{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T01:53:10Z","timestamp":1777513990760,"version":"3.51.4"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,4,12]],"date-time":"2018-04-12T00:00:00Z","timestamp":1523491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["AD-12-11-4956"],"award-info":[{"award-number":["AD-12-11-4956"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the effect of a previously validated electronic health record-based child abuse trigger system on physician compliance with clinical guidelines for evaluation of physical abuse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A randomized controlled trial (RCT) with comparison to a preintervention group was performed. RCT-experimental subjects\u2019 providers received alerts with a direct link to a physical abuse-specific order set. RCT-control subjects\u2019 providers had no alerts, but could manually search for the order set. Preintervention subjects\u2019 providers had neither alerts nor access to the order set. Compliance with clinical guidelines was calculated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ninety-nine preintervention subjects and 130 RCT subjects (73 RCT-experimental and 57 RCT-control) met criteria to undergo a physical abuse evaluation. Full compliance with clinical guidelines was 84% pre-intervention, 86% in RCT-control group, and 89% in RCT-experimental group. The physical abuse order set was used 43 times during the 7-month RCT. When the abuse order set was used, full compliance was 100%. The proportion of cases in which there was partial compliance decreased from 10% to 3% once the order set became available (P\u2009=\u2009.04). Male gender, having &amp;gt;10 years of experience and completion of a pediatric emergency medicine fellowship were associated with increased compliance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\/Conclusion<\/jats:title>\n                  <jats:p>A child abuse clinical decision support system comprised of a trigger system, alerts and a physical abuse order set was quickly accepted into clinical practice. Use of the physical abuse order set always resulted in full compliance with clinical guidelines. Given the high baseline compliance at our site, evaluation of this alert system in hospitals with lower baseline compliance rates will be more valuable in assessing the efficacy in adherence to clinical guidelines for the evaluation of suspected child abuse.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy025","type":"journal-article","created":{"date-parts":[[2018,3,7]],"date-time":"2018-03-07T20:31:17Z","timestamp":1520454677000},"page":"833-840","source":"Crossref","is-referenced-by-count":39,"title":["Integration of physical abuse clinical decision support into the electronic health record at a Tertiary Care Children\u2019s Hospital"],"prefix":"10.1093","volume":"25","author":[{"given":"Srinivasan","family":"Suresh","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A","family":"Saladino","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Fromkin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Heineman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"McGinn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolph","family":"Richichi","sequence":"additional","affiliation":[{"name":"Statistical Analysis and Measurement Consultants Inc., Alexandria, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel P","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,4,12]]},"reference":[{"key":"2020110612361350000_ocy025-B1","volume-title":"Cancer in Children","author":"American Cancer Society","year":"2012"},{"issue":"7","key":"2020110612361350000_ocy025-B2","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.281.7.621","article-title":"Analysis of missed cases of abusive head trauma","volume":"281","author":"Jenny","year":"1999","journal-title":"JAMA"},{"issue":"1","key":"2020110612361350000_ocy025-B3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1542\/peds.2008-3794","article-title":"Delayed identification of pediatric abuse-related fractures","volume":"125","author":"Ravichandiran","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"2020110612361350000_ocy025-B4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/01.pec.0000208180.94166.dd","article-title":"Child abuse fatalities: are we missing opportunities for intervention?","volume":"22","author":"King","year":"2006","journal-title":"Pediatr Emerg Care"},{"issue":"12","key":"2020110612361350000_ocy025-B5","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1097\/PEC.0b013e3181c06217","article-title":"Bruising in infants: those with a bruise may be abused","volume":"25","author":"Pierce","year":"2009","journal-title":"Pediatr Emerg Care."},{"issue":"10","key":"2020110612361350000_ocy025-B6","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1097\/PEC.0b013e3181568039","article-title":"Frena tears and abusive head injury: a cautionary tale","volume":"23","author":"Thackeray","year":"2007","journal-title":"Pediatr Emerg Care"},{"issue":"12","key":"2020110612361350000_ocy025-B7","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/PEC.0b013e31818e9f5d","article-title":"Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse","volume":"24","author":"Oral","year":"2008","journal-title":"Pediatr Emerg Care"},{"issue":"5","key":"2020110612361350000_ocy025-B8","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpeds.2010.04.072","article-title":"Abusive head trauma in children presenting with an apparent life-threatening event","volume":"157","author":"Guenther","year":"2010","journal-title":"J Pediatr"},{"issue":"2","key":"2020110612361350000_ocy025-B9","doi-asserted-by":"crossref","first-page":"e477","DOI":"10.1542\/peds.2013-3793","article-title":"Evaluating children with fractures for child physical abuse","volume":"133","author":"Flaherty","year":"2014","journal-title":"Pediatrics"},{"issue":"4","key":"2020110612361350000_ocy025-B10","doi-asserted-by":"crossref","first-page":"e1314","DOI":"10.1542\/peds.2013-0195","article-title":"Evaluation