Development of a Clinical Decision Support System for Pediatric Abdominal Pain in Emergency Department Settings Across Two Health Systems Within the HCSRN.

Heidi L Ekstrom, Elyse O Kharbanda, Dustin W Ballard, David R Vinson, Gabriela Vazquez-Benitez, Uli K Chettipally, Steven P Dehmer, Gopikrishna Kunisetty, Rashmi Sharma, Adina S Rauchwerger, Patrick J O'Connor, Anupam B Kharbanda
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Abstract

Background: Appendicitis is a common surgical emergency in children, yet diagnosis can be challenging. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN).

Objectives: To describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool's Triage component, aiming to identify pediatric patients at increased risk for appendicitis.

Results: Despite differences by site in design and implementation, such as the use of alerts, incorporating gestalt, and other workflow variations across sites, using simple screening questions and automated exclusions, both systems were able to identify a population with similar appendicitis rates (11.8 percent and 10.6 percent), where use of the full Appy CDS would be indicated.

Discussion: These 2 HCSRN sites designed Appy CDS to capture a population at risk for appendicitis and deliver CDS to that population while remaining locally relevant and adhering to organizational preferences. Despite different approaches to point-of-care CDS, the sites have identified similar cohorts with nearly identical background rates of appendicitis.

Next steps: The full Appy CDS tool, providing personalized risk assessment and tailored recommendations, is undergoing evaluation as part of a pragmatic cluster randomized trial aiming to reduce reliance on advanced diagnostic imaging. The novel approaches to CDS we present could serve as the basis for future ED interventions.

Abstract Image

Abstract Image

Abstract Image

在 HCSRN 的两个医疗系统中,针对急诊科小儿腹痛开发临床决策支持系统。
背景:阑尾炎是儿童常见的外科急症,但诊断却很困难。医疗保健系统研究网络(HCSRN)设计了一个基于电子健康记录(EHR)的临床决策支持系统(CDS),以帮助指导急性腹痛儿科患者的治疗:描述两个大型 HCSRN 附属医疗系统利用完善的平台独立但协同开发和实施临床决策支持工具(Appy CDS)的情况,并评估该工具的 "分诊 "部分,该部分旨在识别阑尾炎风险较高的儿科患者:尽管各医疗机构在设计和实施方面存在差异,如使用警报、结合态势以及其他工作流程方面的差异,但使用简单的筛查问题和自动排除,两个系统都能识别出阑尾炎发病率相似的人群(11.8% 和 10.6%),并在这些人群中使用完整的 Appy CDS:这两个 HCSRN 站点设计了 Appy CDS,以捕捉阑尾炎高危人群,并向该人群提供 CDS,同时保持本地相关性并遵循组织偏好。尽管采用了不同的护理点 CDS 方法,但这两家机构发现了类似的人群,其阑尾炎的背景发病率几乎相同:完整的 Appy CDS 工具可提供个性化的风险评估和量身定制的建议,目前正在进行评估,这是一项务实的分组随机试验的一部分,旨在减少对先进影像诊断的依赖。我们介绍的 CDS 新方法可作为未来 ED 干预措施的基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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