Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia.
JAMA Surg. 2017 Jul 1;152(7):638-645. doi: 10.1001/jamasurg.2017.0131.
Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE.
To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE.
PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed.
Clinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis.
Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently.
Rates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios.
Eleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001).
Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
医疗保健专业人员不能充分评估手术患者的静脉血栓栓塞症（VTE）风险或为其提供预防措施。已实施计算机临床决策支持系统（CCDSS）以协助临床医生并改善 VTE 的预防措施。
评估实施 CCDSS 对 VTE 预防措施的开具和 VTE 发生率的影响。
2016 年 6 月，通过 OVID 检索 PubMed、MEDLINE、OVID 检索 EMBASE、Scopus、Cochrane 对照试验中心注册库和 clinicaltrials.gov，检索自 1991 年 10 月 15 日至 2016 年 2 月 16 日发表的英文文章。还对相关文章的参考文献进行了手动搜索。
包括比较 CCDSS 与 VTE 风险分层以及协助开具预防措施与无决策支持的常规护理的手术患者的临床试验和观察性研究。在筛选出的 188 篇文章中，有 11 篇（5.9%）符合荟萃分析条件。
遵循观察性研究的流行病学指南进行荟萃分析。两位评审员独立提取数据并评估质量。
VTE 预防措施和 VTE 事件的发生率。使用随机效应和固定效应模型汇总优势比和风险比。
纳入了 11 篇文章（9 项前瞻性队列研究和 2 项回顾性队列研究），共纳入 156366 名患者（干预组 104241 名，对照组 52125 名）。使用 CCDSS 与预防 VTE 的适当开具率显著增加相关（优势比，2.35；95%CI，1.78-3.10；P<0.001），与 VTE 事件的风险降低相关（风险比，0.78；95%CI，0.72-0.85；P<0.001）。
使用 CCDSS 增加了开具适当 VTE 预防措施的手术患者比例，并与 VTE 事件的减少相关。
