高危病房中急性肾损伤电子警报的价值：一项试点随机对照试验。
Value of electronic alerts for acute kidney injury in high-risk wards: a pilot randomized controlled trial.
作者信息
Wu Yanhua, Chen Yuanhan, Li Shaowen, Dong Wei, Liang Huaban, Deng Miaoyi, Chen Yingnan, Chen Shixin, Liang Xinling
机构信息
Division of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106, Zhong Shan Road 2, Guangzhou City, 510080, Guangdong Province, China.
Division of Information Management, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106, Zhong Shan Road 2, Guangzhou City, 510080, Guangdong Province, China.
出版信息
Int Urol Nephrol. 2018 Aug;50(8):1483-1488. doi: 10.1007/s11255-018-1836-7. Epub 2018 Mar 19.
PURPOSE
To investigate the application value of "electronic alerts" ("e-alerts") for acute kidney injury (AKI) among high-risk wards of hospitals.
METHODS
A prospective, randomized, controlled study was conducted. We developed an e-alert system for AKI and ran the system in intensive care units and divisions focusing on cardiovascular disease. The e-alert system diagnosed AKI automatically based on serum creatinine levels. Patients were assigned randomly to an e-alert group (467 patients) or non-e-alert group (408 patients). Only the e-alert group could receive pop-up messages.
RESULTS
The sensitivity, specificity, Youden Index and accuracy of the AKI e-alert system were 99.8, 97.7, 97.5 and 98.1%, respectively. The prevalence of the diagnosis for AKI and expanded-AKI (AKI or multiple-organ failure) in the e-alert group was higher than that in the non-e-alert group (AKI 7.9 and 2.7%, P = 0.001; expanded-AKI 16.3 and 6.1%, P < 0.001). The prevalence of nephrology consultation in the e-alert group was higher than that in the non-e-alert group (9.0 and 3.7%, P = 0.001). There was no significant difference in the prevalence dialysis, rehabilitation of renal function or death in the two groups.
CONCLUSION
The e-alert system described here was a reliable tool to make an accurate diagnosis of AKI.
目的
探讨“电子警报”（“e-警报”）在医院高危病房急性肾损伤（AKI）中的应用价值。
方法
进行一项前瞻性、随机、对照研究。我们开发了一种用于AKI的电子警报系统，并在重症监护病房和心血管疾病专科运行该系统。该电子警报系统根据血清肌酐水平自动诊断AKI。患者被随机分为电子警报组（467例患者）和非电子警报组（408例患者）。只有电子警报组能收到弹出消息。
结果
AKI电子警报系统的敏感性、特异性、约登指数和准确性分别为99.8%、97.7%、97.5%和98.1%。电子警报组中AKI和扩展型AKI（AKI或多器官功能衰竭）的诊断患病率高于非电子警报组（AKI分别为7.9%和2.7%，P = 0.001；扩展型AKI分别为16.3%和6.1%，P < 0.001）。电子警报组中肾病会诊的患病率高于非电子警报组（分别为9.0%和3.7%，P = 0.001）。两组在透析患病率、肾功能恢复或死亡方面无显著差异。
结论
本文所述的电子警报系统是准确诊断AKI的可靠工具。
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