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Feasibility and indicator outcomes using computerized clinical decision support in pediatric traumatic brain injury

Ashley A Colletti1, Taniga Kiatchai1,2, Vivian H Lyons2,3

  • 1Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.

Paediatric Anaesthesia
|January 5, 2019
PubMed

Insights

Clinical decision support for pediatric traumatic brain injury anesthesia care is feasible and reliable. This system may reduce secondary insults and improve guideline adherence in pediatric anesthesia.

Area of Science:

  • Pediatric Anesthesiology
  • Neuroanesthesia
  • Clinical Decision Support Systems

Background:

  • Traumatic brain injury (TBI) anesthesia care in pediatric patients presents unique complexities.
  • The efficacy of clinical decision support (CDS) in optimizing pediatric trauma care remains largely unexamined.

Purpose of the Study:

  • To evaluate the feasibility and reliability of CDS for TBI anesthesia care in pediatric patients.
  • To assess key performance indicators (KPIs) related to TBI anesthesia management when using CDS.

Main Methods:

  • CDS was implemented for pediatric patients (<19 years) undergoing craniotomy for suspected TBI.
  • Anesthesia providers received real-time alerts for process adherence and abnormal KPI events.
  • Analysis included 39 cases (19 control, 20 with CDS), reviewing anesthesia records, vital signs, and alert logs.

Main Results:

  • CDS demonstrated high reliability in identifying eligible cases (85% sensitivity, 100% specificity).
  • The system effectively detected monitor (89%) and lab (100%) KPI events with no false positives.
  • Patients managed with CDS experienced reduced median event durations for 4/7 KPIs, including significant reductions in hypocarbia, hypotension, hypothermia, and hyperthermia durations.

Conclusions:

  • CDS is a feasible and reliable tool for pediatric TBI anesthesia care.
  • The implementation of CDS shows potential for improving KPI outcomes and reducing secondary insults.
  • CDS may serve as a valuable strategy to enhance adherence to TBI guidelines in pediatric anesthesia.
Abstract

Keywords:
anesthesia careclinical decision supporttraumatic brain injury

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