- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02633735
EHR-based Decision Support for Pediatric Acute Abdominal Pain in Emergency Care (Appy-CDS)
Although appendicitis is the most common surgical emergency in children, its diagnosis remains a challenge and thus, emergency department (ED) providers increasingly rely on computed tomography to distinguish appendicitis from other conditions. This project (a) uses electronic health record (EHR) technology to deliver patient-specific clinical decision support to ED providers at the point of care, (b) assesses the impact of this intervention on the use of diagnostic imaging and clinical outcomes, and (c) assesses the impact of the intervention on the costs of care delivered. This innovative project will be a template for extending EHR-based clinical decision support to other domains of emergency care to ultimately improve a broad range of pediatric acute care outcomes.
The proposed intervention, referred to as appy-CDS, is specifically designed for widespread use in EDs and could reduce reliance on advanced diagnostic imaging for pediatric and adolescent patients with acute abdominal pain while maintaining or improving clinical outcomes. Investigators aim to develop and implement an interactive, evidence-based clinical decision support tool to optimize care for children and adolescents presenting to a general or non-pediatric ED with acute abdominal pain.
Study Overview
Detailed Description
Abdominal pain is one of the most common reasons for children and adolescents to seek care in the emergency department (ED). Computed tomography (CT) has been promoted as a method to improve diagnostic accuracy when evaluating patients with acute abdominal pain. In the past 20 years, CT use has increased dramatically, especially for children receiving care in general ED settings. Although in some adult cohorts, increased CT use has been associated with decreased rates of negative appendectomies, similar improvements in health outcomes among children with acute abdominal pain have not occurred. Negative consequences of CT include increased costs and substantial exposure to ionizing radiation.
Although appendicitis is the most common surgical emergency in children, its diagnosis remains a challenge and thus, emergency department (ED) providers increasingly rely on computed tomography to distinguish appendicitis from other conditions. This project (a) uses electronic health record (EHR) technology to deliver patient-specific clinical decision support to ED providers at the point of care, (b) assesses the impact of this intervention on the use of diagnostic imaging and clinical outcomes, and (c) assesses the impact of the intervention on the costs of care delivered.
The proposed intervention, referred to as appy-CDS, is specifically designed for widespread use in EDs and could reduce reliance on advanced diagnostic imaging for pediatric and adolescent patients with acute abdominal pain while maintaining or improving clinical outcomes. This cluster randomized trial builds on more than 10 years of work on derivation and validation of ED-based clinical decision rules, previous successful outpatient and emergency department clinical decision support interventions, and complex economic and statistical analyses of risk assessment and ED resource use. In this project, the investigators aim to extend the benefits of previous efforts by developing and implementing an interactive, evidence-based clinical decision support tool to optimize care for children and adolescents presenting to a general or non-pediatric ED with acute abdominal pain. The results of this project will extend the understanding of how to maximize the clinical return on massive public and private sector investments being made in sophisticated EHR systems. If successful, this flexible decision support tool could be adapted and implemented broadly in a range of acute care settings to both standardize and personalize care delivered to pediatric patients.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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Oakland, California, United States, 94612
- Kaiser Permanente Northern California
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Minnesota
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Minneapolis, Minnesota, United States, 55440
- HealthPartners Medical Group
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- children and adolescents ages 5-20 years with abdominal pain
- internal med, family med, or emergency med trained providers at participating EDs
Exclusion Criteria:
- select comorbid conditions
- previous abdominal surgery
- treated for select comorbid conditions
Study Plan
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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NO_INTERVENTION: Usual Care
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EXPERIMENTAL: Appy CDS
The Appy-cds intervention is a point of care clinical decision support system designed to identify pediatric patients at risk for appendicitis using EHR and supplemental data.
The intervention is administered to providers in this arm.
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See description under arm/group section
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pre to Post Ratio of Image Use
Time Frame: pre-intervention of 8 months (average), and post intervention of 23 months
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First, we evaluated whether patient characteristics (age, sex, race/ethnicity) differed by study arm and phase using frequency distributions, means and standard deviations.
Second, we estimated use of imaging for CT, US and CT or US by study arm and phase.
We evaluated the effectiveness of AppyCDS by estimating the ratio of ratios (ROR) and 95% confidence intervals (CI) of intervention arm, from pre-intervention phase to intervention phase as compared to UC arm over the two study phases, for all imaging outcomes.
