Renal Division, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, 8 Xishiku ST, Xicheng District, 100034, Beijing, People's Republic of China.
Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China.
BMC Nephrol. 2021 Aug 4;22(1):271. doi: 10.1186/s12882-021-02459-y.
Clinical decision support systems including both electronic alerts and care bundles have been developed for hospitalized patients with acute kidney injury.
Electronic databases were searched for randomized, before-after and cohort studies that implemented a clinical decision support system for hospitalized patients with acute kidney injury between 1990 and 2019. The studies must describe their impact on care processes, patient-related outcomes, or hospital length of stay. The clinical decision support system included both electronic alerts and care bundles.
We identified seven studies involving 32,846 participants. Clinical decision support system implementation significantly reduced mortality (OR 0.86; 95 % CI, 0.75-0.99; p = 0.040, I = 65.3 %; n = 5 studies; N = 30,791 participants) and increased the proportion of acute kidney injury recognition (OR 3.12; 95 % CI, 2.37-4.10; p < 0.001, I = 77.1 %; n = 2 studies; N = 25,121 participants), and investigations (OR 3.07; 95 % CI, 2.91-3.24; p < 0.001, I = 0.0 %; n = 2 studies; N = 25,121 participants).
Nonrandomized controlled trials of clinical decision support systems for acute kidney injury have yielded evidence of improved patient-centered outcomes and care processes. This review is limited by the low number of randomized trials and the relatively short follow-up period.
已经开发了包括电子警报和护理包在内的临床决策支持系统，用于治疗急性肾损伤的住院患者。
在 1990 年至 2019 年期间，电子数据库中搜索了针对急性肾损伤住院患者实施临床决策支持系统的随机、前后对照和队列研究。这些研究必须描述其对护理流程、患者相关结局或住院时间的影响。临床决策支持系统包括电子警报和护理包。
我们确定了 7 项涉及 32846 名参与者的研究。临床决策支持系统的实施显著降低了死亡率（OR 0.86；95%CI，0.75-0.99；p=0.040，I=65.3%；n=5 项研究；N=30791 名参与者），增加了急性肾损伤识别的比例（OR 3.12；95%CI，2.37-4.10；p<0.001，I=77.1%；n=2 项研究；N=25121 名参与者），以及检查（OR 3.07；95%CI，2.91-3.24；p<0.001，I=0.0%；n=2 项研究；N=25121 名参与者）。
急性肾损伤临床决策支持系统的非随机对照试验提供了改善以患者为中心的结局和护理流程的证据。本综述受到随机试验数量较少和随访时间相对较短的限制。
