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Abstract Background Hospitalization rates for childhood pneumonia vary widely. Risk‐based clinical decision support (CDS) interventions may reduce unwarranted variation. Methods We conducted a pragmatic randomized trial in two US pediatric emergency departments (EDs) comparing electronic health record (EHR)‐integrated prognostic CDS versus usual care for promoting appropriate ED disposition in children (70% satisfied). Implementation barriers include intrinsic (e.g., reaching the right person at the right time) and extrinsic factors (i.e., global pandemic). Conclusions EHR‐based prognostic CDS did not improve ED disposition decisions for children with pneumonia. Although the intervention's content was favorably received, low subject accrual and workflow integration problems likely limited effectiveness. Clinical Trials Registration: NCT06033079.
Williams et al. (Sun,) studied this question.