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pre-intervention of 8 months (average), and post intervention of 23 months
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Anupam B Kharbanda, MD, MSc, Children's Hospital and Clinics of Minnesota
Publications and helpful links
General Publications
- Kharbanda AB, Vazquez-Benitez G, Ballard DW, Vinson DR, Chettipally UK, Dehmer SP, Ekstrom H, Rauchwerger AS, McMichael B, Cotton DM, Kene MV, Simon LE, Zhu J, Warton EM, O'Connor PJ, Kharbanda EO; Clinical Research on Emergency Services and Treatments Network (CREST) and the Critical Care Research Center, HealthPartners Institute. Effect of Clinical Decision Support on Diagnostic Imaging for Pediatric Appendicitis: A Cluster Randomized Trial. JAMA Netw Open. 2021 Feb 1;4(2):e2036344. doi: 10.1001/jamanetworkopen.2020.36344.
- Cotton DM, Vinson DR, Vazquez-Benitez G, Margaret Warton E, Reed ME, Chettipally UK, Kene MV, Lin JS, Mark DG, Sax DR, McLachlan ID, Rauchwerger AS, Simon LE, Kharbanda AB, Kharbanda EO, Ballard DW; Clinical Research on Emergency Services and Treatments (CREST) Network. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med. 2019 Oct;74(4):471-480. doi: 10.1016/j.annemergmed.2019.04.023. Epub 2019 Jun 19.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 14-025
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Appendicitis
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North Estonia Medical CentreTartu University HospitalRecruitingAcute Appendicitis | Appendicitis Acute | Appendicitis Perforated | Acute Appendicitis With Rupture | Appendicitis; Perforation | Acute Appendicitis Without Peritonitis | Acute Appendicitis With Appendix AbscessEstonia
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University of MichiganCompletedAppendicitis | Complicated Appendicitis | Perforated Appendicitis | Ruptured AppendicitisUnited States
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HJ23Hospital Universitari Joan XXIII de Tarragona.Not yet recruitingAcute Appendicitis | Appendicitis Perforated | Appendicitis Suppurative
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Azienda Socio Sanitaria Territoriale degli Spedali...CompletedAppendicitis | Appendicitis Acute | Appendiceal Abscess | Appendicolith | Appendicitis With Perforation | Appendicitis PeritonitisItaly
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Johns Hopkins All Children's HospitalCompleted
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Pirogov Russian National Research Medical UniversityCompletedAcute Appendicitis | Acute Appendicitis With Rupture | Acute Appendicitis Without Peritonitis | Acute Appendicitis With PeritonitisRussian Federation
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Phoenix Children's HospitalTerminatedComplicated Appendicitis | Perforated AppendicitisUnited States
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Faculty Hospital Kralovske VinohradyCompletedAppendicitis | Appendicitis Acute | Retrocecal AppendicitisCzechia
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King Abdulaziz UniversityCompletedAppendicitis | Acute Appendicitis | Pathology | Appendicitis (Diagnosis)Saudi Arabia
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Mauro PoddaAssociazione Chirurghi Ospedalieri ItalianiCompletedAcute Appendicitis | Appendectomy | Antibiotic Therapy | Appendicitis RecurrentItaly
Clinical Trials on Appy CDS
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American Academy of Family PhysiciansUniversity of Colorado, Denver; National Institute of Diabetes and Digestive... and other collaboratorsCompletedChronic Kidney Disease | Chronic Renal Insufficiency | Chronic Kidney Insufficiency | Chronic Renal Diseases | Kidney Insufficiency, ChronicUnited States
-
New York City Department of Health and Mental HygieneAgency for Healthcare Research and Quality (AHRQ); NYUActive, not recruiting
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Children's Hospital of PhiladelphiaActive, not recruitingSleep | Obstructive Sleep Apnea | Sleep-Disordered BreathingUnited States
-
Vanderbilt University Medical CenterCompletedSuicidal Ideation | Suicide, AttemptedUnited States
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Brigham and Women's HospitalNational Institutes of Health (NIH); National Institute on Aging (NIA)RecruitingFall Injury | Falls | Exercise Self-Efficacy | Falls Self-EfficacyUnited States
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Intermountain Health Care, Inc.Completed
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Oregon Health and Science UniversityUniversity of Missouri-Columbia; Vanderbilt University Medical CenterRecruitingHypertension | Multiple Chronic ConditionsUnited States
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Ann & Robert H Lurie Children's Hospital of ChicagoNational Institute of Allergy and Infectious Diseases (NIAID)Enrolling by invitationFood Allergy Peanut | Food Allergy in InfantsUnited States
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Free University Medical CenterUnknown
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HealthPartners InstituteNational Institute on Drug Abuse (NIDA); Hennepin Healthcare Research InstituteCompletedSuicide | Opioid Use | Opioid-use DisorderUnited States