{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:39:41Z","timestamp":1773290381921,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T00:00:00Z","timestamp":1550534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01 NS072308-05"],"award-info":[{"award-number":["R01 NS072308-05"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Traumatic brain injury anesthesia care is complex. The use of clinical decision support to improve pediatric trauma care has not been examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this study was to examine feasibility, reliability, and key performance indicators for traumatic brain injury anesthesia care using clinical decision support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical decision support was activated for patients under 19\u00a0years undergoing craniotomy for suspected traumatic brain injury. Anesthesia providers were prompted to adhere to process measures via on\u2010screen alerts and notified in real time of abnormal monitor data or laboratory results (unwanted key performance indicator events). Process measures pertained to arterial line placement and blood gas draws, neuromuscular blockade, hypotension, anemia, coagulopathy, hyperglycemia, and intracranial hypertension. Unwanted key performance indicators were: hypotension, hypoxia, hypocarbia, hypercarbia, hypothermia, hyperthermia, anesthetic agent overdose; hypoxemia, coagulopathy, anemia, and hyperglycemia. Anesthesia records, vital signs, and alert logs were reviewed for 39 anesthetic cases (19 without clinical decision support and 20 with clinical decision support).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 35 patients aged 11\u00a0months to 17\u00a0years and 77% males were examined. Clinical decision support reliably identified 39\/46 eligible anesthetic cases, with 85% sensitivity and 100% specificity, and was highly sensitive, detecting 89% of monitor key performance indicator events and 100% of reported lab key performance indicator events. There were no false positive alerts. Median event duration was lower in the \u201cwith clinical decision support\u201d group for 4\/7 key performance indicators. Second insult duration was lower for duration of hypocarbia (by 44%), hypotension (29%), hypothermia (12%), and hyperthermia (15%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Use of clinical decision support in pediatric traumatic brain injury anesthesia care is feasible, reliable, and may have the potential to improve key performance indicator outcomes. This observational study suggests the possibility of clinical decision support as a strategy to reduce second insults and improve traumatic brain injury guideline adherence during pediatric anesthesia care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13580","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T18:50:24Z","timestamp":1546627824000},"page":"271-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Feasibility and indicator outcomes using computerized clinical decision support in pediatric traumatic brain injury anesthesia care"],"prefix":"10.1111","volume":"29","author":[{"given":"Ashley A.","family":"Colletti","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine University of Washington Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2544-4735","authenticated-orcid":false,"given":"Taniga","family":"Kiatchai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine University of Washington Seattle Washington"},{"name":"Harborview Injury Prevention and Research Center Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian H.","family":"Lyons","sequence":"additional","affiliation":[{"name":"Harborview Injury Prevention and Research Center Seattle Washington"},{"name":"Department of Epidemiology University of Washington Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bala G.","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine University of Washington Seattle Washington"},{"name":"Harborview Injury Prevention and Research Center Seattle Washington"},{"name":"Center for Perioperative &amp; Pain Initiatives in Quality, Safety, Outcome Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary M.","family":"Grant","sequence":"additional","affiliation":[{"name":"Clinical Education Harborview Medical Center Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2354-5279","authenticated-orcid":false,"given":"Monica S.","family":"Vavilala","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine University of Washington Seattle Washington"},{"name":"Harborview Injury Prevention and Research Center Seattle Washington"},{"name":"Center for Perioperative &amp; Pain Initiatives in Quality, Safety, Outcome Seattle Washington"},{"name":"Department of Pediatrics University of Washington Seattle Washington"},{"name":"Department of Neurological Surgery and Global Health Medicine University of Washington Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc.5571"},{"key":"e_1_2_8_3_1","article-title":"Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents","volume":"4","author":"Adelson PD","year":"2003","journal-title":"Paediatr Crit Care Med"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e318259ee85"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12415"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000507"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjquality.u213581.w5431"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2012.2716"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181f46d89"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2012.2205384"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-015-9718-3"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000027"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000677"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2010.11.002"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2011.05.003"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.4338\/ACI-2016-10-RA-0164"},{"key":"e_1_2_8_17_1","unstructured":"Level I trauma services [Internet].Univeristy of Washington Medicine Provider Resource.2017[cited 01 May 2017].http:\/\/providerresource.uwmedicine.org\/flexpaper\/level-i-trauma-services."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e32834c15b6"},{"key":"e_1_2_8_19_1","first-page":"487","article-title":"Advanced integrated real\u2010time clinical displays","volume":"29","author":"Kruger GH","year":"2011","journal-title":"Anesthesiol Clin"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocv144"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001636"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000858"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpan.13580","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.13580","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T09:11:42Z","timestamp":1694682702000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.13580"}},"subtitle":[],"editor":[{"given":"Joseph","family":"Cravero","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2019,2,19]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1111\/pan.13580"],"URL":"https:\/\/doi.org\/10.1111\/pan.13580","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,19]]},"assertion":[{"value":"2017-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}