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Meta-Analysis
. 2024 Dec;46(2):2400552.
doi: 10.1080/0886022X.2024.2400552. Epub 2024 Sep 9.

The effect of clinical decision support systems on clinical outcomes in acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Obieda Altobaishat  1 , Mohamed Abouzid  2   3 , Ahmed Mazen Amin  4 , Abdallah Bani-Salameh  1 , Mohammad Tanashat  5 , Omar Abdullah Bataineh  1 , Mustafa Turkmani  6   7 , Mohamed Abuelazm  8 , Muner M B Mohamed  9   10
Affiliations
Meta-Analysis

The effect of clinical decision support systems on clinical outcomes in acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Obieda Altobaishat et al. Ren Fail. 2024 Dec.

Abstract

Objectives: To determine whether clinical decision support systems (CDSS) for acute kidney injury (AKI) would enhance patient outcomes in terms of mortality, dialysis, and acute kidney damage progression.

Methods: The systematic review and meta-analysis included the relevant randomized controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until 21st January 2024. The meta-analysis was done using (RevMan 5.4.1). PROSPERO ID: CRD42024517399.

Results: Our meta-analysis included ten RCTs with 18,355 patients. There was no significant difference between CDSS and usual care in all-cause mortality (RR: 1.00 with 95% CI [0.93, 1.07], p = 0.91) and renal replacement therapy (RR: 1.11 with 95% CI [0.99, 1.24], p = 0.07). However, CDSS was significantly associated with a decreased incidence of hyperkalemia (RR: 0.27 with 95% CI [0.10, 0.73], p = 0.01) and increased eGFR change (MD: 1.97 with 95% CI [0.47, 3.48], p = 0.01).

Conclusions: CDSS were not associated with clinical benefit in patients with AKI, with no effect on all-cause mortality or the need for renal replacement therapy. However, CDSS reduced the incidence of hyperkalemia and improved eGFR change in AKI patients.

Keywords: Acute kidney injury; care bundle; clinical decision support system; electronic alert.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
PRISMA flow chart of the screening process.
Figure 2.
Figure 2.
Quality assessment of risk of bias in the included trials. A schematic representation of risks (low = red, unclear = yellow, and high = red) for specific types of biases of each of the studies in the review.
Figure 3.
Figure 3.
Forest Plot of the primary outcomes (all-cause mortality and renal replacement therapy), RR: risk ratio, CI: confidence interval.
Figure 4.
Figure 4.
(A) Forest plot of the hyperkalemia; (B) forest plot of the eGFR; (C) forest plot of the re-hospitalization; (D) forest plot of the creatinine change. RR: risk ratio; CI: confidence interval.
Figure 5.
Figure 5.
(A) Forest plot of the number of patients who received NSAIDs; (B) forest plot of the number of patients who received aminoglycosides; (C) forest plot of number of patients who received ACEi and ARBs; (D) forest plot of number of patients received contrast. RR: risk ratio; CI: confidence interval.
See this image and copyright information in PMC

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