Blunt head trauma is a leading cause of mortality and morbidity in children. However, greater than 95% of the more than 450,000 children who present to US emergency departments annually with blunt head trauma have minor head trauma. Although important traumatic brain injuries (TBI) are infrequent, clinicians obtain cranial computed tomography (CT) in up to 50% of children with minor blunt head trauma, exposing them to radiation with its potential to induce malignancies. Given the substantial burden of blunt head trauma to families and society, as well as the importance of minimizing radiation exposure, this study will investigate whether implementation of the recently validated Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules using computerized clinical decision support can decrease unnecessary use of CT in children with minor blunt head trauma. The overall goal of this study is to promote the appropriate use of CT for children with blunt head trauma by creating a generalizable model to translate evidence into clinical practice.
The study objectives are:
- To rigorously develop an integrated electronic health record blunt head trauma data collection template and computer-based clinical decision support system to implement the PECARN TBI prediction rules for children; and,
- To assess whether implementing the prediction rules via computerized clinical decision support decreases the number of (unnecessary) cranial CTs in children with minor blunt head trauma at very low risk of traumatic brain injuries.
In order to meet study objective one, we will conduct focus groups of clinicians and perform emergency department workflow evaluations; develop an electronic health record blunt head trauma template that captures patient encounter data; and develop computerized clinical decision support to provide CT recommendations. Subsequently (in order to meet objective two), we will conduct a seven–center prospective, interrupted time series trial with concurrent controls that assesses CT use prior to and after the implementation of the electronic health record-clinical decision support (EHR-CDS) intervention system. We hypothesize that the EHR-CDS intervention system will safely decrease the use of CT compared to passive diffusion. This project is funded by the American Recovery and Reinvestment Act—Office of the Secretary (ARRA OS): Grant #S02MC19289-01-00.