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

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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.

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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.