Objectives Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. Methods This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Results Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. Conclusions An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.
Bibliographical noteFunding Information:
From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, Minneapolis, MN; †Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; ‡Department of Mathematics and Statistics, Auburn University, Auburn, AL; §Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN. This investigation was partially funded by a grant from the ABIM Foundation, Putting the Charter Into Practice grant 242. Additional support was provided by National Institutes of Health grants UL1TR000114, U54MD007584, and G12MD007601. Disclosure: The authors declare no conflict of interest. Reprints: Marissa A. Hendrickson, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, M653 E Bldg, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: email@example.com). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161
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- clinical decision support
- community hospital