Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial.

Autor: Van Driest SL; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. sara.van.driest@vumc.org., Wang L; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA., McLemore MF; Health Information Technology, Vanderbilt University School of Medicine, Nashville, TN, USA., Bridges BC; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA., Fleming GM; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA., McGregor TL; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA., Jones DP; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA., Shirey-Rice J; Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN, USA., Gatto CL; Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN, USA., Gay JC; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA., Byrne DW; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA., Weitkamp A; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA., Roden DM; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Bernard G; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2020 Jan; Vol. 87 (1), pp. 118-124. Date of Electronic Publication: 2019 Aug 27.
DOI: 10.1038/s41390-019-0550-1
Abstrakt: Background: Pediatric acute kidney injury (AKI) is common and associated with increased morbidity, mortality, and length of stay. We performed a pragmatic randomized trial testing the hypothesis that AKI risk alerts increase AKI screening.
Methods: All intensive care and ward admissions of children aged 28 days through 21 years without chronic kidney disease from 12/6/2016 to 11/1/2017 were included. The intervention alert displayed if calculated AKI risk was > 50% and no serum creatinine (SCr) was ordered within 24 h. The primary outcome was SCr testing within 48 h of AKI risk > 50%.
Results: Among intensive care admissions, 973/1909 (51%) were randomized to the intervention. Among those at risk, more SCr tests were ordered for the intervention group than for controls (418/606, 69% vs. 361/597, 60%, p = 0.002). AKI incidence and severity were the same in intervention and control groups. Among ward admissions, 5492/10997 (50%) were randomized to the intervention, and there were no differences between groups in SCr testing, AKI incidence, or severity of AKI.
Conclusions: Alerts based on real-time prediction of AKI risk increased screening rates in intensive care but not pediatric ward settings. Pragmatic clinical trials provide the opportunity to assess clinical decision support and potentially eliminate ineffective alerts.
Databáze: MEDLINE
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