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

Abstract

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 >50% and no serum creatinine (SCr) was ordered within 24 hours. The primary outcome was SCr testing within 48 hours of AKI risk >50%. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

Quality improvement goals for pediatric acute kidney injury: pediatric applications of the 22nd Acute Disease Quality Initiative (ADQI) conference

“…The goals of these alert systems are not only to enhance provider awareness but also to reduce AKI severity and duration. However, the benefits of these AKI alert tools remain to be determined [44,45].…”

A scoping review exploring the impact of digital systems on processes and outcomes in the care management of acute kidney injury and progress towards establishing learning healthcare systems

“…[22] There were eight randomised controlled trials. [12,20,29–34] The other studies used a range of observational designs, with the majority being uncontrolled before and after studies.…”

“…In 15 the main purpose of the intervention was harm prevention,[13,17,19,21,22,26,28,32,35–39] in 12 it was earlier diagnosis,[14,20,24,25,30,31,40–45] and in two, risk prediction. [12,46] Harm prevention interventions involved alerts to clinicians of the need to change nephrotoxic drugs (non-prescription, dose altering or drug suspension) based on a patient’s renal function. The main purpose of early diagnosis interventions was to alert individual clinicians of a patient’s deteriorating renal function to trigger an early review and appropriate intervention.…”

“…In almost half the interventions where it was specified, the alert was targeted at a physician,[14,19,24–26,28,32,35,37,39–41] with a member of the multidisciplinary team (MDT) being the next most common target. [12,13,17,21,30,31,38,44,46] The digital maturity of the interventions clustered at level 2 (standalone databases not fully integrated into the EHR)[19,22,25,26,28,30,31,35,37,39,41,45] and level 4[12,14,17,20,32,36,42,43,46], two were at level 1[40,44] and four at level 3. [13,21,24,38]…”

“…[10,11] As well as promoting earlier diagnosis, some digital systems are predictive, identifying patients at risk and allowing closer monitoring or tailoring of treatment to avoid the condition developing. [12] Others play a part in harm-reduction by highlighting the potential dangers of certain drugs or doses to kidney function.…”