Association of Clinical Guidelines and Decision Support with Computed Tomography Use in Pediatric Mild Traumatic Brain Injury - 22/07/21
, Jonathan Rodean, MPP 2, Rebekah C. Mannix, MD, MPH 3, Matt Hall, PhD 2, Elizabeth R. Alpern, MD, MSCE 4, Paul L. Aronson, MD, MHS 5, Pradip P. Chaudhari, MD 6, Eyal Cohen, MD, MSc 7, 8, Stephen B. Freedman, MDCM, MSc 9, 10, Rustin B. Morse, MD, MMM 11, Alon Peltz, MD, MBA 12, Margaret Samuels-Kalow, MD, MPhil, MSHP 13, Samir S. Shah, MD, MSCE 14, Harold K. Simon, MD, MBA 15, 16, Mark I. Neuman, MD, MPH 3Abstract |
Objective |
To examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) are associated with lower use of head computed tomography (CT).
Study design |
We conducted a cross-sectional study of 45 pediatric emergency departments (EDs) in the Pediatric Hospital Information System from 2015 through 2019. We included children discharged with mTBI and surveyed ED clinical directors to ascertain the presence and implementation year of clinical guidelines and CDS. The association of clinical guidelines and CDS with CT use was assessed, adjusting for relevant confounders. As secondary outcomes, we evaluated ED length of stay and rates of 3-day ED revisits and admissions after revisits.
Results |
There were 216 789 children discharged with mTBI, and CT was performed during 20.3% (44 114/216 789) of ED visits. Adjusted hospital-specific CT rates ranged from 11.8% to 34.7% (median 20.5%, IQR 17.3%, 24.3%). Of the 45 EDs, 17 (37.8%) had a clinical guideline, 9 (20.0%) had CDS, and 19 (42.2%) had neither. Compared with EDs with neither a clinical guideline nor CDS, visits to EDs with CDS (aOR 0.52 [0.47, 0.58]) or a clinical guideline (aOR 0.83 [0.78, 0.89]) had lower odds of including a CT for mTBI. ED length of stay and revisit rates did not differ based on the presence of a clinical guideline or CDS.
Conclusions |
Clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
Le texte complet de cet article est disponible en PDF.Abbreviations : CDS, CT, ED, ICD-10-CM, LOS, mTBI, PHIS
Plan
| R.C.M. is supported by funding from the National Football League Charitable foundation, the Department of Defense (DOD W81XWH1920011), and the National Institutes of Health (U01NS096835, 1R01NS115942). P.L.A. is supported by the Agency for Healthcare Research and Quality (AHRQ) (K08HS026006). S.B.F. receives grant support from the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness. M.S.-K. was supported by the Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. H.K.S. is supported by CDC U01 CE002939-Concussion Management Grant, HRSA U03MC33155-01-00 (PECARN), and NCATS UL1 TR002378 Georgia Clinical & Translational Science Alliance. A.P. is supported by funding from the National Institutes of Health (K23HL155425) and the Massachusetts Association of Health Plans. The other authors declare no conflicts of interest. |
Vol 235
P. 178 - août 2021 Retour au numéro
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