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Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support

Shireen M Atabaki1, Brian R Jacobs1, Kathleen M Brown1

  • 1Children's National Medical Center, Washington, D.C.; George Washington University School of Medicine and Health Sciences, Washington, D.C.; and University of Michigan, Ann Arbor, Mich.

Pediatric Quality & Safety
|September 20, 2018
PubMed

Insights

Electronic health record decision support successfully reduced computed tomography (CT) scans for pediatric head trauma patients. This initiative decreased CT utilization without impacting patient safety or return visits.

Area of Science:

  • Pediatric Emergency Medicine
  • Health Informatics
  • Diagnostic Imaging Utilization

Background:

  • Computed tomography (CT) overuse is a concern for the 1.4 million annual emergency department (ED) visits for traumatic brain injury (TBI) in the US.
  • The Pediatric Emergency Care Applied Research Network developed prediction rules to identify children at low risk for clinically important TBI.
  • Electronic health record (EHR) decision support was implemented to reduce CT use in pediatric head trauma cases.

Purpose of the Study:

  • To evaluate the effectiveness of EHR decision support in reducing CT scan rates for pediatric head trauma patients.
  • To assess the impact of decision support on CT utilization in two pediatric EDs.

Main Methods:

  • A pre-implementation (PRE) and post-implementation (POST) comparison of monthly CT rates over one year.
  • Statistical process control charts were used to analyze changes in CT use over time.
  • Multivariate analyses and balancing measures (ED length of stay, 7-day return visits) were conducted.

Main Results:

  • CT scan utilization decreased from 26.8% (PRE) to 18.9% (POST), with an adjusted odds ratio of 0.71.
  • Statistical process control charts indicated a sustained decrease in CT rates post-implementation.
  • No significant changes were observed in ED length of stay or 7-day return visits; no missed diagnoses were reported.

Conclusions:

  • EHR-integrated decision support effectively reduces CT utilization for pediatric head trauma in the ED.
  • The implementation was associated with a significant decrease in CT scans without compromising patient safety or increasing return visits.
Abstract

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