EHR-based Decision Support for Pediatric Acute Abdominal Pain in Emergency Care
Condition: Appendicitis
MeSH terms: Appendicitis; Emergencies; Abdominal Pain; Abdomen, Acute
Study type: Interventional

Summary: 
      Although appendicitis is the most common surgical emergency in children, its diagnosis
      remains a challenge and thus, emergency department (ED) providers increasingly rely on
      computed tomography to distinguish appendicitis from other conditions. This project (a) uses
      electronic health record (EHR) technology to deliver patient-specific clinical decision
      support to ED providers at the point of care, (b) assesses the impact of this intervention on
      the use of diagnostic imaging and clinical outcomes, and (c) assesses the impact of the
      intervention on the costs of care delivered. This innovative project will be a template for
      extending EHR-based clinical decision support to other domains of emergency care to
      ultimately improve a broad range of pediatric acute care outcomes.

      The proposed intervention, referred to as appy-CDS, is specifically designed for widespread
      use in EDs and could reduce reliance on advanced diagnostic imaging for pediatric and
      adolescent patients with acute abdominal pain while maintaining or improving clinical
      outcomes. Investigators aim to develop and implement an interactive, evidence-based clinical
      decision support tool to optimize care for children and adolescents presenting to a general
      or non-pediatric ED with acute abdominal pain.
    

Detailed description: 
      Abdominal pain is one of the most common reasons for children and adolescents to seek care in
      the emergency department (ED). Computed tomography (CT) has been promoted as a method to
      improve diagnostic accuracy when evaluating patients with acute abdominal pain. In the past
      20 years, CT use has increased dramatically, especially for children receiving care in
      general ED settings. Although in some adult cohorts, increased CT use has been associated
      with decreased rates of negative appendectomies, similar improvements in health outcomes
      among children with acute abdominal pain have not occurred. Negative consequences of CT
      include increased costs and substantial exposure to ionizing radiation.

      Although appendicitis is the most common surgical emergency in children, its diagnosis
      remains a challenge and thus, emergency department (ED) providers increasingly rely on
      computed tomography to distinguish appendicitis from other conditions. This project (a) uses
      electronic health record (EHR) technology to deliver patient-specific clinical decision
      support to ED providers at the point of care, (b) assesses the impact of this intervention on
      the use of diagnostic imaging and clinical outcomes, and (c) assesses the impact of the
      intervention on the costs of care delivered.

      The proposed intervention, referred to as appy-CDS, is specifically designed for widespread
      use in EDs and could reduce reliance on advanced diagnostic imaging for pediatric and
      adolescent patients with acute abdominal pain while maintaining or improving clinical
      outcomes. This cluster randomized trial builds on more than 10 years of work on derivation
      and validation of ED-based clinical decision rules, previous successful outpatient and
      emergency department clinical decision support interventions, and complex economic and
      statistical analyses of risk assessment and ED resource use. In this project, the
      investigators aim to extend the benefits of previous efforts by developing and implementing
      an interactive, evidence-based clinical decision support tool to optimize care for children
      and adolescents presenting to a general or non-pediatric ED with acute abdominal pain. The
      results of this project will extend the understanding of how to maximize the clinical return
      on massive public and private sector investments being made in sophisticated EHR systems. If
      successful, this flexible decision support tool could be adapted and implemented broadly in a
      range of acute care settings to both standardize and personalize care delivered to pediatric
      patients.
    

Intervention name(s): Appy CDS
Intervention type(s): Other
Intervention description(s): See description under arm/group section
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel cluster-randomized clinical trial at 14 general EDs in two large care system to evaluate the impact of appy-CDS intervention with a pre and post intervention phases
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Clinical Decision Support