Utilizing Electronic Clinical Decision Support to Enhance mTBI Care at the Primary Care Point of Entry

Children's Hospital of Philadelphia (CHOP)

Status: Enrolling

Conditions: Mild Traumatic Brain Injury; Brain Concussion

Treatments: Other: electronic Clinical Decision Support tool for risk stratification of pediatric patients with mTBI

Study type: Observational

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT06693778

22-020695

U01CE003479 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

Six primary care practices within a large Philadelphia pediatric care network will use an electronic Clinical Decision Support (eCDS) tool as standard care for concussion evaluation. The eCDS tool will include a prediction rule for children aged 5-18 assessed for mild traumatic brain injury (mTBI). The eCDS tool predicts risk for persistent symptoms and prompts referral to specialty care for those deemed high risk. This research proposes to analyze the clinical and process outcomes in these six practices relative to the rest of the care network, specifically, whether the eCDS tool reduces time to symptom resolution.

Full description

The electronic Clinical Decision Support tool will include a prediction rule for children aged 5-18 assessed for mild traumatic brain injury (mTBI). It predicts risk for persistent symptoms and prompts referral to specialty care for those who are high-risk. The eCDS tool consists of a validated, age-appropriate symptom scale, risk stratification with indication for specialty referral, personalized return to activity guidance based on symptom exacerbation, and guidance on minimizing prolonged rest and promoting active management.

Each year for three years, the eCDS tool will go live at a new pair of sites (1 urban, 1 suburban). Training will be provided to the primary care providers at these sites on utilizing the eCDS tool. Anonymous questionnaires will be administered among providers who used the eCDS tool in order to evaluate its appropriateness and acceptability. Interviews will be conducted with a subset of providers to obtain more detailed feedback on the eCDS tool. A medical record review will be conducted of mTBI patients evaluated with the eCDS tool.

Enrollment: 3,000 estimated patients

Sex: All

Ages: 5 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 5-18 year old patients evaluated for mild Traumatic Brain Injury at a Children's Hospital of Philadelphia primary care practice within the study timeframe

Exclusion criteria

• Evidence of moderate or severe TBI

Trial design

3,000 participants in 2 patient groups

Select Primary Care Practices

Description:

Select pediatric primary care practices (3 urban and 3 suburban) that are evaluating patients for mild traumatic brain injury with an electronic clinical decision support tool.

Treatment:

Other: electronic Clinical Decision Support tool for risk stratification of pediatric patients with mTBI

Comparison Primary Care Practices

Description:

Pediatric primary care practices that are NOT using the electronic clinical decision support tool to evaluate patients for mild traumatic brain injury.