Does clinical decision support system promote expert consensus for appropriate imaging referrals?...

Area of Science:

• Radiology and Medical Imaging
• Health Informatics
• Clinical Decision Support

Background:

• Chest-abdominal-pelvis (CAP) CT scans are frequently utilized in the Emergency Department (ED).
• The appropriateness of CAP CT scan ordering in the ED requires evaluation to optimize resource utilization and patient care.
• Clinical decision support systems (CDSS) offer a potential solution for standardizing and improving diagnostic imaging appropriateness.

Purpose of the Study:

• To assess the appropriateness of CAP CT scan utilization in the ED.
• To compare expert physician ratings of CAP CT scan appropriateness before and after using the ESR iGuide CDSS.
• To evaluate the impact of the ESR iGuide on expert agreement and the alignment of recommendations with established guidelines.

Main Methods:

• A retrospective study analyzed 100 CAP CT scans ordered in the ED.
• Four expert physicians rated scan appropriateness on a 7-point scale, both with and without the assistance of the ESR iGuide CDSS.
• Inter-rater reliability and appropriateness percentages were calculated before and after CDSS consultation.

Main Results:

• Expert appropriateness ratings increased from 5.2 to 5.85 (p < 0.01) after using the ESR iGuide.
• Appropriate test utilization rose from 63% to 89% with CDSS use.
• The ESR iGuide identified 85% of CAP CT scans as not recommended (score 0), while Abdominal-Pelvis CT was deemed appropriate in 76% of cases.

Conclusions:

• Inappropriate CAP CT scan ordering, both in frequency and body region selection, is prevalent in the ED.
• The ESR iGuide CDSS significantly improved the appropriateness of CAP CT scan ordering and enhanced expert agreement.
• Implementing CDSS like the ESR iGuide is crucial for standardizing workflows and promoting informed decision-making in diagnostic imaging.