Prospective evaluation of the MET-AP system providing triage plans for acute pediatric abdominal pain

• Published in: International journal of medical informatics (Shannon, Ireland) Ireland), 2008-03, Vol.77 (3), p.208-218
• Main Authors: Farion, Ken J, Michalowski, Wojtek, Rubin, Steven, Wilk, Szymon, Correll, Rhonda, Gaboury, Isabelle
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - therapy; Acute Disease; Adolescent; Child; Child, Preschool; Clinical; Cohort Studies; Computer; Decision support system; Diagnosis, Computer-Assisted; Emergency Service, Hospital; Female; Follow-Up Studies; Handheld; Hospital; Humans; Infant; Internal Medicine; Male; Medical Records Systems, Computerized; Other; Outcome Assessment (Health Care); Patient Discharge; Pediatric abdominal pain; Point-of-Care Systems; Prospective Studies; Triage; Triage - methods
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2007.01.004

Abstract Background Children with acute abdominal pain (AP) are frequently assessed in the Emergency Department (ED). Though the majority of patients have benign causes, uncertainty during the physician's initial assessment may result in unnecessary tests and prolonged observation before a definitive disposition decision can be made. A rule-based mobile clinical decision support system, Mobile Emergency Triage-Abdominal Pain (MET-AP), has been developed to recommend an appropriate triage plan (discharge, consult surgery or observe/investigate) early in the ED visit, with the goal of promoting ED efficiencies and improved patient outcomes. Objective To prospectively evaluate the accuracy of MET-AP to recommend the correct triage plan when used during the initial assessment by staff emergency physicians (EPs) and residents in a tertiary care pediatric ED. Design Prospective cohort study. Staff EPs and/or residents examined children, aged 1–16 years, with acute, non-traumatic AP of less than 10 days duration. Details of their initial assessment, along with their blinded prediction of the correct triage plan, were recorded electronically. Inter-observer assessments were collected, where possible. Telephone and chart follow-up at 10–14 days was conducted to determine the patient's outcome/diagnosis, and thus the gold standard triage plan appropriate for the patient's visit. Measurements Accuracy of MET-AP to recommend the correct triage plan (i.e., to match the gold standard plan); accuracy of physicians to predict the correct triage plan; inter-observer agreement between staff EPs and residents for each clinical attribute recorded within MET-AP. Results Over 8 months, 574 patients with AP completed follow-up (10% appendicitis, 13% other pathology, 77% benign/resolving conditions). For patient assessments by the staff EP ( n = 457), the MET-AP recommendation was correct for 72% of patients (95% CI's: 67.9–76.1), while the physician's prediction was correct in 70% of cases (65.9–74.2) ( p = 0.518). However, staff EP triage plans were more conservative than those generated by MET-AP, and a small number of patients whose triage plan should have been “consult surgery” would have been “discharged” by MET-AP. For resident assessments ( n = 339), MET-AP and physician accuracies were slightly lower, but not statistically different from staff results or from each other. Inter-observer agreement on most attributes was moderate to near perfect. Conclusion MET-AP shows pro