kaiser Permanente, Sacramento, CA., Tham E; Department of Pediatrics, Section of Emergency Medicine, University of Colorado, Aurora, CO., Hoffman JM; Nationwide Children's Hospital, Columbus, OH., Swietlik M; Department of Research Informatics, Children's Hospital Colorado, Aurora, CO., Deakyne Davies SJ; Department of Research Informatics, Children's Hospital Colorado, Aurora, CO., Alessandrini EA; Cincinnati Children's Hospital Medical Center, Cincinnati, OH., Tzimenatos L; Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA., Bajaj L; Department of Pediatrics, Section of Emergency Medicine, University of Colorado, Aurora, CO., Mark DG; Division of Research, Kaiser Permanente, Oakland, CA; Oakland Medical Center, Kaiser Permanente, Oakland, CA., Offerman SR; South Sacramento Medical Center, Kaiser Permanente, Sacramento, CA., Chettipally UK; South San Francisco Medical Center, Kaiser Permanente, South San Francisco, CA., Paterno MD; Division of General Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA., Schaeffer MH; Information Systems, Partners HealthCare System, Boston, MA., Richards R; Department of Pediatrics, University of Utah, Salt Lake City, UT., Casper TC; Department of Pediatrics, University of Utah, Salt Lake City, UT., Goldberg HS; Division of General Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; Information Systems, Partners HealthCare System, Boston, MA., Grundmeier RW; Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA., Dayan PS; Department of Pediatrics, Division of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Jazyk: angličtina
Zdroj: Annals of emergency medicine [Ann Emerg Med] 2019 May; Vol. 73 (5), pp. 440-451. Date of Electronic Publication: 2018 Dec 22.
DOI: 10.1016/j.annemergmed.2018.11.011
Abstrakt: Study Objective: To determine the effect of providing risk estimates of clinically important traumatic brain injuries and management recommendations on emergency department (ED) outcomes for children with isolated intermediate Pediatric Emergency Care Applied Research Network clinically important traumatic brain injury risk factors.
Methods: This was a secondary analysis of a nonrandomized clinical trial with concurrent controls, conducted at 5 pediatric and 8 general EDs between November 2011 and June 2014, enrolling patients younger than 18 years who had minor blunt head trauma. After a baseline period, intervention sites received electronic clinical decision support providing patient-level clinically important traumatic brain injury risk estimates and management recommendations. The following primary outcomes in patients with one intermediate Pediatric Emergency Care Applied Research Network risk factor were compared before and after clinical decision support: proportion of ED computed tomography (CT) scans, adjusted for age, time trend, and site; and prevalence of clinically important traumatic brain injuries.
Results: The risk of clinically important traumatic brain injuries was known for 3,859 children with isolated findings (1,711 at intervention sites before clinical decision support, 1,702 at intervention sites after clinical decision support, and 446 at control sites). In this group, pooled CT proportion decreased from 24.2% to 21.6% after clinical decision support (odds ratio 0.86; 95% confidence interval 0.73 to 1.01). Decreases in CT use were noted across intervention EDs, but not in controls. The pooled adjusted odds ratio for CT use after clinical decision support was 0.73 (95% confidence interval 0.60 to 0.88). Among the entire cohort, clinically important traumatic brain injury was diagnosed at the index ED visit for 37 of 37 (100%) patients before clinical decision support and 32 of 33 patients (97.0%) after clinical decision support.
Conclusion: Providing specific risks of clinically important traumatic brain injury through electronic clinical decision support was associated with a modest and safe decrease in ED CT use for children at nonnegligible risk of clinically important traumatic brain injuries.
(Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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