- For children with head trauma presenting to the emergency department (ED), clinicians in this study ordered fewer head CTs if provided with electronic clinical decision support (CDS).
Why this matters
- Decisions about head CTs for children with 1 “intermediate” Pediatric Emergency Care Applied Research Network (PECARN) risk factor for clinically important brain injury can be especially difficult.
- Proportion undergoing head CTs after vs before CDS: 21.6% vs 24.2%.
- aOR: 0.73 (95% CI, 0.60-0.88).
- No change at control sites.
- Among 5804 patients with non-negligible risk, 37/37 important injuries were found before intervention and 32/33 after.
- Child with missed injury did not require intubation or neurosurgery.
- Secondary analysis of nonrandomized multicenter before-and-after TBI-KT trial.
- Participants were children with minor blunt head trauma and 1 PECARN intermediate-risk factor, with known risk for clinically important injury (n=3859).
- At intervention sites, clinicians received CDS in electronic health record (EHR; n=1702) after baseline period without support (n=1711); control sites received no CDS (n=446).
- CDS included risk estimates, recommendations.
- Outcome: proportion of patients undergoing head CT in ED.
- Funding: American Recovery and Reinvestment Act.
- Use of CDS tool was optional.
- Potential unmeasured confounders.