1. Randomized Trial of a Clinical Decision Support System:
Impact on the Management of Children with Fever
without Apparent Source
JOLT ROUKEMA, MD, PHD, EWOUT W. STEYERBERG, PHD, JOHAN VAN DER LEI, MD, PHD,
HENRIËTTE A. MOLL, MD, PHD
J Am Med Inform Assoc. 2008;15:107–113.
Speaker : Yen-Chih Huang
Advisor : Yu-Chuan Li

2. Introduction
Fever Without apparent Source (FWS)
- body temperature ≧ 38.0 degrees Celsius
- no apparent source found after evaluation
Serious Bacterial Infection (SBI)
1 – 36 months
Sophia Children’s Hospital ( 2003.9.1 – 2005.12.31 )
Time spent at the ED
Identified SBI
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3. OpenSDE
http://www2.eur.nl/fgg/mi/OpenSDE/
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4. Two Rules
GP-referred (general practitioner)
Self-referred
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5. GP-referred
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6. Self-referred
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7. 1744 Febrile children,
1-36 months
375 chronic co-morbidity
1399 Eligible
716 not registered
683 CDSS - Registered
293 Fever with a clear source
390 Patients with FWS
218 Low risk-score
172 High risk-score & randomized
( Informed consent n = 164 )
74 Order laboratory tests 90 Routine evaluation by physician
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8. Methods
Randomization ( 1-1000 )
- odd : intervention group (order laboratory tests)
- even : control group
laboratory tests
- complete blood count (CBC)
- C-reactive protein (CRP)
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9. Measurements
ED time
- arrival time ～ departure time
Serious Bacterial Infection (SBI)
- culture or radiographically
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10. 1744 Febrile children,
Results 1-36 months
375 chronic co-morbidity
1399 Eligible
716 not registered
49% 683 CDSS - Registered
293 Fever with a clear source
57% 390 Patients with FWS
218 Low risk-score
172 High risk-score & randomized
( Informed consent n = 164 )
95% (164/172)
74 Order laboratory tests 90 Routine evaluation by physician
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11. Results
Laboratory tests:
- intervention group : 82% ( 61/74 )
- control group : 44% ( 40/90 )
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12. Results
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13. Results
30 patients missing time of arrival at or departure from the ED
(16 in the intervention group, 14 in the control group)
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14. Results
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15. Conclusion
Time constraints
ED nurses were aware the decision rule
FWS registration rate is relatively high
Laboratory tests affected diagnostic testing
The prediction rules need adjustment
Reduce false high-risk
Increasing the risk-score threshold
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16. 九
十
七
年
十
二
THANK YOU ！ 月
一
日
天
氣
：
陰
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