title: Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection: A Multi-Center Study of Clinical Decision Support for Children with Head Trauma.
abstract: BACKGROUND
  Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts.
  
  
  OBJECTIVE
  To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR.
  
  
  METHODS
  As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity.
  
  
  RESULTS
  Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75-89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites.
  
  
  CONCLUSIONS
  CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.
authors.affiliation: Children's Hospital Colorado , Department of Research Informatics, Aurora, Colorado, United States.
authors.forename: S J
authors.initials: SJ
authors.lastname: Deakyne
authors.affiliation: University of Colorado , Department of Pediatrics, Section of Emergency Medicine, Aurora, Colorado, United States.
authors.forename: L
authors.initials: L
authors.lastname: Bajaj
authors.affiliation: Nationwide Children's Hospital , Columbus, Ohio, United States.
authors.forename: J
authors.initials: J
authors.lastname: Hoffman
authors.affiliation: Children's Hospital Medical Center , Cincinnati, Ohio, United States.
authors.forename: E
authors.initials: E
authors.lastname: Alessandrini
authors.affiliation: Kaiser Permanente, San Rafael Medical Center , San Rafael, California, United States.
authors.forename: D W
authors.initials: DW
authors.lastname: Ballard
authors.affiliation: Kaiser Permanente, Sacramento Medical Center , Sacramento, California, United States.
authors.forename: R
authors.initials: R
authors.lastname: Norris
authors.affiliation: University of California Davis School of Medicine , Departments of Emergency Medicine and Pediatrics, Sacramento, California, United States.
authors.forename: L
authors.initials: L
authors.lastname: Tzimenatos
authors.affiliation: Children's Hospital Colorado , Department of Clinical Application Services, Aurora, Colorado, United States.
authors.forename: M
authors.initials: M
authors.lastname: Swietlik
authors.affiliation: University of Colorado , Department of Pediatrics, Section of Emergency Medicine, Aurora, Colorado, United States.
authors.forename: E
authors.initials: E
authors.lastname: Tham
authors.affiliation: Children's Hospital of Philadelphia and Perelman School of Medicine , Philadelphia, Pennsylvania, United States.
authors.forename: R W
authors.initials: RW
authors.lastname: Grundmeier
authors.affiliation: University of California Davis School of Medicine , Departments of Emergency Medicine and Pediatrics, Sacramento, California, United States.
authors.forename: N
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: Columbia University College of Physicians and Surgeons , Department of Pediatrics, Division of Emergency Medicine, New York, New York, United States.
authors.forename: P S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000451:nursing; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D000069342:Medical Overuse / Q000517:prevention & control*; D011859:Radiography
keywords: Head trauma; chief complaints; electronic health record; sensitivity and specificity