A handheld decision-support system may improve diagnostic decision making for patients with suspected pulmonary embolism (PE) in the emergency department, suggests a study published in the Nov. 17 online edition of the Annals of Internal Medicine.
Twenty emergency departments in France were part of the clinical study. Pierre-Marie Roy, MD, PhD, and colleagues from Centre Hospitalier Universitaire d'Angers and Université d'Angers in Angers, France, sought to assess the effectiveness of a handheld clinical decision support system to improve the diagnostic work-up of suspected PE among patients in the emergency department.
Testing for PE often differs from that recommended by evidence-based guidelines, according to Roy and colleagues.
The cluster randomized trial (providers were not blinded, outcome assessment was automated) involved a pre-intervention period involving 20 centers and 1,103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing.
After the pre-intervention period, 1,768 consecutive outpatients with suspected PE were assigned to randomly chosen emergency departments that activated a clinical decision support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1,015 patients).
The appropriateness of diagnostic work-up, defined as any sequences of tests that yielded a post-test probably less than 5 percent or greater than 85 percent, and the number of tests per patient were measured.
The authors found that the proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the pre-intervention period in both groups. However, the increase was greater in the computer-based guidelines group. Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines groups.
According to the authors, the study was not designed to show a difference in the clinical outcomes of patients during follow-up.