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Information about ongoing health services research and public health projects
| A systematic review evaluating the effectiveness of clinical decision support for pediatric patients with sepsis on sepsis identification and physician adherence to process measures for sepsis management, comparing electronic and non-electronic tools | |
|---|---|
| Investigator (PI): | Phillips, Kaitlyn; McPhee, Christa |
| Performing Organization (PO): |
(Current): Children's Hospital at Montefiore, Division of Hospital Medicine / (718) 741-2549 |
| Supporting Agency (SA): | Agency for Healthcare Research and Quality (AHRQ) |
| Initial Year: | 2020 |
| Final Year: | 2020 |
| Record Source/Award ID: | PROSPERO/ CRD42020181988 ; RePorter/ K12HS026396 |
| Award Type: | Grant |
| Abstract: | Review question. What is the effectiveness of clinical decision support for pediatric patients with sepsis on sepsis identification and physician adherence to process measures for sepsis management, comparing electronic and non-electronic tools? Searches. We will search MEDLINE, Web of Science, and Cochrane. Restrictions include studies published before 2004. Types of study to be included. We will include randomized trials to assess the benefits of clinical decision support. However, if not available, we will also use observational studies such pre/post studies or cohort studies. Condition or domain being studied. Sepsis is a life-threatening condition caused by a dysregulated host response to infection that causes organ dysfunction and that affects children and adults. It requires early identification and timely, specific interventions to prevent morbidity and mortality. Participants/population. Inclusion criteria: We will include patients <18 years old treated in the emergency department/inpatient unit/intensive care unit for systemic inflammatory response syndrome (SIRS), sepsis, or septic shock; intervention must include electronic clinical decision support; outcomes must report on performance of tool (identification) and/or process measures (management); and studies published after 2004 (first edition of surviving sepsis guidelines). Exclusion criteria: We will exclude patients >/=18 years old; lack of clinical decision support; no comparison group identified (either pre/post, electronic vs. non-electronic); lack of reporting on outcomes of identification or management; and secondary data analysis. Intervention(s), exposure(s). The interventions to be reviewed include those which use electronic clinical decision support (alerts, reminders, order sets, diagnostic tools, management tools) to help either identify or manage sepsis in pediatric patients. Comparator(s)/control. We will compare electronic clinical decision support to non-electronic forms of clinical decision support (either paper-based tools or other), if available. We will also compare outcomes in populations comparing periods where electronic clinical decision support was not available to a period when it was available (pre-post implementation). Main outcome(s). The main outcomes include 1. sepsis identification, including performance of the clinical decision support in being able to accurate identify sepsis; and 2. sepsis management, including success of the clinical decision support in being able to improve adherence to process measures of sepsis management (for example, administering timely antibiotics, fluid resuscitation, and sending appropriate laboratory studies. Measures of effect. Measures of effect are 1. sensitivity/specificity/positive and negative predictive values of performance of clinical decision support in accurate sepsis identification, and 2. odds ratios of improved adherence to process measures of sepsis management when using clinical decision support. Additional outcome(s). Additional outcomes are characteristics of successful approaches to implementation of clinical decision support. Measures of effect. Measures of effect are descriptive. Data extraction (selection and coding). Study selection: Two reviewers will independently screen abstracts and select studies for inclusion in a blinded fashion. Disagreements between reviewers will be resolved by discussion and consensus. Data extraction: Two reviewers will fully review the articles chosen for inclusion to extract data on study design/methods, setting, participant characteristics, description of type of clinical decision support, and outcomes. Discrepancies will be resolved by discussion and consensus. If necessary, study investigators will be contacted for missing data. Data will be recorded use a software system that is to be determined. Risk of bias (quality) assessment. Both reviewers will be involved in quality assessment. Each will assess the risk of bias (inclusion/exclusion criteria, method of randomization) at the study level. A formal risk of bias assessment is not planned. Disagreements will be resolved by discussion and consensus. Strategy for data synthesis. The data will be synthesized as follows: (1) number of studies that used clinical decision support for identification of sepsis, number studies that used clinical decision support for management of sepsis; (2) for identification of sepsis, diagnostic accuracy or performance of the clinical decision support will be summarized using qualitative analysis (sensitivity, specificity, positive and negative predictive values); and (3) for management, data will be synthesized by measures of effectiveness of adherence to process measures of sepsis care. Analysis of subgroups or subsets. There is no planned investigation of subgroups. |
| MeSH Terms: |
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| Country: | United States |
| State: | New York |
| Zip Code: | 10467 |
| UI: | 20212014 |
| Project Status: | Completed |
