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PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in
Francesco Corazza1, Marta Arpone1, Deborah Snijders1
1Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy.
Insights
A new app, PediAppRREST, was developed to aid in paediatric cardiac arrest (PCA) management. This study evaluates its effectiveness in reducing guideline deviations during simulated PCA scenarios, aiming to improve patient outcomes.
Area of Science:
- Medical Simulation
- Pediatric Emergency Medicine
- Clinical Decision Support Systems
Background:
- Paediatric cardiac arrest (PCA) has a high mortality rate, with frequent deviations from established guideline recommendations during management.
- Existing cognitive aids for PCA management may have limitations in accessibility and usability.
Purpose of the Study:
- To evaluate the effectiveness of the PediAppRREST interactive tablet application in reducing deviations from Paediatric Advanced Life Support (PALS) guideline recommendations during simulated PCA events.
- To compare the performance of healthcare teams using the PediAppRREST app against those using a standard PALS pocket reference card or no cognitive aid.
Main Methods:
- A multicentre, simulation-based, randomized controlled trial involving 105 teams (315 participants) from Paediatric, Emergency Medicine, and Anaesthesiology programs in Italy.
- Teams were randomized into three arms: PediAppRREST app users, PALS pocket reference card users (CtrlPALS+), and a control group with no cognitive aid (CtrlPALS-).
- The primary outcome was the number of deviations (delays and errors) from PALS guidelines, assessed using the c-DEV15plus checklist.
Main Results:
- Pre-results indicate the study is registered (NCT04619498) and has received ethical approval.
- The study design allows for statistical comparison of guideline adherence across the three intervention arms using ANOVA and Tukey-Kramer adjustments.
Conclusions:
- The PediAppRREST app has the potential to improve adherence to PCA management guidelines.
- Further refinement and dissemination of the app are planned based on study outcomes, aiming to enhance the quality of care for critically ill children.
Introduction:
Paediatric cardiac arrest (PCA), despite its low incidence, has a high mortality. Its management is complex and deviations from guideline recommendations occur frequently. We developed a new interactive tablet app, named PediAppRREST, to support the management of PCA. The app received a good usability evaluation in a previous pilot trial. The aim of the study is to evaluate the effectiveness of the PediAppRREST app in reducing deviations from guideline recommendations in PCA management.
Methods And Analysis:
This is a multicentre, simulation-based, randomised controlled, three-parallel-arm study. Participants are residents in Paediatric, Emergency Medicine, and Anaesthesiology programmes in Italy. All 105 teams (315 participants) manage the same scenario of in-hospital PCA. Teams are randomised by the study statistician into one of three study arms for the management of the PCA scenario: (1) an intervention group using the PediAppRREST app or (2) a control group Paediatric Advanced Life Support (CtrlPALS+) using the PALS pocket reference card; or (3) a control group (CtrlPALS-) not allowed to use any PALS-related cognitive aid. The primary outcome of the study is the number of deviations (delays and errors) in PCA management from PALS guideline recommendations, according to a novel checklist, named c-DEV15plus. The c-DEV15plus scores will be compared between groups with a one-way analysis of variance model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance.
Ethics And Dissemination:
The Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the project to be a negligible risk study and approved it through an expedited review process. The results of the study will be disseminated in peer-reviewed journals, and at national and international scientific conferences. Based on the study results, the PediAppRREST app will be further refined and will be available for download by institutions/healthcare professionals.
Trial Registration Number:
NCT04619498; Pre-results.
