Evidence map›Paper›PMID 29530029›Full record

Trial reportBMC medical informatics and decision making2018

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial.

Ronald W Gimbel, Ronald G Pirrallo, Steven C Lowe, David W Wright, Lu Zhang, Min-Jae Woo, Paul Fontelo, Fang Liu, Zachary Connor

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medical informatics and decision making, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03449862 (Effect of Clinical Decision Rules, Patient Cost and Malpractice Information on Clinician Brain CT Image Ordering), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03449862 nacompletednot on this map

Effect of Clinical Decision Rules, Patient Cost and Malpractice Information on Clinician Brain CT Image Ordering: a Randomized Controlled Trial

TypeinterventionalSponsorClemson UniversityRan2016 to 2018Enrolled167ConditionsClinical Decision-MakingArmsSimulation-based clinical decision on brain CT ordering
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Ronald W GimbelDepartment of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA. rgimbel@clemson.edu.ORCID 0000-0001-8185-4013
Ronald G PirralloDepartment of Emergency Medicine, Greenville Health System, Greenville, SC, USA.
Steven C LoweDepartment of Radiology, Greenville Health System, Greenville, SC, USA.
David W WrightDepartment of Emergency Medicine, Emory University, Atlanta, GA, USA.
Lu ZhangDepartment of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA.
Min-Jae WooDepartment of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA.
Paul FonteloLister Hill National Center for Biomedical Communication, National Library of Medicine, Bethesda, MD, USA.
Fang LiuLister Hill National Center for Biomedical Communication, National Library of Medicine, Bethesda, MD, USA.
Zachary ConnorDepartment of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA.

Funding

National Biomedical Information ServicesZIHLM200888 · NLM · NATIONAL LIBRARY OF MEDICINE · PI PALTOO, DINA · 2009 to 2025
$5200.7M
6 · The paper itself

Abstract

backgroundThe frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems.

methodsMulti-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision.

resultsOne hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order.

conclusionThis study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review.

trial registrationNCT03449862 , February 27, 2018, Retrospectively registered.

Indexed as

Clinical Decision-MakingMalpracticeAdultBrain InjuriesCanadaCraniocerebral TraumaDouble-Blind MethodEmergency Service, HospitalFemaleHumansMaleMiddle AgedNeuroimagingPatient SimulationTomography, X-Ray ComputedCanadian CT head ruleClinical decision makingCT brainEmergency department cliniciansEvidence-based medicineMalpractice informationMild head traumaPatient cost informationSimulation research

Identifiers

PMID29530029
PMCPMC5848437

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.