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The concept of computerized decision-support in pediatrics is not new. A mathematical approach was described for the diagnosis of congenital heart disease (Warner, 1961). In this study, long before the advent of echocardiography, data were drawn from 1,035 patients referred for cardiac catheterization. Given multiple clinical findings, a matrix of 33 different congenital heart diseases and 50 associated clinical findings was used to calculate the probability of a specific diagnosis. The diagnostic accuracy of this system matched that of 3 pediatric cardiologists.
Although, historically, CDSS was primarily were focused on diagnostic recommendations, pediatric decision-support that can be provided by any computer system which deals with clinical data and medical knowledge to help deliver patient-specific advice. Laboratory systems that flag abnormal values, immunization registries that issue vaccination reminders and automated pediatric electrocardiograph (ECG) interpretation are just a few examples of CDSS in common use today.
Clinical Decision-Support Systems can be categorized by type (simple rule-based alerts versus more complex methods like neural networking and Bayesian statistics), domain (problem-focused versus general diagnostic support), or access (handled computer versus Web-based versus integrated within an electronic medical record) (Longhurst and Hahn, 2004).
Support systems may be helpful for managing illness and the survival of newborns in the first 28 days of life. They may also influence the performance of doctors treating these newborn infants. The review authors searched the medical literature and contacted experts to find studies on CDSS used with newborns. They identified three randomized controlled studies that met the criteria for the review. Two of these three studies were on computer-aided drug prescribing and the other one was on computerized physiological monitoring of newborns. One of the studies on computer-aided prescribing showed that the CDSS used resulted in fewer drug dosage errors. The studies found no other benefits. The studies did not consider long-term outcomes in the newborns, just short-term effects. Also, with rapid changes in computer technology, current CDSS are more advanced than those used in the three studies. The Cochrane review authors conclude that there is not enough data to determine whether or not CDSS are beneficial for newborn care (Longhurst, 2003).
