Use of Traumatic Brain Injury Prediction Rules With Clinical Decision Support.
OBJECTIVE
We determined whether implementing the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules and providing risks of clinically important TBIs (ciTBIs) with computerized clinical decision support (CDS) reduces computed tomography (CT) use for children with minor head trauma.


METHODS
Nonrandomized trial with concurrent controls at 5 pediatric emergency departments (PEDs) and 8 general EDs (GEDs) between November 2011 and June 2014. Patients were <18 years old with minor blunt head trauma. Intervention sites received CDS with CT recommendations and risks of ciTBI, both for patients at very low risk of ciTBI (no Pediatric Emergency Care Applied Research Network rule factors) and those not at very low risk. The primary outcome was the rate of CT, analyzed by site, controlling for time trend.


RESULTS
We analyzed 16 635 intervention and 2394 control patients. Adjusted for time trends, CT rates decreased significantly (P< .05) but modestly (2.3%-3.7%) at 2 of 4 intervention PEDs for children at very low risk. The other 2 PEDs had small (0.8%-1.5%) nonsignificant decreases. CT rates did not decrease consistently at the intervention GEDs, with low baseline CT rates (2.1%-4.0%) in those at very low risk. The control PED had little change in CT use in similar children (from 1.6% to 2.9%); the control GED showed a decrease in the CT rate (from 7.1% to 2.6%). For all children with minor head trauma, intervention sites had small decreases in CT rates (1.7%-6.2%).


CONCLUSIONS
The implementation of TBI prediction rules and provision of risks of ciTBIs by using CDS was associated with modest, safe, but variable decreases in CT use. However, some secular trends were also noted.
Division of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
Peter S
PS
Dayan
Kaiser Permanente, San Rafael Medical Center, San Rafael, California.|Division of Research, Kaiser Permanente, Oakland, California.
Dustin W
DW
Ballard
Section of Emergency Medicine, Department of Pediatrics, University of Colorado, Aurora, Colorado.
Eric
E
Tham
Nationwide Children's Hospital, Columbus, Ohio.
Jeff M
JM
Hoffman
Department of Research Informatics, Children's Hospital Colorado, Aurora, Colorado.
Marguerite
M
Swietlik
Department of Research Informatics, Children's Hospital Colorado, Aurora, Colorado.
Sara J
SJ
Deakyne
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Evaline A
EA
Alessandrini
Departments of Emergency Medicine and.|Pediatrics, University of California Davis School of Medicine, Sacramento, California.
Leah
L
Tzimenatos
Section of Emergency Medicine, Department of Pediatrics, University of Colorado, Aurora, Colorado.
Lalit
L
Bajaj
Division of Research, Kaiser Permanente, Oakland, California.|Kaiser Permanente, Roseville Medical Center, Roseville, California.
David R
DR
Vinson
Kaiser Permanente, Oakland Medical Center, Oakland, California.
Dustin G
DG
Mark
Kaiser Permanente, South Sacramento Medical Center, Sacramento, California,.
Steve R
SR
Offerman
Kaiser Permanente, South San Francisco Medical Center, San Francisco, California.
Uli K
UK
Chettipally
Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Marilyn D
MD
Paterno
Information Systems, Partners HealthCare System, Boston, Massachusetts.
Molly H
MH
Schaeffer
Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
Jun
J
Wang
Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
T Charles
TC
Casper
Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Information Systems, Partners HealthCare System, Boston, Massachusetts.
Howard S
HS
Goldberg
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Robert W
RW
Grundmeier
Departments of Emergency Medicine and.|Pediatrics, University of California Davis School of Medicine, Sacramento, California.
Nathan
N
Kuppermann
D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*