Table 2.

Summary of KPI based CDS rules for pediatric TBI neurosurgery

Treatment guideline	Decision rule	Frequency of notification
Beginning reminder for Arterial line and ABG	No arterial line or arterial blood gas (ABG) at the beginning of case	Once
Arterial blood gas	No ABG at the beginning of case	Repeat 3 times, then Stop
	Last ABG is more than an hour ago	Q18
Emergency hemorrhage panel	No EHP at the beginning of case	Repeat 3 times, then Stop
	Last EHP is more than an hour ago	Q18
Administration of muscle relaxants	If muscle relaxant has not been given by start of procedure	Once
Normocarbia maintenance	PaCO2 out of range (30–40 mmHg)	Once per new Lab result
	EtCO2 (5 min median) out of range (30–40 mmHg)	Q12 min
Avoidance of hypoxemia/hypoxia	PaO2 <60 mmHg	Once per new Lab result
	SpO2 (5 min median) <90%	Q12 min
Avoidance of hypotension	SBP (5 min median) <70+2xAge or 90 maximum	Q6 Min
Normothermia maintenance	Temperature out of range (35–38 deg	Q12
Blood glucose management	Blood glucose >180 mg/dL	Once per new Lab result
Anesthetic dose managementMinimum alveolar concentration (MAC) maintenance	Age adjusted MAC (5 min median) >1.0	Q12 Min
Transfusion trigger	Hematocrit < 25% and no blood transfusion	Once per new Lab result
Coagulopathy treatment	Platelet < 100,000 or INR > 1.3	Once per new Lab result

Note: For continuous variables, the median value within a 5-minute moving window was computed. This median was compared against the threshold to detect an unwanted event. If no unwanted event is detected in the 5-minute window, the window was advanced by 1-minute for the next sample. However, if an unwanted event is detected, the window is moved by 5 minutes. Hence, if there is an extended period of an unwanted event, consecutive 5-minute non-overlapping epochs are used to trigger alerts. On the other hand brief unwanted incidences that are clinically irrelevant are not alerted.