title: Electronic Alerts for Acute Kidney Injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) often takes a complicated course if diagnosed late and undertreated. Electronic alerts that provide an early warning of AKI are intended to support treating physicians in making the diagnosis of AKI and treating it appropriately. The available evidence on the effects of such alert systems is inconsistent.
  
  
  METHODS
  We employed the PRISMA recommendations for systematic literature reviews to identify relevant articles in the PubMed, Scopus, and Web of Science databases. All of the studies that were retrieved were independently assessed by two of the authors with respect to the methods of computer-assisted electronic alert systems and their effects on process indicators and clinical endpoints.
  
  
  RESULTS
  16 studies with a total of 32 842 patients were identified. 8.5% of admitted patients had community-acquired or hospital-acquired AKI, with an in-hospital mortality of 22.8%. Fifteen electronic alert systems were in use throughout the participating hospitals. In 13 of 15 studies, alarm activation was accompanied by concrete treatment recommendations. A randomized controlled trial in which no such recommendations were given did not reveal any benefit of the alert system for the patients. In controlled but non-randomized trials, however, the provision of concrete treatment recommendations when the alert was activated led to more frequent implementation of diagnostic or therapeutic measures, less loss of renal function, lower in-hospital mortality, and lower mortality after discharge compared to control groups without an electronic alert for AKI.
  
  
  CONCLUSIONS
  Non-randomized controlled trials of electronic alerts for AKI that were coupled with treatment recommendations have yielded evidence of improved care processes and treatment outcomes for patients with AKI. This review is limited by the low number of randomized trials and the wide variety of endpoints used in the studies that were evaluated.
authors.affiliation: Department of Research and Science, Medical School Brandenburg Theodor Fontane (MHB); Medical Faculty, Otto-von-Guericke Universität (OvGU), Magdeburg; MVZ Diaverum, Potsdam; MHB; University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, OVGU Magdeburg; Clinic for Nephrology, Essen University Hospital; Medical Department, Division of Nephrology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Clinic for Renal and Hypertensive Disorders, Rheumatological and Immunological Diseases (Medical Clinic II), University Hospital Aachen; Department of Clinical Chemistry and Pathobiochemistry (IKCP), OVGU Magdeburg; Department of Social Medicine & Health Economics (ISMG), OVGU Magdeburg.
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.forename: Walter
authors.initials: W
authors.lastname: Zidek
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.forename: Christian
authors.initials: C
authors.lastname: Albert
authors.forename: Berend
authors.initials: B
authors.lastname: Isermann
authors.forename: Bernt-Peter
authors.initials: BP
authors.lastname: Robra
authors.forename: Anja
authors.initials: A
authors.lastname: Haase-Fielitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D056902:Clinical Alarms / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D017052:Hospital Mortality; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome