Impact of integrated clinical decision support systems in the management of pediatric acute kidney injury: a pilot study

Menon, Shina; Tarrago, Rod; Carlin, Kristen; Wu, Hong Jiang; Yonekawa, Karyn

doi:10.1038/s41390-020-1046-8

Cited by 25 publications

(20 citation statements)

References 23 publications

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“…In a single center study of AKI alerts in hospitalized children, Menon et al implemented an alert and clinical decision support tool and showed improved documentation (<50–74% documented) and adjustment/discontinuation of medications. However, there was no statistical difference in documentation of AKI in the hospital discharge summary, nephrology consultation, or outpatient nephrology follow-up, perhaps due to small sample size ( 17 ). In a large, multicenter randomized controlled clinical trial of provider AKI alerts in adults, there was no difference in progression of AKI, dialysis or death between the intervention and control arms.…”

Section: Discussionmentioning

confidence: 97%

“…In the National Health Service in the United Kingdom, Bhojani et al found that only 26% of AKI episodes were documented by the medical team based on a review of progress notes from a sample of 11% of patients with AKI ( 10 ). Menon et al found that 47% of laboratory-identified kidney injuries were documented in a review of progress notes ( 17 ). We found that clinicians were more likely to document kidney for higher absolute values of peak creatinine (serum creatinine >1 mg/dL) as well as higher baseline creatinine suggesting that AKI is more readily recognized in pediatric patients who are closer to adult size.…”

Section: Discussionmentioning

confidence: 99%

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AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

Jones¹,

Neu²,

Fadrowski³

2022

Front. Pediatr.

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Background: Acute kidney injury (AKI) is common in hospitalized children. We hypothesized that hospital-acquired AKI would be underrecognized and under-reported, with potential implications for prevention of future AKI and CKD risk stratification.Methods: Five hundred thirty-two cases of AKI occurring over a 1 year period in a tertiary children's hospital in the United States were studied. AKI documentation was defined as any mention of AKI in the admission history and physical note, progress notes, or discharge summary. Nephrology follow-up was defined as a completed outpatient clinic visit within 1 year of discharge. Logistic regression was used to assess factors associated with documentation, consultation, and follow-up.Results: AKI developed during 584/7,640 (7.6%) of hospitalizations: 532 cases met inclusion criteria. Documentation was present in 34% (185/532) of AKI cases and 90 (16.9%) had an inpatient nephrology consult. Among 501 survivors, 89 (17.8%) had AKI in their hospital discharge summary and 54 had outpatient nephrology follow up. Stage 3 AKI, peak creatinine >1 mg/dL and longer length of stay were associated with documentation. Stage 3 AKI and higher baseline creatinine were associated with inpatient nephrology consultation. Inpatient nephrology consultation was positively associated with outpatient nephrology follow up, but documentation in the discharge summary was not.Conclusion: Most cases of AKI were not documented and the proportion of children seen by a nephrologist was low, even among those with more severe injury. Increased severity of AKI was associated with documentation and inpatient consultation. Poor rates of documentation has implications for AKI recognition and appropriate management and follow up.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

Jones¹,

Neu²,

Fadrowski³

2022

Front. Pediatr.

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“…Care bundles have been recommended and used with e-alerts as an attempt to improve the outcomes associated with AKI (6,28,29,38,40). Currently, care bundles include general common sense measures such as optimal fluid management, medication review, and urinalyses (Table 1).…”

Section: Interventions Associated With Alertmentioning

confidence: 99%

“…Thus, the ability to detect these episodes of AKI can improve the management of these patients to provide the best care possible. However, AKI is often under-recognized and under-documented (5,6). With the widespread use of electronic health records (EHR), it has become possible to use a variety of clinical decision support systems (CDSS) to improve patient care (7).…”

Section: Introductionmentioning

confidence: 99%

For Whom the Bell Tolls: Acute Kidney Injury and Electronic Alerts for the Pediatric Nephrologist

Nguyen

Menon

2021

Front. Pediatr.

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With the advent of the electronic medical record, automated alerts have allowed for improved recognition of patients with acute kidney injury (AKI). Pediatric patients have the opportunity to benefit from such alerts, as those with a diagnosis of AKI are at risk of developing long-term consequences including reduced renal function and hypertension. Despite extensive studies on the implementation of electronic alerts, their overall impact on clinical outcomes have been unclear. Understanding the results of these studies have helped define best practices in developing electronic alerts with the aim of improving their impact on patient care. As electronic alerts for AKI are applied to pediatric patients, identifying their strengths and limitations will allow for continued improvement in its use and efficacy.

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“…In recent years, interest in the implementation of electronic information and alert systems to support decision making by physicians has generally increased [6]. A clinical decision support system (CDSS) can support the recognition, monitoring, and timely treatment of AKI and provide an opportunity to improve management and thus clinical outcome [7,8]. However, so far, use of CDSS has shown a minor impact on the outcome of AKI [2,9].…”

Section: Introductionmentioning

confidence: 99%

Laboratory diagnostic of acute kidney injury and its progression: risk of underdiagnosis in female and elderly patients

Kister

Schmidt

Heuft

et al. 2022

Preprint

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ObjectiveAcute kidney injury (AKI) is a common disease, with high morbidity and mortality rates. In this study, we investigate the potential influence of sex and age on laboratory diagnostic and outcome. It is known that serum creatinine (SCr) has limitations as a laboratory diagnostic parameter for AKI due to its dependence on muscle mass, which may lead to incorrect or delayed diagnosis for certain patient groups, such as women and the elderly.MethodsOverall, 7592 cases with AKI, hospitalized at the University of Leipzig Medical Center (ULMC) between 1st January 2017 and 31st December 2019, were retrospectively analyzed. Diagnosis and staging of AKI was performed according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, based on the level and dynamics of SCr. The impact of sex and age was analyzed by the recalculation of a female to male and an old to young SCr using the CKD-EPI equation.ResultsThe incidence proportion of AKI in our study cohort was 12.0%, with progressive AKI occurring in 19.2% of these cases (n = 1458). Male cases with AKI were overrepresented (59.6%), with a significantly higher first (+3.5 ml/min) and last eGFR (+2.7 ml/min) (p < 0.001). The highest incidence proportion of AKI was found in the [61–81) age group in female (49.5%) and male (52.7%) cases. Males with progressive AKI were overrepresented (p = 0.04). By defining and staging AKI on the basis of relative and absolute changes in SCr level, it is more difficult for patients with low muscle mass and thus a lower baseline SCr to be diagnosed by an absolute SCr increase. AKIN1 and AKIN3 can be diagnosed by a relative or absolute change in SCr. In females, both stages were less frequently detected by an absolute criterion alone (AKIN1 ♀ 20.2%, ♂ 29.5%, p < 0.001; AKIN3 ♀ 13.4%, ♂ 15.2%, p < 0.001). A recalculated SCr for females (to males) and males (to young males) displayed the expected increase in AKI occurrence and severity with age and in general in females.ConclusionOur study illustrates how SCr as the sole parameter for diagnosis and staging of AKI bears the risk of underdiagnosis of patient groups with low muscle mass, such as women and the elderly. A sex- and age-adapted approach might offer advantages.

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Impact of integrated clinical decision support systems in the management of pediatric acute kidney injury: a pilot study

Cited by 25 publications

References 23 publications

AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

For Whom the Bell Tolls: Acute Kidney Injury and Electronic Alerts for the Pediatric Nephrologist

Laboratory diagnostic of acute kidney injury and its progression: risk of underdiagnosis in female and elderly patients

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