Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical Trial: Heart and Lung Failure-Pediatric Insulin Titration Trial (HALF-PINT).
Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical Trial: Heart and Lung Failure-Pediatric Insulin Titration Trial (HALF-PINT).
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DOI：
10.1016/j.chest.2021.04.049
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发表时间：
2021-09
期刊：
影响因子：
9.6
通讯作者：
HALF-PINT Study Investigators
中科院分区：
文献类型：
--
作者：
Hirshberg EL;Alexander JL;Asaro LA;Coughlin-Wells K;Steil GM;Spear D;Stone C;Nadkarni VM;Agus MSD;HALF-PINT Study Investigators
在儿科重症监护试验中使用电子临床决策支持（CDS）系统是罕见的。我们试图详细描述CDS工具（儿童医院儿童血糖正常电子表格[检查]）在32项多中心心肺衰竭-儿科胰岛素滴定试验期间用于高血糖管理的使用。在接受CRISKS治疗的危重儿科患者中，使用者依从性如何与结局相关;哪些患者和临床医生因素可能导致观察到的CRISKS依从性差异？在一项前瞻性随机对照试验中使用CDS工具的依从性观察性回顾性研究中，我们比较了高依从性和低依从性的患者。我们调查了依从性与血糖指标之间的关联。我们描述了一个计算机接口分析框架（用户，功能，表示和任务分析框架），并使用该框架对用户交互进行分类。我们讨论了未来的随机对照试验的影响。在4.5年的时间里，698名儿童中有658名接受了≥24小时的ECONOKS方案治疗，每名患者的中位数为119项建议。每例患者的依从性较高（中位数为99.5%），只有30例患者的依从性较低（<90%）。依从性低的患者来自32个研究中心中的16个，年轻（P = 0.02），不太可能接受强心剂支持（P = 0.04）。他们更有可能被随机分配到较低的血糖目标（80% vs 48%; P < .001），并且在血糖目标上花费的时间更短（53% vs 75%; P < .001）。覆盖（按用户、功能、表示和任务分析框架分类）在很大程度上（89%）归因于用户，其中患者因素占29%。在心肺衰竭-儿科胰岛素滴定试验中使用RISKKS，为在各种环境中管理危重儿童的高血糖症提供了一种高度可重复和明确的方法。CDS系统代表了进行明确的复杂儿科重症监护试验的重要机制。ClinicalTrials.gov标识符：NCT 01565941，2012年3月29日注册; https://clinicaltrials.gov/ct2/show/NCT01565941? term=HALF-PINT&draw=2&rank=1
The use of electronic clinical decision support (CDS) systems for pediatric critical care trials is rare. We sought to describe in detail the use of a CDS tool (Children’s Hospital Euglycemia for Kids Spreadsheet [CHECKS]), for the management of hyperglycemia during the 32 multicenter Heart And Lung Failure-Pediatric Insulin Titration trial. In critically ill pediatric patients who were treated with CHECKS, how was user compliance associated with outcomes; and what patient and clinician factors might account for the observed differences in CHECKS compliance? During an observational retrospective study of compliance with a CDS tool used during a prospective randomized controlled trial, we compared patients with high and low CHECKS compliance. We investigated the association between compliance and blood glucose metrics. We describe CHECKS and use a computer interface analysis framework (the user, function, representation, and task analysis framework) to categorize user interactions. We discuss implications for future randomized controlled trials. Over a 4.5-year period, 658 of 698 children were treated with the CHECKS protocol for ≥24 hours with a median of 119 recommendations per patient. Compliance per patient was high (median, 99.5%), with only 30 patients having low compliance (<90%). Patients with low compliance were from 16 of 32 sites, younger (P = .02), and less likely to be on inotropic support (P = .04). They were more likely to be have been assigned randomly to the lower blood glucose target (80% vs 48%; P < .001) and to have spent a shorter time (53% vs 75%; P < .001) at the blood glucose target. Overrides (classified by the user, function, representation, and task analysis framework), were largely (89%) due to the user with patient factors contributing 29% of the time. The use of CHECKS for the Heart And Lung Failure-Pediatric Insulin Titration trial resulted in a highly reproducible and explicit method for the management of hyperglycemia in critically ill children across varied environments. CDS systems represent an important mechanism for conducting explicit complex pediatric critical care trials. ClinicalTrials.gov Identifier: NCT01565941, registered March 29 2012; https://clinicaltrials.gov/ct2/show/NCT01565941?term=HALF-PINT&draw=2&rank=1
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影响因子：
2.2
作者：
Agus, Michael S. D.;Hirshberg, Ellie;Nadkarni, Vinay M.
通讯作者：
Nadkarni, Vinay M.
DOI：
10.1016/j.ijmedinf.2015.12.002
发表时间：
2016-03-01
影响因子：
4.9
作者：
Goldberg, Howard S.;Paterno, Marilyn D.;Dayan, Peter S.
通讯作者：
Dayan, Peter S.
影响因子：
2.4
作者：
Macrae D;Pappachan J;Grieve R;Parslow R;Nadel S;Schindler M;Baines P;Fortune PM;Slavik Z;Goldman A;Truesdale A;Betts H;Allen E;Snowdon C;Percy D;Broadhead M;Quick T;Peters M;Morris K;Tasker R;Elbourne D
通讯作者：
Elbourne D
影响因子：
158.5
作者：
Macrae, Duncan;Grieve, Richard;Elbourne, Diana
通讯作者：
Elbourne, Diana
影响因子：
8.8
作者：
Morris, Alan H.;Orme, James, Jr.;Warner, Homer
通讯作者：
Warner, Homer