Effect of clinical decision support systems on clinical outcome for acute kidney injury: a systematic review and meta-analysis

Abstract

Background Clinical decision support systems including both electronic alerts and care bundles have been developed for hospitalized patients with acute kidney injury. Methods Electronic databases were searched for randomized, before-after and cohort studies that implemented a clinical decision support system for hospitalized patients with acute kidney injury between 1990 and 2019. The studies must describe their impact on care processes, patient-related outcomes, or hospital length of stay. The clinical decision support system included both electronic alerts and care bundles. Results We identified seven studies involving 32,846 participants. Clinical decision support system implementation significantly reduced mortality (OR 0.86; 95\u2009% CI, 0.75–0.99; p \u2009=\u20090.040, I 2 \u2009=\u200965.3\u2009%; n \u2009=\u20095 studies; N \u2009=\u200930,791 participants) and increased the proportion of acute kidney injury recognition (OR 3.12; 95\u2009% CI, 2.37–4.10; p \u2009<\u20090.001, I 2 \u2009=\u200977.1\u2009%; n \u2009=\u20092 studies; N \u2009=\u200925,121 participants), and investigations (OR 3.07; 95\u2009% CI, 2.91–3.24; p \u2009<\u20090.001, I 2 \u2009=\u20090.0\u2009%; n \u2009=\u20092 studies; N \u2009=\u200925,121 participants). Conclusions Nonrandomized controlled trials of clinical decision support systems for acute kidney injury have yielded evidence of improved patient-centered outcomes and care processes. This review is limited by the low number of randomized trials and the relatively short follow-up period.