title: A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.
abstract: BACKGROUND
  Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines.
  
  
  OBJECTIVE
  To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department.
  
  
  METHODS
  Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032).
  
  
  METHODS
  20 emergency departments in France.
  
  
  METHODS
  1103 and 1768 consecutive outpatients with suspected pulmonary embolism.
  
  
  METHODS
  After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients).
  
  
  METHODS
  Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome).
  
  
  RESULTS
  The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001).
  
  
  CONCLUSIONS
  The study was not designed to show a difference in the clinical outcomes of patients during follow-up.
  
  
  CONCLUSIONS
  A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.
authors.affiliation: Centre Hospitalier Universitaire d'Angers and Université d'Angers, Angers, France. pmroy@chu-angers.fr
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.forename: Florence
authors.initials: F
authors.lastname: Gillaizeau
authors.forename: Catherine
authors.initials: C
authors.lastname: Legall
authors.forename: Aurore
authors.initials: A
authors.lastname: Armand-Perroux
authors.forename: Ludovic
authors.initials: L
authors.lastname: Martino
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hachelaf
authors.forename: Alain-Eric
authors.initials: AE
authors.lastname: Dubart
authors.forename: Jeannot
authors.initials: J
authors.lastname: Schmidt
authors.forename: Mirko
authors.initials: M
authors.lastname: Cristiano
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Chretien
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
mesh_terms: D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis*