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COVID-19 Inclusive Clinical Decision Support Tool Accurately Identifies Patients At Risk For VTE  – Renal And Urology News – Renal.PlatoHealth.ai

The use of a tool for clinical decision support (CDS) to identify patients requiring pharmacologic prophylaxis for venous thromboembolism (VTE) helped to accurately identify patients at risk, but it did not result in increased use of prophylaxis, according to a recent study. The study’s results were reported in the journal Pediatric Blood & Cancer.

The institution where the researchers conducted this analysis is a quaternary care children’s hospital in the US. In this study, the researchers updated their institution’s existing CDS module for VTE prophylaxis by incorporating risk factors for VTE related to having COVID-19. 

Goals of the study included assessing the performance of the updated CDS system at identifying which high-risk patients should receive pharmacologic prophylaxis and assessing any impacts of the new CDS system on prescribing patterns for pharmacologic prophylaxis. 

The study included hospitalized, symptomatic patients who tested positive for COVID-19 by either polymerase chain reaction analysis or antigen testing, conducted within 24 hours of admission. The researchers evaluated care of patients from during the 6-month period prior to the launch of the updated CDS module (preintervention period) and during the 6 months after its launch (postintervention period).

This work uniquely highlights discrepancies between CDS performance and clinician behavior, and the need for ongoing monitoring of CDS alerts, especially those that may have been impacted by COVID-19.

The percentage of patients overall who triggered a CDS alert was significantly higher in the post-intervention period at 44.3%, compared with a rate of 8.9% in the preintervention period (P <.0001). However, the rate of prescribing of VTE prophylaxis was not significantly different in the postintervention period (40.9%) compared with the preintervention period (36.6%; P =.53).

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The researchers also evaluated certain parameters of the updated CDS module’s functionality in comparison with the original module. The updated module’s sensitivity was 55.0% compared with 13.3% for the prior CDS module. 

The updated module also had improved accuracy (62.5% vs 42.0%), improved negative predictive value (44.9% vs 36.3%), and an improved value on a statistical metric called the F1-score (66.7% vs 23.5%). However, the updated module scored worse for specificity (78.6% vs 100.0%) and positive predictive value (84.6% vs 100.0%) than the original CDS module did.

Overall, the researchers found that the new CDS module improved the accuracy of identifying COVID-19-positive patients in need of VTE prophylaxis, however, prescribing of pharmacologic prophylaxis remained unchanged. 

“This work uniquely highlights discrepancies between CDS performance and clinician behavior, and the need for ongoing monitoring of CDS alerts, especially those that may have been impacted by COVID-19,” the researchers wrote in their report. 

This article originally appeared on Hematology Advisor