{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:27:35Z","timestamp":1793345255207,"version":"4.5.0"},"reference-count":40,"publisher":"Walter de Gruyter GmbH","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"j_jpem-2018-0566_s_999\"><jats:title id=\"d2783957e44440\">Background<\/jats:title><jats:p>Many barriers exist to the appropriate recognition and management of life-threatening adrenal crisis in the emergency department (ED). Clinical decision support (CDS) is a health information technology (IT) component that provides useful information to providers as healthcare is being delivered. We hypothesized that CDS incorporated into the electronic health record (EHR) could improve the recognition and management of adrenal crisis within the pediatric ED.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0566_s_998\"><jats:title id=\"d2783957e44448\">Methods<\/jats:title><jats:p>We retrospectively analyzed the impact of electronic CDS on the management of patients with known adrenal insufficiency (AI) presenting to two pediatric ED locations over a 19-month period with symptoms suggestive of adrenal crisis. Outcome variables assessed included the frequency of hydrocortisone (HC) administration, appropriateness of HC dosing, and timing to HC order placement and administration.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0566_s_997\"><jats:title id=\"d2783957e44456\">Results<\/jats:title><jats:p>A total of 145 encounters were reviewed. When the electronic CDS was in place at the time of the ED visit, patients were nearly 3 times as likely to receive HC (p\u2009=\u20090.002). Among those patients who received HC, the presence of the CDS increased the likelihood of an appropriate 50-mg\/m<jats:sup>2<\/jats:sup>dose of HC being given from 20 to 53% (p\u2009=\u20090.02). However, the CDS did not significantly reduce the time from ED arrival to HC order placement (p\u2009=\u20090.36) or administration (p\u2009=\u20090.59).<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0566_s_996\"><jats:title id=\"d2783957e44467\">Conclusions<\/jats:title><jats:p>The use of innovative health IT strategies, such as the electronic CDS, can improve the recognition and management of adrenal crisis among patients with AI presenting to the pediatric ED.<\/jats:p><\/jats:sec>","DOI":"10.1515\/jpem-2018-0566","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T09:02:30Z","timestamp":1556701350000},"page":"513-518","source":"Crossref","is-referenced-by-count":5,"title":["Utilizing health information technology to improve the recognition and management of life-threatening adrenal crisis in the pediatric emergency department: medical alert identification in the 21st century"],"prefix":"10.1515","volume":"32","author":[{"given":"Kelsee L.","family":"Halpin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily L.","family":"Paprocki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"McDonough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","reference":[{"key":"ref51","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1515\/jpem-2017-0435","article-title":"Improved medical-alert ID ownership and utilization in youth with congenital adrenal hyperplasia following a parent educational intervention","volume":"31","year":"2018","journal-title":"J Pediatr Endocrinol Metab"},{"key":"ref301","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.ando.2018.04.015","article-title":"Acute adrenal crisis and mortality in adrenal insufficiency: still a concern in 2018!","volume":"79","year":"2018","journal-title":"Ann Endocrinol (Paris)"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ejim.2014.11.006","article-title":"A European emergency card for adrenal insufficiency can save lives","volume":"26","year":"2015","journal-title":"Eur J Intern Med"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"e6333","DOI":"10.1136\/bmj.e6333","article-title":"How to avoid precipitating an acute adrenal crisis","volume":"345","year":"2012","journal-title":"Br Med J"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/jamia\/ocw086","article-title":"Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records","volume":"24","year":"2017","journal-title":"J Am Med Inform Assoc"},{"key":"ref231","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ejim.2014.11.006","article-title":"A European emergency card for adrenal insufficiency can save lives","volume":"26","year":"2015","journal-title":"Eur J Intern Med"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.ando.2017.10.010","article-title":"Group 1. Epidemiology of primary and secondary adrenal insufficiency: prevalence and incidence, acute adrenal insufficiency, long-term morbidity and mortality","volume":"78","year":"2017","journal-title":"Ann Endocrinol (Paris)"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/joim.12162","article-title":"Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency","volume":"275","year":"2014","journal-title":"J Intern Med"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1365-2516.2010.02415.x","article-title":"Use of emergency medical identification in the paediatric haemophilia population: a national study","volume":"17","year":"2011","journal-title":"Haemophilia"},{"key":"ref351","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/jamia\/ocw151","article-title":"The use of computerized clinical decision support systems in emergency care: a substantive review of the literature","volume":"24","year":"2017","journal-title":"J Am Med Inform Assoc"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.apergo.2009.12.006","article-title":"Reflective analysis of safety research in the hospital accident & emergency departments","volume":"41","year":"2010","journal-title":"Appl Ergon"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/PEC.0000000000001069","article-title":"Implementation of an electronic clinical decision support tool for pediatric appendicitis within a hospital network","volume":"34","year":"2018","journal-title":"Pediatric Emerg Care"},{"key":"ref241","first-page":"448","article-title":"The key to adrenal insufficiency education: repetition, repetition, repetition","volume":"14","year":"2017","journal-title":"Pediatr Endocrinol Rev"},{"key":"ref341","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1136\/bmjqs-2017-007333","article-title":"Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study","volume":"27","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"ref401","doi-asserted-by":"crossref","first-page":"557","DOI":"10.5811\/westjem.2015.4.25760","article-title":"Importance of decision support implementation in emergency department vancomycin dosing","volume":"16","year":"2015","journal-title":"West J Emerg Med"},{"key":"ref411","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/cen.12609","article-title":"Timelines in the management of adrenal crisis \u2013 targets, limits and reality","volume":"82","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref311","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/joim.12162","article-title":"Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency","volume":"275","year":"2014","journal-title":"J Intern Med"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline","volume":"101","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1136\/bmjqs-2017-007333","article-title":"Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study","volume":"27","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"258","DOI":"10.7861\/clinmedicine.17-3-258","article-title":"Adrenal insufficiency \u2013 recognition and management","volume":"17","year":"2017","journal-title":"Clin Med (Lond)"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1210\/jc.2014-3191","article-title":"High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study","volume":"100","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"e6333","DOI":"10.1136\/bmj.e6333","article-title":"How to avoid precipitating an acute adrenal crisis","volume":"345","year":"2012","journal-title":"Br Med J"},{"key":"ref391","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/1062860614557636","article-title":"Clinical decision support for early recognition of sepsis","volume":"31","year":"2016","journal-title":"Am J Med Qual"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.ando.2017.10.010","article-title":"Group 1. 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