{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T07:00:17Z","timestamp":1768287617071,"version":"3.49.0"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"American Recovery and Reinvestment Act-Office of the Secretary (ARRA OS)","award":["#S02MC19289\u201301\u201300"],"award-info":[{"award-number":["#S02MC19289\u201301\u201300"]}]},{"name":"Health Resources and Services Administration (HRSA)"},{"name":"Maternal and Child Health Bureau (MCHB)"},{"name":"Emergency Medical Services for Children (EMSC)","award":["U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685"],"award-info":[{"award-number":["U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial.<\/jats:p><jats:p>Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic\u00ae EHR. All sites implementing EHR-based CDS built the rules by using the vendor\u2019s CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations.<\/jats:p><jats:p>The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed.<\/jats:p><jats:p>The process of a centralized build and export of a CDS system in one commercial EHR system successfully supported a multicenter clinical trial.<\/jats:p>","DOI":"10.4338\/aci-2015-10-cr-0144","type":"journal-article","created":{"date-parts":[[2016,6,15]],"date-time":"2016-06-15T14:00:39Z","timestamp":1465999239000},"page":"534-542","source":"Crossref","is-referenced-by-count":15,"title":["Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma"],"prefix":"10.4338","volume":"07","author":[{"given":"Marguerite","family":"Swietlik","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Deakyne","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Hoffman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Grundmeier","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn","family":"Paterno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Rocha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Schaeffer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepika","family":"Pabbathi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evaline","family":"Alessandrini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin","family":"Ballard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Goldberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Kuppermann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Dayan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Tham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Pediatric Emergency Care Applied Research Network (PECARN)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2017,12,16]]},"reference":[{"key":"10.4338\/ACI-2015-10-CR-0144-1","unstructured":"Centers for Disease Control and Prevention. Rates of TBI-related Emergency Department Visits by Age Group- United States, 2001-2010 2014 [updated February 24, 2014; cited 2014 October 22]. Available from: http:\/\/www.cdc.gov\/traumaticbraininjury\/data\/rates_ed_byage.html"},{"key":"10.4338\/ACI-2015-10-CR-0144-2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-002-0671-1"},{"key":"10.4338\/ACI-2015-10-CR-0144-3","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.2.1760289"},{"key":"10.4338\/ACI-2015-10-CR-0144-4","doi-asserted-by":"crossref","unstructured":"Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Craft AW, Parker L, Berrington de Gonz\u00e1lez A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet 2012; 380(9840): 499-505. doi: http:\/\/dx.doi.org\/10.1016\/S0140-6736(12)60815-0","DOI":"10.1016\/S0140-6736(12)60815-0"},{"key":"10.4338\/ACI-2015-10-CR-0144-5","doi-asserted-by":"crossref","unstructured":"Hennelly KE, Mannix R, Nigrovic LE, Lee LK, Thompson KM, Monuteaux MC, Proctor M, Schutzman S. Pediatric traumatic brain injury and radiation risks: A clinical decision analysis. The Journal of Pediatrics 2013; 162(2): 392-397. doi: http:\/\/dx.doi.org\/10.1016\/j.jpeds.2012.07.018","DOI":"10.1016\/j.jpeds.2012.07.018"},{"key":"10.4338\/ACI-2015-10-CR-0144-6","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.311"},{"key":"10.4338\/ACI-2015-10-CR-0144-7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2360"},{"key":"10.4338\/ACI-2015-10-CR-0144-8","doi-asserted-by":"crossref","unstructured":"Nishijima DK, Yang Z, Urbich M, Holmes JF, Zwienenberg-Lee M, Melnikow J, Kuppermann N. Cost-effectiveness of the PECARN Rules in Children With Minor Head Trauma. 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