for bleeding disorders in suspected child abuse","volume":"131","author":"Anderst","year":"2013","journal-title":"Pediatrics"},{"issue":"5","key":"2020110612361350000_ocy025-B11","doi-asserted-by":"crossref","first-page":"e1337","DOI":"10.1542\/peds.2015-0356","article-title":"The evaluation of suspected child physical abuse","volume":"135","author":"Christian","year":"2015","journal-title":"Pediatrics"},{"issue":"3","key":"2020110612361350000_ocy025-B12","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1542\/peds.2004-2731","article-title":"Variation in the diagnosis of child abuse in severely injured infants","volume":"117","author":"Trokel","year":"2006","journal-title":"Pediatrics"},{"issue":"5","key":"2020110612361350000_ocy025-B13","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1542\/peds.2012-0244","article-title":"Variation in occult injury screening for children with suspected abuse in selected US Children's Hospitals","volume":"130","author":"Wood","year":"2012","journal-title":"Pediatrics"},{"key":"2020110612361350000_ocy025-B14","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/BLO.0b013e31805c0849","article-title":"What factors affect the identification and reporting of child abuse-related fractures?","volume":"461","author":"Lane","year":"2007","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"2020110612361350000_ocy025-B15","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.jpedsurg.2009.02.044","article-title":"Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline","volume":"44","author":"Rangel","year":"2009","journal-title":"J Pediatr Surgery"},{"issue":"13","key":"2020110612361350000_ocy025-B16","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1001\/jama.288.13.1603","article-title":"Racial differences in the evaluation of pediatric fractures for physical abuse","volume":"288","author":"Lane","year":"2002","journal-title":"JAMA"},{"issue":"3","key":"2020110612361350000_ocy025-B17","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1542\/peds.2010-0031","article-title":"Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury","volume":"126","author":"Wood","year":"2010","journal-title":"Pediatrics"},{"issue":"2","key":"2020110612361350000_ocy025-B18","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1542\/peds.2008-2467","article-title":"Skeletal surveys in infants with isolated skull fractures","volume":"123","author":"Wood","year":"2009","journal-title":"Pediatrics"},{"issue":"3","key":"2020110612361350000_ocy025-B19","first-page":"1","article-title":"Development of an electronic medical record-based child physical abuse alert system","volume":"6","author":"Berger","year":"2017","journal-title":"J Am Med Inform Assoc"},{"issue":"7","key":"2020110612361350000_ocy025-B20","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.chiabu.2013.11.005","article-title":"Accuracy of a screening instrument to identify potential child abuse in emergency departments","volume":"38","author":"Louwers","year":"2014","journal-title":"Child Abuse Neglect"},{"issue":"5","key":"2020110612361350000_ocy025-B21","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.annemergmed.2015.06.020","article-title":"Barriers and facilitators to detecting child abuse and neglect in general emergency departments","volume":"66","author":"Tiyyagura","year":"2015","journal-title":"Ann Emerg Med"},{"issue":"3","key":"2020110612361350000_ocy025-B22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1136\/emermed-2013-202733","article-title":"Screening methods to detect child maltreatment: high variability in Dutch emergency departments","volume":"31","author":"Hoytema van Konijnenburg","year":"2014","journal-title":"Emerg Med J"},{"key":"2020110612361350000_ocy025-B23","volume-title":"Non-federal Acute Care Hospital Electronic Health Record Adoption","author":"Office of the National Coordinator for Health Information Technology"},{"key":"2020110612361350000_ocy025-B24"},{"issue":"11","key":"2020110612361350000_ocy025-B25","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.ijmedinf.2012.02.009","article-title":"Integrating usability testing and think-aloud protocol analysis with \u201cnear-live\u201d clinical simulations in evaluating clinical decision support","volume":"81","author":"Li","year":"2012","journal-title":"Int J Med Inform"},{"key":"2020110612361350000_ocy025-B26","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/1748-5908-6-109","article-title":"Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care","volume":"6","author":"Mann","year":"2011","journal-title":"Implement Sci"},{"issue":"2","key":"2020110612361350000_ocy025-B27","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.2196\/humanfactors.4537","article-title":"Usability testing of a complex clinical decision support tool in the emergency department: lessons learned","volume":"2","author":"Press","year":"2015","journal-title":"JMIR Human Factors"},{"issue":"1","key":"2020110612361350000_ocy025-B28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/ebmed-2015-110214","article-title":"Formative assessment and design of a complex clinical decision support tool for pulmonary embolism","volume":"21","author":"Khan","year":"2016","journal-title":"Evid Based Med"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/833\/34150267\/ocy025.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/833\/34150267\/ocy025.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T17:42:58Z","timestamp":1604684578000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/7\/833\/4969337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,12]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,4,12]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocy025","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,7]]},"published":{"date-parts":[[2018,4,12]]}}}