Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial.

Summary

In 77 Chinese hospitals enrolling 21,603 acute ischaemic stroke patients, a cluster randomized CDSS intervention reduced 3‑month new vascular events versus usual care (adjusted HR 0.74). CDSS improved adherence to evidence-based performance measures and reduced longer-term vascular events without excess bleeding.

Key Findings

• CDSS reduced 3‑month new vascular events versus usual care (adjusted HR 0.74, 95% CI 0.58–0.93; P=0.01).
• Composite evidence-based care performance was higher with CDSS (improved composite and all‑or‑none measures).
• Reductions in vascular events persisted at 6 and 12 months; no signal for increased moderate/severe bleeding.

Clinical Implications

Health systems should consider integrating validated CDSS to standardize imaging interpretation, etiologic classification, and evidence-based therapies in acute stroke pathways to reduce recurrent vascular events.

Limitations

• Cluster design may allow residual cluster-level confounding or contamination.
• Generalizability outside the Chinese hospital network and integration with diverse EHRs remains to be tested.

Future Directions

Evaluate cost-effectiveness, workflow integration, and model transparency; validate in other health systems and explore extension to secondary prevention clinics.