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Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection: A Multi-Center
S J Deakyne1, L Bajaj2, J Hoffman3
1Children's Hospital Colorado , Department of Research Informatics, Aurora, Colorado, United States.
Insights
Site-specific chief complaint groupings accurately identify children with head trauma for electronic health record alerts. These tailored groupings improve clinical decision support for cranial computed tomography scans, balancing sensitivity and specificity.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Clinical Decision Support
Background:
- Cranial computed tomography (CT) overuse in children with blunt head trauma leads to unnecessary radiation exposure.
- The Pediatric Emergency Care Applied Research Network (PECARN) provides prediction rules to identify children not requiring CT scans.
- Electronic health record (EHR)-based clinical decision support (CDS) can implement these rules but requires precise patient identification to minimize alerts.
Purpose of the Study:
- To develop, implement, and evaluate site-specific chief complaint (CC) groupings for accurately identifying pediatric head trauma patients.
- To activate data collection within an EHR system using these CC groupings.
- To optimize the accuracy of CDS alerts for head trauma evaluations.
Main Methods:
- A 13-site clinical trial compared CT use before and after CDS implementation.
- Four PECARN sites developed and implemented CC groupings to trigger clinical trial alerts (CTAs).
- CC groupings were tested for high sensitivity and at least moderate specificity.
Main Results:
- Identical CC groupings were not feasible across all sites due to variability in available CCs.
- Significant variation in sensitivity and specificity was observed between sites for similar CC groupings.
- Implemented CC groupings achieved >90% sensitivity and 75-89% specificity, with site-specific tailoring based on feedback.
Conclusions:
- CC groupings can be successfully implemented across multiple sites to trigger CTAs for EHR data collection.
- Site-specific variations in CC groupings are necessary to achieve high sensitivity and moderate-to-high specificity.
- Future trials should consider the balance of sensitivity and specificity based on clinical condition prevalence, morbidity, and intervention goals.
Background:
Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts.
Objectives:
To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR.
Methods:
As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity.
Results:
Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75-89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites.
Conclusions:
CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.
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