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Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class

KIRSTEN COLPAERT UGent, Eric Hoste UGent, Kristof Steurbaut UGent, Dominique Benoit UGent, Sofie Van Hoecke UGent, Filip De Turck UGent and Johan Decruyenaere UGent (2012) CRITICAL CARE MEDICINE. 40(4). p.1164-1170
abstract
OBJECTIVE: To evaluate whether a real-time electronic alert system or "AKI sniffer," which is based on the classification criteria (Risk, Injury and Failure), would have an impact on therapeutic interventions and acute kidney injury progression. DESIGN: Prospective intervention study. SETTING: Surgical and medical intensive care unit in a tertiary care hospital. PATIENTS: A total of 951 patients having in total 1079 admission episodes were admitted during the study period (prealert control group: 227, alert group: 616, and postalert control group: 236). INTERVENTIONS: Three study phases were compared: a 1.5-month prealert control phase in which physicians were blinded for the acute kidney injury sniffer and a 3-month intervention phase with real-time alerting of worsening class through the Digital Enhanced Cordless Technology telephone system followed by a second 1.5-month postalert control phase. MEASUREMENTS AND MAIN RESULTS: A total of 2593 acute kidney injury alerts were recorded with a balanced distribution over all study phases. Most acute kidney injury alerts were class risk (59.8%) followed by class injury (34.1%) and failure (6.1%). A higher percentage of patients in the alert group received therapeutic intervention within 60 mins after the acute kidney injury alert (28.7% in alert group vs. 7.9% and 10.4% in the pre- and postalert control groups, respectively, p < .001). In the alert group, more patients received fluid therapy (23.0% vs. 4.9% and 9.2%, p < .01), diuretics (4.2% vs. 2.6% and 0.8%, p < .001), or vasopressors (3.9% vs. 1.1% and 0.8%, p < .001). Furthermore, these patients had a shorter time to intervention (p < .001). A higher proportion of patients in the alert group showed return to a baseline kidney function within 8 hrs after an acute kidney injury alert "from normal to risk" compared with patients in the control group (p = .048). CONCLUSIONS: The real-time alerting of every worsening class by the acute kidney injury sniffer increased the number and timeliness of early therapeutic interventions. The borderline significant improvement of short-term renal outcome in the class risk patients needs to be confirmed in a large multicenter trial.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
CLASSIFICATION, IBCN, EPIDEMIOLOGY, OUTCOMES, CARDIAC-SURGERY, CRITERIA, clinical decisions support systems, acute kidney injury, computer systems, intensive care unit, RIFLE classification, treatment outcome, ACUTE-RENAL-FAILURE, CRITICALLY-ILL PATIENTS, INTENSIVE-CARE-UNIT, DECISION-SUPPORT, HOSPITALIZED-PATIENTS
journal title
CRITICAL CARE MEDICINE
Crit. Care Med.
volume
40
issue
4
pages
1164 - 1170
Web of Science type
Article
Web of Science id
000301813700016
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
6.124 (2012)
JCR rank
2/26 (2012)
JCR quartile
1 (2012)
ISSN
0090-3493
DOI
10.1097/CCM.0b013e3182387a6b
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2033325
handle
http://hdl.handle.net/1854/LU-2033325
date created
2012-02-15 11:29:14
date last changed
2013-10-11 11:10:29
@article{2033325,
  abstract     = {OBJECTIVE: To evaluate whether a real-time electronic alert system or {\textacutedbl}AKI sniffer,{\textacutedbl} which is based on the classification criteria (Risk, Injury and Failure), would have an impact on therapeutic interventions and acute kidney injury progression.
DESIGN: Prospective intervention study.
SETTING: Surgical and medical intensive care unit in a tertiary care hospital.
PATIENTS: A total of 951 patients having in total 1079 admission episodes were admitted during the study period (prealert control group: 227, alert group: 616, and postalert control group: 236).
