Traumatic Brain Injury - Knowledge Translation

Phase 3

Completed

• Conditions: Traumatic Brain Injury
• Interventions: Other: Computerized clinical decision support

• Registration Number: NCT01453621
• Lead Sponsor: Columbia University

Brief Summary

Blunt head trauma (BHT) accounts for \>450,000 emergency department (ED) visits for children annually in the US. Fortunately, \>95% of head trauma in children is minor in nature. Although most children have minor head trauma, clinicians obtain cranial CTs in 35-50% of these children, which carries a radiation risk of malignancy. Recently, the investigators conducted a study of 44,000 children in the Pediatric Emergency Care Applied Research Network (PECARN) in which the investigators developed and validated clinical prediction rules that identify which children with minor BHT are at very low risk of having clinically-important traumatic brain injuries (TBI) and, therefore, do not require a CT scan. In this proposal, the investigators aim to assess whether implementing the PECARN TBI prediction rules (one for preverbal, one for verbal children) via computerized clinical decision support (CDS) decreases the number of (unnecessary) cranial CT scans obtained by ED physicians for children with minor BHT at very low risk of clinically-important TBIs. After a two-site pilot phase to test and refine the CDS, the investigators will conduct a seven-center prospective trial. The investigators will measure cranial CT use prior to and after the intervention implementation of CDS and clinician education. The investigators will study the use of CT by practitioners for children \<18 years for 12 months pre- and post-intervention.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2011-09-27
• Study First Submitted QC: 2011-10-17
• Study First Posted: 2011-10-18
• Study Start: 2011-11
• Primary Completion: 2014-07
• Study Completion: 2014-07
• Status Verified: 2015-04
• Last Update Submitted: 2015-04-15
• Last Update Posted: 2015-04-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 28669

Inclusion Criteria

Not provided

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Exclusion Criteria

Not provided

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Clinical decision support (post-intervention phase)	Computerized clinical decision support	Clinicians will receive computerized clinical decision support regarding the risk of clinically important traumatic brain injury (TBI) based on the prediction rules

Primary Outcome Measures

Name	Time	Method
Change in proportion of cranial CT use in children with minor blunt head trauma at very low risk of clinically important traumatic brain injuries	Baseline and 1 year post-intervention	The investigators will assess the rate of cranial CT use pre- and post implementation of computerized clinical decision support

Trial Locations

Locations (1)

Columbia University Medical Center; 🇺🇸 New York, New York, United States