title: Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden.
abstract: BACKGROUND
  The steady increase in the use of computed tomography (CT) has particular concerns for children. Family physicians must often select pediatric imaging without any decision support. We hypothesized that point-of-care decision support would lead to the selection of imaging that lowered radiation exposure and improved guideline congruence.
  
  
  METHODS
  Our double-blind, randomized simulation included family physicians in the Military Health System. Participants initially reviewed a pediatric hematuria scenario and selected imaging without decision support. Participants were subsequently randomized to either receive imaging-appropriateness guidelines and then estimated radiation exposure information or receive estimated radiation information then guidelines; imaging selections were required after each step. The primary outcome was the selected imaging modality with point-of-care decision support.
  
  
  RESULTS
  The first arm increased CT ordering after viewing the guidelines (P = .008) but then decreased it after reviewing radiation exposure information (P = .007). In the second arm radiation information decreased CT and plain film use (P = not significant), with a subsequent increase in ultrasound and CT after the guideline presentation (P = .05).
  
  
  CONCLUSIONS
  Decision support during a simulated pediatric scenario helped family physicians select imaging that lowered radiation exposure and was aligned with current guidelines, especially when presented with radiation information after guideline review. This information could help inform electronic medical record design.
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG). christopher.bunt@usuhs.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Bunt
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Harry B
authors.initials: HB
authors.lastname: Burke
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Towbin
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Albert
authors.initials: A
authors.lastname: Hoang
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Mark B
authors.initials: MB
authors.lastname: Stephens
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Paul
authors.initials: P
authors.lastname: Fontelo
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Gimbel
mesh_terms: D002648:Child; D020000:Decision Support Systems, Clinical; D004311:Double-Blind Method; D005194:Family Practice / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006417:Hematuria / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000069079:Radiation Exposure / Q000517:prevention & control* / Q000592:standards / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*
keywords: Clinical Decision Support Systems; Decision Making; Evidence-Based Medicine; Radiation; Radiology