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Meta-Analysis
. 2017 Jul 1;152(7):638-645.
doi: 10.1001/jamasurg.2017.0131.

Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical Patients: A Systematic Review and Meta-analysis

Zachary M Borab  1 , Michael A Lanni  2 , Michael G Tecce  2 , Christopher J Pannucci  3 , John P Fischer  2
Affiliations
Meta-Analysis

Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical Patients: A Systematic Review and Meta-analysis

Zachary M Borab et al. JAMA Surg. .

Abstract

Importance: Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE.

Objective: To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE.

Data sources: PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed.

Study selection: Clinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis.

Data extraction and synthesis: Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently.

Main outcomes and measures: Rates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios.

Results: Eleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001).

Conclusions and relevance: Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram Showing Identification of Included Studies
Figure 2.
Figure 2.. Forest Plot Comparing Overall Rate of Venous Thromboembolism Events in Patients With Computerized Clinical Decision Support System (CCDSS) Intervention vs Routine Care
A Mantel-Haenszel random-effects model was used to conduct the meta-analysis. The size of each data marker corresponds to the weight of the study assigned by the random-effects model. RR indicates risk ratio.
See this image and copyright information in PMC

Comment in

References

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