Effect of an electronic alert on risk of contrast-induced acute kidney injury in hospitalized patients undergoing computed tomography

Am J Kidney Dis. 2012 Jul;60(1):74-81. doi: 10.1053/j.ajkd.2012.02.331. Epub 2012 Apr 11.

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).

Study design: Quality improvement report.

Setting & participants: 463 adult inpatients in a single center with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2).

Quality improvement plan: 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.

Outcome & measurements: 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).

Limitations: 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.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / diagnostic imaging
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / prevention & control*
  • Adult
  • Aged
  • Computers
  • Contrast Media / adverse effects*
  • Female
  • Glomerular Filtration Rate
  • Hospitalization
  • Humans
  • Male
  • Medical Order Entry Systems*
  • Middle Aged
  • Radiographic Image Enhancement
  • Reminder Systems*
  • Tomography, X-Ray Computed

Substances

  • Contrast Media