Implementation of Electronic Clinical Decision Support for Pediatric Appendicitis

Area of Science:

• Pediatric Emergency Medicine
• Clinical Decision Support Systems
• Medical Imaging

Background:

• Computed tomography (CT) and ultrasound (US) are frequently used for acute abdominal pain in children.
• There is a need to standardize care and reduce unnecessary CT utilization while ensuring patient safety.
• Appendicitis is a common surgical emergency in pediatric patients.

Purpose of the Study:

• To implement and evaluate an electronic clinical decision support tool for pediatric patients with suspected appendicitis.
• To standardize care pathways and decrease the use of CT scans.
• To maintain or improve patient safety and diagnostic accuracy.

Main Methods:

• A quasi-experimental study involving pediatric patients (3-18 years) with possible appendicitis.
• Implementation of a multicomponent electronic clinical decision support tool.
• Outcomes measured included CT and US utilization, missed appendicitis, revisits, perforation rates, and ED length of stay.

Main Results:

• CT use decreased by 54% (from 38.8% to 17.7%) after tool implementation.
• Segmented regression showed a significant monthly decrease in CT trend (-3.5%; P = .007).
• Ultrasound use increased, but total imaging trends and key safety outcomes (missed appendicitis, perforation, revisits, LOS) remained unchanged.

Conclusions:

• The electronic clinical decision support tool effectively reduced CT utilization in pediatric appendicitis evaluations.
• The tool demonstrated success in maintaining high-quality care and patient safety.
• This approach offers a viable strategy for optimizing imaging practices in pediatric emergency departments.