Clinical Decision Support for In-Hospital AKI
Clinical Decision Support for In-Hospital AKI
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DOI：
10.1681/asn.2017070765
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发表时间：
2018-02-01
影响因子：
13.6
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
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作者：
Al-Jaghbeer, Mohammed;Dealmeida, Dilhari;Kellum, John A.
阿基具有显著的死亡率和发病率风险。使用临床决策支持系统（CDSS）可能会改善结果。我们对2012年10月至2015年9月期间入院前未患ESRD的528，108例患者进行了一项多中心、序贯期分析，以确定使用CDSS是否可缩短阿基患者的住院时间和院内死亡率。我们比较了CDSS实施前12个月（181，696）和实施后24个月（346，412）接受治疗的患者。共同主要结局为住院死亡率和住院时间，经人口统计学和合并症调整。64，512例患者（12.2%）被诊断为阿基。阿基患者的粗死亡率从实施CDSS前的10.2%降至实施CDSS后的9.4%（比值比，0.91; 95%置信区间[95% CI]，0.86至0.96; P=0.001），但无阿基患者的粗死亡率没有变化（从1.5%降至1.4%）。平均住院时间从9.3天减少到9.0天（P
AKI carries a significant mortality and morbidity risk. Use of a clinical decision support system(CDSS) might improve outcomes. We conducted a multicenter, sequential period analysis of 528,108 patients without ESRD before admission, from October of 2012 to September of 2015, to determine whether use of a CDSS reduces hospital length of stay and in-hospital mortality for patients with AKI. We compared patients treated 12 months before (181,696) and 24 months after (346,412) implementation of the CDSS. Coprimary outcomes were hospital mortality and length of stay adjusted by demographics and comorbidities. AKI was diagnosed in 64,512 patients (12.2%). Crude mortality rate fell from 10.2% before to 9.4% after CDSS implementation (odds ratio, 0.91; 95% confidence interval [95% CI], 0.86 to 0.96; P=0.001) for patients with AKI but did not change in patients without AKI (from 1.5% to 1.4%). Mean hospital duration decreased from 9.3 to 9.0 days (P