title: Effect of an electronic alert on risk of contrast-induced acute kidney injury in hospitalized patients undergoing computed tomography.
abstract: BACKGROUND
  Prophylaxis against contrast-induced acute kidney injury (AKI) in hospitalized patients is underused. We evaluated the impact of a computerized alert program for contrast-induced AKI for hospitalized patients undergoing contrast-enhanced computed tomography (CT).
  
  
  METHODS
  Quality improvement report.
  
  
  METHODS
  463 adult inpatients in a single center with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2).
  
  
  METHODS
  We developed a computer alert program in which the responsible physician was alerted to a patient's risk of contrast-induced AKI in the form of a warning message box and was recommended to consider prophylactic measures for contrast-induced AKI when he or she ordered contrast-enhanced CT for patients with eGFR <60 mL/min/1.73 m(2). The intervention was applied simultaneously to all hospitalized patients from March 18, 2010. The hospital's contrast-induced AKI preventive guidelines included prehydration, posthydration, and oral N-acetylcysteine.
  
  
  METHODS
  Use of prophylactic interventions, development of contrast-induced AKI. Contrast-induced AKI was defined as an increase in serum creatinine level (≥0.3 mg/dL or ≥50%) 24-72 hours after contrast medium exposure.
  
  
  RESULTS
  258 adult inpatients with eGFR <60 mL/min/1.73 m(2) were identified as undergoing contrast-enhanced CT before application of the computer alert program (from October 28, 2009, to March 17, 2010), and 205, after its application (from March 18, 2010, to August 5, 2010). Individuals in the postalert group received contrast-induced AKI prophylaxis more often than those in the prealert group (55% vs 25% for total prophylaxis; P < 0.001). The incidence of contrast-induced AKI was lower in the postalert group than in the prealert group (3% vs 10%; P = 0.02).
  
  
  CONCLUSIONS
  Observation bias; only 61.5% of participants were evaluated for contrast-induced AKI.
  
  
  CONCLUSIONS
  Implementation of a computerized alert program in hospitalized patients was followed by increased use of prophylaxis and decreased risk of contrast-induced AKI.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ajin
authors.initials: A
authors.lastname: Cho
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Yoon
authors.forename: Hye Ryoun
authors.initials: HR
authors.lastname: Jang
authors.forename: Wooseong
authors.initials: W
authors.lastname: Huh
authors.forename: Yoon-Goo
authors.initials: YG
authors.lastname: Kim
authors.forename: Dae Joong
authors.initials: DJ
authors.lastname: Kim
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Oh
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D003201:Computers; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D017010:Reminder Systems; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media