美国耶鲁大学医学院F Perry Wilson团队研究了电子健康记录预警对急性肾损伤预后的影响。2021年1月18日，该研究发表在《英国医学杂志》上。

为了确定电子健康记录警报是否可改善急性肾损伤患者的死亡率、透析和急性肾损伤的进展，研究组在美国康涅狄格州和罗得岛州的耶鲁纽黑文卫生系统中的六家医院（四所教学医院和两所非教学医院）进行了一项双盲、多中心、平行、随机对照试验。

研究组共招募了6030例成年住院急性肾损伤患者，基于急性肾损伤“弹出”警报的电子健康记录，在提供者打开患者的医疗记录时设置了相关的急性肾损伤命令。主要结局指标为随机分组后14天内，急性肾损伤进展、接受透析或死亡的综合结局。

6030名患者在22个月内被随机分组??。接受电子警报的3059名患者中有653名（21.3％）发生主要结局，接受常规护理的2971名患者中有622名（20.9%），组间差异不显著。每家医院的分析显示，两所非教学医院的预后较差（n=765，13%），警报与主要结局的高风险相关，相对风险为1.49。这些中心的死亡人数更多，其中警报组为15.6％，显著高于常规护理组（8.6％）。某些急性肾损伤护理措施在警戒组有所增加，但似乎并没有改善这些预后。

研究结果表明，电子警报并不能降低急性肾损伤住院患者发生主要结局的风险。

附：英文原文

Title: Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial

Author: F Perry Wilson, Melissa Martin, Yu Yamamoto, Caitlin Partridge, Erica Moreira, Tanima Arora, Aditya Biswas, Harold Feldman, Amit X Garg, Jason H Greenberg, Monique Hinchcliff, Stephen Latham, Fan Li, Haiqun Lin, Sherry G Mansour, Dennis G Moledina, Paul M Palevsky, Chirag R Parikh, Michael Simonov, Jeffrey Testani, Ugochukwu Ugwuowo

Issue&Volume: 2021/01/18

Abstract:

Objective To determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury.

Design Double blinded, multicenter, parallel, randomized controlled trial.

Setting Six hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers.

Participants 6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria.

Interventions An electronic health record based “pop-up” alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient’s medical record.

Main outcome measures A composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury.

Results 6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes.

Conclusions Alerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury.

DOI: 10.1136/bmj.m4786

Source: https://www.bmj.com/content/372/bmj.m4786