Randomized Trial of a Clinical Decision Support System
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Randomized Trial of a Clinical Decision Support System:
JOLT ROUKEMA, MD, PHD, EWOUT W. STEYERBERG, PHD, JOHAN VAN DER LEI, MD, PHD, HENRIËTTE A. MOLL, MD, PHD
Impact on the Management of Children with Fever without Apparent Source
J Am Med Inform Assoc. 2008;15:107–113.
Speaker : Yen-Chih Huang Advisor : Yu-Chuan Li
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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OpenSDE
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http://www2.eur.nl/fgg/mi/OpenSDE/
Two Rules
GP-referred (general practitioner)Self-referred
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GP-referred
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Self-referred
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1744 Febrile children, 1-36 months
1399 Eligible
683 CDSS - Registered
390 Patients with FWS
172 High risk-score & randomized( Informed consent n = 164 )
375 chronic co-morbidity
716 not registered
293 Fever with a clear source
218 Low risk-score
74 Order laboratory tests 90 Routine evaluation by physician
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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Measurements
ED time- arrival time ～ departure time
Serious Bacterial Infection (SBI) - culture or radiographically
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1744 Febrile children, 1-36 months
1399 Eligible
683 CDSS - Registered
390 Patients with FWS
172 High risk-score & randomized( Informed consent n = 164 )
375 chronic co-morbidity
716 not registered
293 Fever with a clear source
218 Low risk-score
74 Order laboratory tests 90 Routine evaluation by physician
49%
57%
95% (164/172)
Results
Results
Laboratory tests:- intervention group : 82% ( 61/74 )- control group : 44% ( 40/90 )
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Results
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Results
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30 patients missing time of arrival at or departure from the ED(16 in the intervention group, 14 in the control group)
Results
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Conclusion
Time constraintsED nurses were aware the decision ruleFWS registration rate is relatively highLaboratory tests affected diagnostic testing
The prediction rules need adjustmentReduce false high-riskIncreasing the risk-score threshold
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THANK YOU ！
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九十七年十二月一日
天氣：陰
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