Year: 2025
Type: article
Abstract: Objectives: The Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) clinical prediction rule (CPR) was developed to reduce unnecessary imaging in pediatric trauma patients while ensuring accurate diagnosis. This study aimed to identify barriers and facilitators to future implementation of this rule in diverse emergency department settings. Methods: We conducted 40 interviews with 48 clinicians, including emergency department physicians, surgeons, nurses, and advanced practice providers at 21 healthcare facilities across the United States. Semi-structured interviews explored determinants impacting implementation, guided by the Tailored Implementation for Chronic Diseases (TICD) framework. We conducted a deductive thematic analysis using the TICD domains as a priori codes. Three researchers independently coded the transcripts and identified key themes aligned with the TICD framework. Results: Barriers included limited guideline accessibility, workflow disruptions, and inconsistent integration with electronic health records. Clinicians' concerns regarding the applicability and adherence to guidelines were also significant. Facilitators identified included institutional support, stakeholder engagement, and targeted education that addressed knowledge gaps. Implementation strategies varied by context, with suggestions for electronic health record-based decision tools in resource-equipped facilities and external aids, such as pocket cards, in lower-resource settings. Addressing legal concerns, clinician resistance, and workflow alignment emerged as critical priorities. Conclusion: Implementing the PECARN CSI clinical prediction rule requires addressing contextual barriers such as workflow challenges, clinician adherence, and technology integration. Context-sensitive strategies are essential for successful adoption and improved decision-making in pediatric trauma care. Future research should evaluate the impact of these strategies on clinician behavior and patient outcomes.
Source: Pediatrics Open Science
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
Funders: U.S. Department of Health and Human Services, Cincinnati Children's Hospital Medical Center, Nationwide Children's Hospital, Seattle Children's Research Institute, Scheme for Promotion of Academic and Research Collaboration, Health Resources and Services Administration, University at Buffalo, National Institute of Child Health and Human Development, Maternal and Child Health Bureau, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G100803575, G1324327976, G147013906, G2125547326, G2566951180, G2849384411, G2869228400, G2877048000, G3267003661, G3716290499, G3898252455, Development and Testing of a Pediatric Cervical Spine Injury Risk Assessment Tool, G476259359, G5142404812, G5175038653, G5394279576, G5608931986, G6583493691, G6998960079, G7324745131, G7797997618, G78948565, G8038725866, G8217610507, G8253428667, G873100486
OpenAlex ID: W4415565617