Related Experiment Video
Updated: Jan 20, 2026
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Acute kidney injury risk-based screening in pediatric inpatients: a pragmatic randomized trial
Sara L Van Driest1, Li Wang2, Michael F McLemore3
1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. sara.van.driest@vumc.org.
Insights
AKI risk alerts improved screening in pediatric intensive care but not wards. This highlights the need to refine clinical decision support tools for better pediatric acute kidney injury (AKI) detection.
Area of Science:
- Pediatric Nephrology
- Clinical Informatics
- Critical Care Medicine
Background:
- Pediatric acute kidney injury (AKI) is a significant clinical challenge with severe consequences.
- Early detection and intervention are crucial for improving outcomes in pediatric AKI.
- Current screening methods may not be optimally effective in identifying at-risk children.
Purpose of the Study:
- To evaluate the effectiveness of an AKI risk alert system in increasing AKI screening in pediatric patients.
- To test the hypothesis that real-time AKI risk alerts improve the rate of serum creatinine (SCr) testing.
Main Methods:
- A pragmatic randomized trial was conducted involving pediatric admissions (28 days to 21 years) without pre-existing chronic kidney disease.
- An alert system was implemented, triggering if calculated AKI risk exceeded 50% and no SCr test was ordered within 24 hours.
- The primary outcome measured was SCr testing within 48 hours of the AKI risk threshold being met.
Main Results:
- In intensive care unit (ICU) admissions, the intervention group showed significantly higher SCr testing rates (69%) compared to controls (60%, p=0.002).
- AKI incidence and severity remained comparable between intervention and control groups in the ICU.
- No significant differences in SCr testing, AKI incidence, or severity were observed in pediatric ward admissions between the groups.
Conclusions:
- Real-time AKI risk alerts effectively increased screening rates in pediatric intensive care settings.
- The alert system did not improve screening in pediatric ward settings, suggesting context-specific effectiveness.
- Pragmatic trials are valuable for assessing clinical decision support tools and identifying potentially ineffective alerts.
Background:
Pediatric acute kidney injury (AKI) is common and associated with increased morbidity, mortality, and length of stay. We performed a pragmatic randomized trial testing the hypothesis that AKI risk alerts increase AKI screening.
Methods:
All intensive care and ward admissions of children aged 28 days through 21 years without chronic kidney disease from 12/6/2016 to 11/1/2017 were included. The intervention alert displayed if calculated AKI risk was > 50% and no serum creatinine (SCr) was ordered within 24 h. The primary outcome was SCr testing within 48 h of AKI risk > 50%.
Results:
Among intensive care admissions, 973/1909 (51%) were randomized to the intervention. Among those at risk, more SCr tests were ordered for the intervention group than for controls (418/606, 69% vs. 361/597, 60%, p = 0.002). AKI incidence and severity were the same in intervention and control groups. Among ward admissions, 5492/10997 (50%) were randomized to the intervention, and there were no differences between groups in SCr testing, AKI incidence, or severity of AKI.
Conclusions:
Alerts based on real-time prediction of AKI risk increased screening rates in intensive care but not pediatric ward settings. Pragmatic clinical trials provide the opportunity to assess clinical decision support and potentially eliminate ineffective alerts.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:20Acute Kidney Injury V: Interprofessional Care
01:22Acute Kidney Injury VI: Nursing Management
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention