A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial

Area of Science:

• Emergency Medicine
• Clinical Decision Support
• Diagnostic Imaging

Background:

• Pulmonary embolism (PE) diagnosis often deviates from evidence-based guidelines.
• Improving diagnostic accuracy for PE is crucial in emergency settings.

Purpose of the Study:

• To evaluate the effectiveness of a handheld clinical decision-support system (CDSS) in optimizing the diagnostic pathway for suspected PE.
• To assess if a CDSS improves adherence to guidelines and appropriateness of diagnostic testing.

Main Methods:

• A cluster randomized trial was conducted across 20 French emergency departments.
• Handheld CDSS was implemented in 10 centers, while 10 centers used paper-based guidelines.
• Appropriateness of diagnostic work-up and the number of tests per patient were primary and secondary outcomes, respectively.

Main Results:

• The proportion of patients receiving appropriate diagnostic work-ups increased significantly more in the CDSS group compared to the paper guidelines group.
• The computer-based guidelines group showed a greater increase in appropriate diagnostic work-ups (19.3 percentage points, P = 0.023).
• Patients managed with the CDSS underwent fewer diagnostic tests per patient (1.76 vs. 2.25, P < 0.001).

Conclusions:

• A handheld decision-support system effectively improved diagnostic decision-making for suspected pulmonary embolism in emergency departments.
• The study demonstrated that technology-driven guidelines enhance appropriate testing and reduce test utilization.