BackgroundThe use of big data and machine learning within clinical decision support systems (CDSSs) has the potential to transform medicine through better prognosis, diagnosis and automation of tasks. Real-time application of machine learning algorithms, however, is dependent on data being present and entered prior to, or at the point of, CDSS deployment. Our aim was to determine the feasibility of automating CDSSs within electronic health records (EHRs) by investigating the timing, data categorization, and completeness of documentation of their individual components of two common Clinical Decision Rules (CDRs) in the Emergency Department.MethodsThe CURB-65 severity score and HEART score were randomly selected from a list of the top emergency medicine CDRs. Emergency department (ED) visits with ICD-9 codes applicable to our CDRs were eligible. The charts were reviewed to determine the categorization components of the CDRs as structured and/or unstructured, median times of documentation, portion of charts with all data components documented as structured data, portion of charts with all structured CDR components documented before ED departure. A kappa score was calculated for interrater reliability.ResultsThe components of the CDRs were mainly documented as structured data for the CURB-65 severity score and HEART score. In the CURB-65 group, 26.8% of charts had all components documented as structured data, and 67.8% in the HEART score. Documentation of some CDR components often occurred late for both CDRs. Only 21 and 11% of patients had all CDR components documented as structured data prior to ED departure for the CURB-65 and HEART score groups, respectively. The interrater reliability for the CURB-65 score review was 0.75 and 0.65 for the HEART score.ConclusionOur study found that EHRs may be unable to automatically calculate popular CDRs—such as the CURB-65 severity score and HEART score—due to missing components and late data entry.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0170-9) contains supplementary material, which is available to authorized users.

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Objectives: Needle decompression is potentially life-saving in cases of tension pneumothorax. Although Advanced Trauma Life Support recommends an 8-cm needle for decompression for adults, no detailed pediatric guidelines exist, specifically regarding needle length or site of decompression.Methods: Point-of-care ultrasound was used to measure chest wall thickness (CWT), the distance between skin and pleural line, bilaterally at the second intercostal midclavicular line and the fourth intercostal anterior axillary line in children of various ages and sizes. Patients were grouped based on Broselow tape weight categories. Measurements were compared between left versus right sides at the 2 anatomic sites. Interclass correlation coefficients were calculated to assess for interrater reliability.Results: A convenience sample of 163 patients from our emergency department was enrolled. For patients who fit into Broselow tape categories, CWT at the second intercostal midclavicular line ranged from 1.11 to 1.91 cm and at the fourth intercostal anterior axillary line ranged from 1.13 to 1.92 cm. In patients larger than the largest Broselow category, 77% had a CWT less than the length of a standard 1.25-in (3.175 cm) catheter. There were no significant differences in the measurements of CWT based on laterality nor anatomic site. Conclusions:The standard 1.25-in (3.175 cm) catheters are sufficient to treat most tension pneumothoraces in pediatric patients.

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