Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons...

Area of Science:

• Emergency Medicine
• Clinical Informatics
• Pediatric Traumatology

Background:

• Emergency department (ED) clinicians face challenges in determining the necessity of computed tomography (CT) scans for children with blunt head trauma to rule out traumatic brain injury (TBI).
• The Pediatric Emergency Care Applied Research Network (PECARN) developed evidence-based prediction rules to identify low-risk pediatric patients who may not require CT scans, aiming to reduce unnecessary radiation exposure and healthcare costs.

Purpose of the Study:

• To describe the strategy for implementing the PECARN TBI prediction rules using electronic health record (EHR) clinical decision support (CDS) within a multicenter clinical trial.
• To evaluate the feasibility and effectiveness of integrating these prediction rules into routine clinical workflows in diverse ED settings.

Main Methods:

• A multicenter clinical trial involving 13 EDs was conducted, with 10 sites implementing EHR-based CDS using the Epic EHR system.
• The CDS intervention was designed based on sociotechnical analysis, enabling immediate display of recommendations after data entry, with a centralized build and export of the intervention package.

Main Results:

• Despite variations in site-specific workflows and provider involvement, the centralized development and export of the CDS system successfully supported the multicenter clinical trial.
• Challenges included varying completion rates and provider types completing the electronic data form due to customized workflows and site-specific change management processes.

Conclusions:

• The implementation strategy of a centralized build and export of a CDS system within a commercial EHR successfully facilitated a multicenter clinical trial.
• This approach demonstrates a viable method for disseminating and implementing clinical prediction rules across multiple healthcare institutions, potentially improving the care of pediatric head trauma patients.