Impact of clinical decision support on head computed tomography use in patients with mild traumatic brain injury in the ED
This is a review of research article, “Impact of clinical decision support on head computed tomography use in patients with mild traumatic brain injury in the ED by Ivan et al “.
Around 1.2 million outpatient visits occurs for mild traumatic brain injuries in the EDs. Most of the patients undergo unnecessary head CT scan although most patients have no clinical consequence. It leads to over diagnosis and unnecessary cost to the patients and hospitals.
The observational cohort study was performed at academic quaternary care ,793 bed ,level 1 trauma center in between January 1,2009 and December 31,2010.This study has included all adult ED patient with a discharge diagnosis of MTBI.A control cohort consisting of ED patients with MTBI abstracted from most recent publicly available National Hospital Ambulatory Medical Care Survey (NHAMCS) during study period. A real time computerized CDS was installed in the institutional imaging computerized physician order entry (CPOE) for intervention purpose.
The study result observed a decrease in the utilization rate of head CT scans among the patient with MTBI after intervention of CDS. In the pre-intervention, 58.1% of MTBI ED visits (n = 372/640) were associated with a head CT being performed, whereas in the post-CDS intervention, utilization decreased to a rate of 50.3% (n = 333/662).
Implementation of CDS for MTBI patients is associated with significant decrease in head CT use.
This study didn’t mention how did they manage unintended consequences such as changes in workflow, communication changes, duplicate errors on implementation of CPOE and CDS system.
- Ivan K. Ip, Ali S. Raja, Anurag Gupta, James Andruchow, Aaron Sodickson, Ramin Khorasani, Impact of clinical decision support on head computed tomography use in patients with mild traumatic brain injury in the ED, The American Journal of Emergency Medicine, Available online 12 November 2014, ISSN 0735-6757, http://dx.doi.org/10.1016/j.ajem.2014.11.005. (http://www.sciencedirect.com/science/article/pii/S0735675714007943).