Abstract
Background:Appendicitis is a common surgical emergency in children, yet diagnosis can be challenging. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN).Objectives:To describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool’s Triage component, aiming to identify pediatric patients at increased risk for appendicitis.Results:Despite differences by site in design and implementation, such as the use of alerts, incorporating gestalt, and other workflow variations across sites, using simple screening questions and automated exclusions, both systems were able to identify a population with similar appendicitis rates (11.8 percent and 10.6 percent), where use of the full Appy CDS would be indicated.Discussion:These 2 HCSRN sites designed Appy CDS to capture a population at risk for appendicitis and deliver CDS to that population while remaining locally relevant and adhering to organizational preferences. Despite different approaches to point-of-care CDS, the sites have identified similar cohorts with nearly identical background rates of appendicitis.Next Steps:The full Appy CDS tool, providing personalized risk assessment and tailored recommendations, is undergoing evaluation as part of a pragmatic cluster randomized trial aiming to reduce reliance on advanced diagnostic imaging. The novel approaches to CDS we present could serve as the basis for future ED interventions.
Highlights
Abdominal pain is a common reason for children and adolescents to seek care in the emergency department (ED) [1]
We have developed and validated a pediatric appendicitis risk calculator, which can accurately predict risk for appendicitis in pediatric patients presenting to the ED [13]
Results of Triage clinical decision support (CDS) The purpose of the Triage Alert (Triage-based trigger) is to reliably identify a study cohort at elevated risk for appendicitis at both the intervention and control EDs. This cohort comprises the analytic sample that will be used to determine the impact of the full Appy CDS system on computed tomography (CT) and US use
Summary
In some adult cohorts, increased use of diagnostic imaging has been associated with decreases in negative appendectomies, similar improvements in health outcomes among children with acute abdominal pain have not occurred [4,5,6,7]. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN). Objectives: To describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool’s Triage component, aiming to identify pediatric patients at increased risk for appendicitis. The novel approaches to CDS we present could serve as the basis for future ED interventions
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