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Updated: Aug 4, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic
Emma K Jones1, Ivana Ninkovic, Matthew Bahr
1From the Department of Surgery (E.K.J., D.M., G.B.M., C.J.T.), University of Minnesota; Fairview Health Services IT (I.N., S.D., G.B.M.); Trauma Services (M.B., M.D.), Fairview Health Services, Minneapolis; Department of Surgery (J.O.), Essentia Health, Duluth; Department of Radiology (T.A.), Institute for Health Informatics (G.B.M.), University of Minnesota; Fairview Health Services IT (G.B.M., C.J.T.); Center for Learning Health System Sciences (G.B.M., C.J.T.), University of Minnesota, Minneapolis, Minnesota.
Background:
Traumatic rib fractures are associated with high morbidity and mortality. Clinical decision support systems (CDSS) have been shown to improve adherence to evidence-based (EB) practice and improve clinical outcomes. The objective of this study was to investigate if a rib fracture CDSS reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The independent association of two process measures, an admission EB order set and a pain-inspiratory-cough score early warning system, with LOS were investigated.
Methods:
The CDSS was scaled across nine US trauma centers. Following multiple imputation, multivariable regression models were fit to evaluate the association of the CDSS on primary and secondary outcomes. As a sensitivity analysis, propensity score matching was also performed to confirm regression findings.
Results:
Overall, 3,279 patients met inclusion criteria. Rates of EB practices increased following implementation. On risk-adjusted analysis, in-hospital LOS preintervention versus postintervention was unchanged (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 0.97-1.15, p = 0.2) but unplanned transfer to the ICU was reduced (odds ratio, 0.28; 95% CI, 0.09-0.84, p = 0.024), as was 1-year mortality (hazard ratio, 0.6; 95% CI, 0.4-0.89, p = 0.01). Provider utilization of the admission order bundle was 45.3%. Utilization was associated with significantly reduced LOS (IRR, 0.87; 95% CI, 0.77-0.98; p = 0.019). The early warning system triggered on 34.4% of patients; however, was not associated with a significant reduction in hospital LOS (IRR, 0.76; 95% CI, 0.55-1.06; p = 0.1).
Conclusion:
A novel, user-centered, comprehensive CDSS improves adherence to EB practice and is associated with a significant reduction in unplanned ICU admissions and possibly mortality, but not hospital LOS.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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