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Randomized Trial of a Clinical Decision Support System

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Randomized Trial of a Clinical Decision Support System

  1. 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. 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 Page 2
  3. 3. OpenSDE http://www2.eur.nl/fgg/mi/OpenSDE/ Page 3
  4. 4. Two Rules GP-referred (general practitioner) Self-referred Page 4
  5. 5. GP-referred Page 5
  6. 6. Self-referred Page 6
  7. 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 Page 7
  8. 8. Methods Randomization ( 1-1000 ) - odd : intervention group (order laboratory tests) - even : control group laboratory tests - complete blood count (CBC) - C-reactive protein (CRP) Page 8
  9. 9. Measurements ED time - arrival time ~ departure time Serious Bacterial Infection (SBI) - culture or radiographically Page 9
  10. 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 Page 10
  11. 11. Results Laboratory tests: - intervention group : 82% ( 61/74 ) - control group : 44% ( 40/90 ) Page 11
  12. 12. Results Page 12
  13. 13. Results 30 patients missing time of arrival at or departure from the ED (16 in the intervention group, 14 in the control group) Page 13
  14. 14. Results Page 14
  15. 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 Page 15
  16. 16. 九 十 七 年 十 二 THANK YOU ! 月 一 日 天 氣 : 陰 Page 16

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