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REVIEW ARTICLE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 28-34

Using Clinical Decision Support Systems for Acute Kidney Injury Pragmatic Trials


1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic; Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Pittsburgh, PA, USA
2 Department of Nephrology, Chronic Kidney Disease Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Clinical Statistics, Mayo Clinic; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
4 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh; Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
5 Department of Medicine, Division of Nephrology and Hypertension, University of California San Diego, San Diego, CA, USA

Correspondence Address:
Dr. Kianoush Kashani
Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
USA
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DOI: 10.4103/jtccm.jtccm_6_18

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Following the initial introduction of clinical decision support systems (CDSS) into the clinical practice in the 1970s, the complexity and performance quality of CDSSs have increased. The current literature on the efficacy and effectiveness of such systems shows conflicting results. While some studies show a clear benefit in quality-of-care improvement, others fail to replicate these outcomes. Heterogeneity of studies and the complexity of CDSS characteristics drive these conflicting conclusions. The lower cost and the easier implementation of pragmatic clinical trials provide an excellent platform to prove the effectiveness of CDSS in the real-world scenarios. To achieve better results, a series of explanatory trials are needed to identify the most effective CDSS in controlled settings. Therefore, utilization of both explanatory and pragmatic trial designs is necessary to evaluate the safety and efficacy of CDSS on the care of patients with acute kidney injury (AKI) in the acute setting. In this review, the authors provide an overview of the literature on critical care-related CDSS, its characteristics and dimensions, differences between pragmatic and explanatory trials, and potential proposals for both trial designs for AKI.


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