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2017 ; 114
(1-02
): 1-8
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Electronic Alerts for Acute Kidney Injury
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Haase M
; Kribben A
; Zidek W
; Floege J
; Albert C
; Isermann B
; Robra BP
; Haase-Fielitz A
Dtsch Arztebl Int
2017[Jan]; 114
(1-02
): 1-8
PMID28143633
show ga
BACKGROUND: Acute kidney injury (AKI) often takes a complicated course if
diagnosed late and undertreated. Electronic alerts that provide an early warning
of AKI are intended to support treating physicians in making the diagnosis of AKI
and treating it appropriately. The available evidence on the effects of such
alert systems is inconsistent. METHODS: We employed the PRISMA recommendations
for systematic literature reviews to identify relevant articles in the PubMed,
Scopus, and Web of Science databases. All of the studies that were retrieved were
independently assessed by two of the authors with respect to the methods of
computer-assisted electronic alert systems and their effects on process
indicators and clinical endpoints. RESULTS: 16 studies with a total of 32 842
patients were identified. 8.5% of admitted patients had community-acquired or
hospital-acquired AKI, with an in-hospital mortality of 22.8%. Fifteen electronic
alert systems were in use throughout the participating hospitals. In 13 of 15
studies, alarm activation was accompanied by concrete treatment recommendations.
A randomized controlled trial in which no such recommendations were given did not
reveal any benefit of the alert system for the patients. In controlled but
non-randomized trials, however, the provision of concrete treatment
recommendations when the alert was activated led to more frequent implementation
of diagnostic or therapeutic measures, less loss of renal function, lower
in-hospital mortality, and lower mortality after discharge compared to control
groups without an electronic alert for AKI. CONCLUSION: Non-randomized controlled
trials of electronic alerts for AKI that were coupled with treatment
recommendations have yielded evidence of improved care processes and treatment
outcomes for patients with AKI. This review is limited by the low number of
randomized trials and the wide variety of endpoints used in the studies that were
evaluated.
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