Validation and Implementation of Clinical Decision Support for Managing Children with Mild Head Injuries and Intracranial Injury

治疗轻度头部损伤和颅内损伤儿童的临床决策支持的验证和实施

• 批准号: 10172855
• 负责人: JACOB GREENBERG
• 金额: $ 1.23万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172855
• 关键词: Validation; Implementation; Clinical; Decision; Support

PROJECT SUMMARY/ABSTRACT Mild traumatic brain injury (mTBI) is a major health problem in children, leading to approximately 600,000 emergency department visits each year in the United States. However, there is limited evidence guiding the management of the 14% of children with mTBI that have intracranial injury identified on computed tomography imaging. Accurate risk stratification of these patients is of paramount importance to ensure appropriately close clinical attention and intensive care unit (ICU) monitoring for high-risk children, while avoiding the psychological harm and substantial resource utilization associated with avoidable ICU admission. Several lines of evidence suggest that current practice based on physician gestalt is not evidence-based, may place some children at risk of harm, and is associated with high rates of avoidable ICU admission. To address this evidence gap, the Applicant, Dr. Jacob Greenberg, recently utilized a large multicenter dataset to develop and internally validate the Children's Intracranial Injury Decision Aid (CHIIDA) score to stratify the risk of neurological decline in these patients. However, spontaneous uptake of risk models is rare, reflecting a lack of external validation and focused implementation studies. Recognizing these challenges, this application proposes a hybrid effectiveness- implementation study to both externally validate the CHIIDA score using a modern multicenter dataset and study its implementation into the electronic health record. This two-year F32 postdoctoral fellowship will pursue these objectives through the following specific aims: 1) externally validate the CHIIDA model for managing children with mTBI and intracranial injury; 2a) define the sociotechnical context for implementing electronic clinical decision support in the care of children with mTBI and intracranial injury; and 2b) employ human-centered design to develop and evaluate a prototype electronic clinical decision support tool for risk-stratifying children with mTBI and intracranial injury. This study supports the Agency for Healthcare Research and Quality's (AHRQ) mission of implementing usable, evidence-based clinical decision support into the electronic health record to improve the safety and quality of healthcare delivery. Consistent with this goal, this study's results will ultimately lead to a cluster- randomized trial of electronic clinical decision support based on the CHIIDA model. At the same time, the proposed training plan will provide the Applicant with valuable skills in qualitative research methods, implementation science, biomedical informatics, and risk model validation. Consequently, this F32 postdoctoral fellowship will support the Applicant's goal of becoming an independent health services researcher committed to developing and implementing evidence-based programs to improve healthcare safety and quality.

项目总结/文摘

项目成果

Measures of Intracranial Injury Size Do Not Improve Clinical Decision Making for Children With Mild Traumatic Brain Injuries and Intracranial Injuries.

颅内损伤大小的测量并不能改善患有轻度创伤性脑损伤和颅内损伤的儿童的临床决策。

• DOI: 10.1227/neu.0000000000001895
• 发表时间: 2022
• 期刊: Neurosurgery
• 影响因子: 4.8
• 作者: Greenberg,JacobK;Olsen,MargaretA;Johnson,GabrielleW;Ahluwalia,Ranbir;Hill,Madelyn;Hale,AndrewT;Belal,Ahmed;Baygani,Shawyon;Foraker,RandiE;Carpenter,ChristopherR;Ackerman,LaurieL;Noje,Corina;Jackson,EricM;Burns,Erin;Saya
• 通讯作者: Saya

Translating Data Analytics Into Improved Spine Surgery Outcomes: A Roadmap for Biomedical Informatics Research in 2021.

• DOI: 10.1177/21925682211008424
• 发表时间: 2022-06
• 期刊: Global spine journal
• 影响因子: 2.4
• 作者: Greenberg JK;Otun A;Ghogawala Z;Yen PY;Molina CA;Limbrick DD Jr;Foraker RE;Kelly MP;Ray WZ
• 通讯作者: Ray WZ

Usability and Acceptability of Clinical Decision Support Based on the KIIDS-TBI Tool for Children with Mild Traumatic Brain Injuries and Intracranial Injuries.

基于 KIIDS-TBI 工具的临床决策支持对于轻度创伤性脑损伤和颅内损伤儿童的可用性和可接受性。

• DOI: 10.1055/s-0042-1745829
• 发表时间: 2022
• 期刊: Applied clinical informatics
• 影响因子: 2.9
• 作者: Greenberg,JacobK;Otun,Ayodamola;Kyaw,PyiTheim;Carpenter,ChristopherR;Brownson,RossC;Kuppermann,Nathan;LimbrickJr,DavidD;Foraker,RandiE;Yen,Po-Yin
• 通讯作者: Yen,Po-Yin

Leveraging Artificial Intelligence and Synthetic Data Derivatives for Spine Surgery Research.

• DOI: 10.1177/21925682221085535
• 发表时间: 2023-10
• 期刊: GLOBAL SPINE JOURNAL
• 影响因子: 2.4
• 作者: Greenberg, Jacob K.;Landman, Joshua M.;Kelly, Michael P.;Pennicooke, Brenton H.;Molina, Camilo A.;Foraker, Randi E.;Ray, Wilson Z.
• 通讯作者: Ray, Wilson Z.