title: Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department.
abstract: Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures.
  
  
  CONCLUSIONS
  Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.
authors.affiliation: Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands. d.geurts@erasmusmc.nl.
authors.forename: Dorien
authors.identifier: http://orcid.org/0000-0002-0536-6648
authors.initials: D
authors.lastname: Geurts
authors.affiliation: Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: de Vos-Kerkhof
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ewout
authors.initials: E
authors.lastname: Steyerberg
authors.affiliation: Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.affiliation: Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands.
authors.forename: Henriëtte
authors.initials: H
authors.lastname: Moll
authors.affiliation: Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D003661:Decision Support Techniques; D003681:Dehydration / Q000209:etiology / Q000451:nursing*; D003967:Diarrhea / Q000451:nursing; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000451:nursing*; D005759:Gastroenteritis / Q000150:complications / Q000451:nursing*; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D057184:Practice Patterns, Nurses'; D014839:Vomiting / Q000451:nursing
keywords: Acute gastroenteritis; Children; Clinical decision support system; Emergency department; Randomized control trial