Baird David, De Souza Nicosha, Logan Rachael, Walker Heather, Guthrie Bruce, Bell Samira
Renal Unit, Ninewells Hospital, Dundee, UK.
Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK.
Clin Kidney J. 2020 Oct 21;14(2):639-646. doi: 10.1093/ckj/sfaa151. eCollection 2021 Feb.
Automated acute kidney injury (AKI) electronic alerts (e-alerts) are rule-based warnings triggered by changes in creatinine and are intended to facilitate earlier detection in AKI. We assessed the impact of the introduction in the Tayside region of UK in April 2015 of automated AKI e-alerts with an accompanying education programme.
Interrupted time-series analysis using segmented regression was performed involving all adults with AKI aged ≥18 years who had a serum creatinine measured between 1 April 2013 and 31 March 2017. Analysis evaluated associations of AKI e-alert introduction on rate and severity (Stages 2-3) of AKI as well as mortality and occupied hospital bed days per patient per month in the population with AKI.
There were 32 320 episodes of AKI during the observation period. Implementation of e-alerts had no effect on the rate of any AKI [incidence rate ratio (IRR) 0.996, 95% confidence interval (CI) 0.991 to 1.001, P = 0.086] or on the rate of severe AKI (IRR 0.995, 95% CI 0.990 to 1.000, P = 0.061). Subgroup analysis found no impact on the rate or severity of AKI in hospital or in the community. Thirty-day mortality following AKI did not improve (IRR 0.998, 95% CI 0.987 to 1.009, P = 0.688). There was a slight reduction in occupied bed days (β-coefficient -0.059, 95% CI -0.094 to -0.025, P = 0.002).
Introduction of automated AKI e-alerts was not associated with a change in the rate, severity or mortality associated with AKI, but there was a small reduction in occupied hospital bed days.
自动急性肾损伤（AKI）电子警报（e - 警报）是由肌酐变化触发的基于规则的警告，旨在促进AKI的早期检测。我们评估了2015年4月在英国泰赛德地区引入自动AKI e - 警报及配套教育计划的影响。
采用分段回归进行中断时间序列分析，纳入2013年4月1日至2017年3月31日期间血清肌酐检测的所有年龄≥18岁的成年AKI患者。分析评估了AKI e - 警报引入对AKI发生率和严重程度（2 - 3期）以及AKI患者群体的死亡率和每月每位患者占用医院病床天数的影响。
观察期内共有32320例AKI发作。e - 警报的实施对任何AKI的发生率[发病率比（IRR）0.996，95%置信区间（CI）0.991至1.001，P = 0.086]或严重AKI的发生率（IRR 0.995，95%CI 0.990至1.000，P = 0.061）均无影响。亚组分析发现对医院或社区中AKI的发生率或严重程度没有影响。AKI后的30天死亡率没有改善（IRR 0.998，95%CI 0.987至1.009，P = 0.688）。占用病床天数略有减少（β系数 - 0.059，95%CI - 0.094至 - 0.025，P = 0.002）。
引入自动AKI e - 警报与AKI的发生率、严重程度或死亡率的变化无关，但占用医院病床天数略有减少。
