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

Zhao, Youlu; Zheng, Xizi; Wang, Jinwei; Xu, Damin; Li, Shuangling; Lv, Jicheng; Yang, Li

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 % CI, 0.75–0.99; p = 0.040, I(2) = 65.3 %; n = 5 studies; N = 30,791 participants) and increased the proportion of acute kidney injury recognition (OR 3.12; 95 % CI, 2.37–4.10; p < 0.001, I(2) = 77.1 %; n = 2 studies; N = 25,121 participants), and investigations (OR 3.07; 95 % CI, 2.91–3.24; p < 0.001, I(2) = 0.0 %; n = 2 studies; N = 25,121 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-021-02459-y.