CADDIE2-evaluation of a clinical decision-support system for early detection of systemic inflammatory response syndrome in paediatric intensive care: study protocol for a diagnostic study

Antje Wulff; Sara Montag; Bianca Steiner; Michael Marschollek; Philipp Beerbaum; André Karch; Thomas Jack

doi:10.1136/bmjopen-2019-028953

CADDIE2-evaluation of a clinical decision-support system for early detection of systemic inflammatory response syndrome in paediatric intensive care: study protocol for a diagnostic study

BMJ Open. 2019 Jun 19;9(6):e028953. doi: 10.1136/bmjopen-2019-028953.

Authors

Antje Wulff¹, Sara Montag², Bianca Steiner³, Michael Marschollek¹, Philipp Beerbaum², André Karch⁴, Thomas Jack²

Affiliations

¹ Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Hannover, Germany.
² Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
³ Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Braunschweig, Germany.
⁴ Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.

Abstract

Introduction: Systemic inflammatory response syndrome (SIRS) is one of the most critical indicators determining the clinical outcome of paediatric intensive care patients. Clinical decision support systems (CDSS) can be designed to support clinicians in detection and treatment. However, the use of such systems is highly discussed as they are often associated with accuracy problems and 'alert fatigue'. We designed a CDSS for detection of paediatric SIRS and hypothesise that a high diagnostic accuracy together with an adequate alerting will accelerate the use. Our study will (1) determine the diagnostic accuracy of the CDSS compared with gold standard decisions created by two blinded, experienced paediatricians, and (2) compare the system's diagnostic accuracy with that of routine clinical care decisions compared with the same gold standard.

Methods and analysis: CADDIE2 is a prospective diagnostic accuracy study taking place at the Department of Pediatric Cardiology and Intensive Care Medicine at the Hannover Medical School; it represents the second step towards our vision of cross-institutional and data-driven decision-support for intensive care environments (CADDIE). The study comprises (1) recruitment of up to 300 patients (start date 1 August 2018), (2) creation of gold standard decisions (start date 1 May 2019), (3) routine SIRS assessments by physicians (starts with recruitment), (4) SIRS assessments by a CDSS (start date 1 May 2019), and (5) statistical analysis with a modified approach for determining sensitivity and specificity and comparing the accuracy results of the different diagnostic approaches (planned start date 1 July 2019).

Ethics and dissemination: Ethics approval was obtained at the study centre (Ethics Committee of Hannover Medical School). Results of the main study will be communicated via publication in a peer-reviewed journal.

Trial registration number: ClinicalTrials.gov NCT03661450; Pre-results.

Keywords: clinical decision support systems; clinical trial; systemic inflammatory response syndrome.

Publication types

Clinical Trial Protocol

MeSH terms

Child
Clinical Decision Rules
Clinical Decision-Making / methods
Critical Care / methods*
Data Accuracy
Decision Support Systems, Clinical / standards*
Humans
Pediatrics / methods
Reproducibility of Results
Systemic Inflammatory Response Syndrome* / diagnosis
Systemic Inflammatory Response Syndrome* / therapy

Associated data

ClinicalTrials.gov/NCT03661450