利用电子病历评估用于葡萄球菌血症的计算机决策支持系统。

Leveraging electronic medical records to evaluate a computerized decision support system for staphylococcus bacteremia.

作者信息

Palm Julia, Alaid Ssuhir, Ammon Danny, Brandes Julian, Dürschmid Andreas, Fischer Claudia, Fortmann Jonas, Friebel Kristin, Geihs Sarah, Hartig Anne-Kathrin, He Donghui, Heidel Andrew J, Hetfeld Petra, Ihle Roland, Kahle Suzanne, Koi Verena, Konik Margarethe, Kretzschmann Frauke, Kruse Henner, Lippmann Norman, Lübbert Christoph, Marx Gernot, Mikolajczyk Rafael, Mlocek Anne, Moritz Stefan, Müller Christoph, Müller Susanne, Pérez Garriga Ariadna, Phan-Vogtmann Lo An, Pietzner Diana, Pletz Mathias W, Popp Mario, Rebenstorff Maike, Renz Jonas, Rißner Florian, Röhrig Rainer, Saleh Kutaiba, Schönherr Sebastian G, Spreckelsen Cord, Stempel Anja, Stolz Abel, Thomas Eric, Thon Susanne, Tiller Daniel, Uschmann Sebastian, Wendt Sebastian, Wendt Thomas, Winnekens Philipp, Witzke Oliver, Hagel Stefan, Scherag André

机构信息

Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany.

IT Department, Data Integration Center, University Hospital Halle, Halle, Germany.

出版信息

NPJ Digit Med. 2025 Mar 28;8(1):180. doi: 10.1038/s41746-025-01569-3.

Infectious disease specialists (IDS) improve outcomes of patients with Staphylococcus bacteremia, but immediate IDS access is not always guaranteed. We investigated whether a care-integrated computerized decision support system (CDSS) can safely enhance the standard of care (SOC) for these patients. We conducted a multicenter, noninferiority, interventional stepped-wedge cluster randomized controlled trial relying on the data integration centers at five university hospitals. By this means, electronic medical records can be used for part of the trial documentation. We analyzed 5056 patients from 134 wards (Staphylococcus aureus (SAB): n = 812, coagulase-negative staphylococci (CoNS): n = 4244) and found that the CDSS was noninferior to the SOC for hospital mortality in all patients. Noninferiority regarding the 90-day mortality/relapse in SAB patients was not observed and there was no evidence for differences in vancomycin usage among CoNS patients. Despite low reported usage, physicians rated the CDSS's usability favorably. Trial registration: drks.de; Identifier: DRKS00014320; Registration Date: 2019-05-06.

传染病专家（IDS）可改善葡萄球菌血症患者的治疗效果，但并非总能保证及时获得IDS的诊治。我们调查了一种整合医疗的计算机化决策支持系统（CDSS）是否能安全提高这些患者的标准治疗（SOC）水平。我们依托五所大学医院的数据整合中心开展了一项多中心、非劣效性、干预性阶梯楔形整群随机对照试验。通过这种方式，电子病历可用于部分试验记录。我们分析了来自134个病房的5056例患者（金黄色葡萄球菌（SAB）：n = 812，凝固酶阴性葡萄球菌（CoNS）：n = 4244），发现CDSS在所有患者的医院死亡率方面不劣于SOC。未观察到CDSS在SAB患者90天死亡率/复发率方面不劣于SOC，且没有证据表明CoNS患者在万古霉素使用上存在差异。尽管报告的使用频率较低，但医生对CDSS的可用性评价良好。试验注册：drks.de；标识符：DRKS00014320；注册日期：2019年5月6日。