INTERVENTIONS: Three study phases were compared: a 1.5-month prealert control phase in which physicians were blinded for the acute kidney injury sniffer and a 3-month intervention phase with real-time alerting of worsening class through the Digital Enhanced Cordless Technology telephone system followed by a second 1.5-month postalert control phase.
MEASUREMENTS AND MAIN RESULTS: A total of 2593 acute kidney injury alerts were recorded with a balanced distribution over all study phases. Most acute kidney injury alerts were class risk (59.8\%) followed by class injury (34.1\%) and failure (6.1\%). A higher percentage of patients in the alert group received therapeutic intervention within 60 mins after the acute kidney injury alert (28.7\% in alert group vs. 7.9\% and 10.4\% in the pre- and postalert control groups, respectively, p {\textlangle} .001). In the alert group, more patients received fluid therapy (23.0\% vs. 4.9\% and 9.2\%, p {\textlangle} .01), diuretics (4.2\% vs. 2.6\% and 0.8\%, p {\textlangle} .001), or vasopressors (3.9\% vs. 1.1\% and 0.8\%, p {\textlangle} .001). Furthermore, these patients had a shorter time to intervention (p {\textlangle} .001). A higher proportion of patients in the alert group showed return to a baseline kidney function within 8 hrs after an acute kidney injury alert {\textacutedbl}from normal to risk{\textacutedbl} compared with patients in the control group (p = .048).
CONCLUSIONS: The real-time alerting of every worsening class by the acute kidney injury sniffer increased the number and timeliness of early therapeutic interventions. The borderline significant improvement of short-term renal outcome in the class risk patients needs to be confirmed in a large multicenter trial.},
  author       = {COLPAERT, KIRSTEN and Hoste, Eric and Steurbaut, Kristof and Benoit, Dominique and Van Hoecke, Sofie and De Turck, Filip and Decruyenaere, Johan},
  issn         = {0090-3493},
  journal      = {CRITICAL CARE MEDICINE},
  keyword      = {CLASSIFICATION,IBCN,EPIDEMIOLOGY,OUTCOMES,CARDIAC-SURGERY,CRITERIA,clinical decisions support systems,acute kidney injury,computer systems,intensive care unit,RIFLE classification,treatment outcome,ACUTE-RENAL-FAILURE,CRITICALLY-ILL PATIENTS,INTENSIVE-CARE-UNIT,DECISION-SUPPORT,HOSPITALIZED-PATIENTS},
  language     = {eng},
  number       = {4},
  pages        = {1164--1170},
  title        = {Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class},
  url          = {http://dx.doi.org/10.1097/CCM.0b013e3182387a6b},
  volume       = {40},
  year         = {2012},
}

Chicago
COLPAERT, KIRSTEN, Eric Hoste, Kristof Steurbaut, Dominique Benoit, Sofie Van Hoecke, Filip De Turck, and Johan Decruyenaere. 2012. “Impact of Real-time Electronic Alerting of Acute Kidney Injury on Therapeutic Intervention and Progression of RIFLE Class.” Critical Care Medicine 40 (4): 1164–1170.
APA
COLPAERT, KIRSTEN, Hoste, E., Steurbaut, K., Benoit, D., Van Hoecke, S., De Turck, F., & Decruyenaere, J. (2012). Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. CRITICAL CARE MEDICINE, 40(4), 1164–1170.
Vancouver
1.
COLPAERT K, Hoste E, Steurbaut K, Benoit D, Van Hoecke S, De Turck F, et al. Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class. CRITICAL CARE MEDICINE. 2012;40(4):1164–70.
MLA
COLPAERT, KIRSTEN, Eric Hoste, Kristof Steurbaut, et al. “Impact of Real-time Electronic Alerting of Acute Kidney Injury on Therapeutic Intervention and Progression of RIFLE Class.” CRITICAL CARE MEDICINE 40.4 (2012): 1164–1170. Print.