Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA.
University of Washington School of Medicine, Seattle, WA, USA.
Pediatr Res. 2021 Apr;89(5):1164-1170. doi: 10.1038/s41390-020-1046-8. Epub 2020 Jul 3.
Acute kidney injury (AKI) is common but not often recognized. Early recognition and management may improve patient outcomes.
This is a prospective, nonrandomized study of clinical decision support (CDS) system [combining electronic alert and standardized care pathway (SCP)] to evaluate AKI detection and progression in hospitalized children. The study was done in three phases: pre-, intervention (CDS) and post. During CDS, text-page with AKI stage and link to SCP was sent to patient's contact provider at diagnosis of AKI using creatinine. The SCP provided guidelines on AKI management [AEIOU: Assess cause of AKI, Evaluate drug doses, Intake-Output charting, Optimize volume status, Urine dipstick].
In all, 239 episodes of AKI in 225 patients (97 females, 43.1%) were analyzed. Proportion of patients with decrease in the stage of AKI after onset was 71.4% for CDS vs. 64.4% for pre- and 55% for post-CDS phases (p = 0.3). Documentation of AKI was higher during CDS (74.3% CDS vs. 47.5% pre- and 57.5% post-, p < 0.001). Significantly greater proportion of patients had nephrotoxic medications adjusted, or fluid plan changed during CDS. Patients from CDS phase had higher eGFR at discharge and at follow-up.
AKI remains under-recognized. CDS (electronic alerts and SCP) improve recognition and allow early intervention. This may improve long-term outcomes, but larger studies are needed.
Acute kidney injury can cause significant morbidity and mortality. It is under-recognized in children. Clinical decision support can be used to leverage existing data in the electronic health record to improve AKI recognition. This study demonstrates the use of a novel, electronic health record-linked, clinical decision support tool to improve the recognition of AKI and guideline-adherent clinical care.
急性肾损伤（AKI）很常见，但往往未被识别。早期识别和治疗可能会改善患者的预后。
这是一项前瞻性、非随机的临床决策支持系统（CDS）研究，旨在评估住院儿童 AKI 的检测和进展。该研究分为三个阶段：前、干预（CDS）和后。在 CDS 期间，当肌酐检测到 AKI 时，系统会向患者的主治医生发送包含 AKI 分期和链接到 SCP 的文本页面。SCP 提供了 AKI 管理指南[AEIOU：评估 AKI 的原因、评估药物剂量、出入量图表、优化容量状态、尿液试纸]。
共分析了 225 名患者的 239 例 AKI 发作（女性 97 例，占 43.1%）。与前和后 CDS 阶段相比，CDS 后 AKI 分期降低的患者比例为 71.4%（CDS 组 vs. 64.4%，p=0.3）。CDS 期间 AKI 的记录率更高（74.3% vs. 47.5%，p<0.001）。在 CDS 期间，有更多的患者调整了肾毒性药物，或改变了液体计划。CDS 组患者出院时和随访时的 eGFR 更高。
AKI 的认识仍然不足。CDS（电子警报和 SCP）可以提高识别率，并允许早期干预。这可能会改善长期预后，但需要更大规模的研究。
急性肾损伤可导致严重的发病率和死亡率。儿童中 AKI 的识别不足。临床决策支持可以利用电子健康记录中的现有数据来提高 AKI 的识别率。本研究展示了一种新的、与电子健康记录相关的临床决策支持工具的使用，以提高 AKI 的识别率和指南一致的临床护理。
