评估临床决策支持警报,以确定住院患者的肝功能障碍和需要调整药物治疗的需要
Kevin B Nguyen1, Scott Jacobs2, Nissa Tasnim3
1St. Christopher's Hospital for Children, Philadelphia, PA, USA.
概括
目前的肝功能障碍预警工具只有55%的准确性. 虽然替代模型显示出有希望的结果,但它们有可能错过患有严重肝脏问题的患者.
科学领域:
- 临床信息学 临床信息学
- 肝病学 肝病学是一种肝病学.
- 药物监督 药物监督 药物监督
背景情况:
- 临床决策支持工具对于管理患者护理至关重要.
- 肝功能障碍警报的目的是防止肝脏疾病患者的药物相关伤害.
- 优化警报系统可以减少警报疲劳,提高临床相关性.
研究的目的:
- 评估和优化现有的肝功能障碍预警工具.
- 改善临床相关肝功能障碍患者的鉴定.
- 尽量减少系统生成的无关警报的数量.
主要方法:
- 一个回顾性回顾住院的成年患者肝功能障碍警报.
- 基于Child-Pugh评分和药物警告的警报相关性的分析.
- 评估14种替代警报模型,包括那些不包括特定实验室值的警报模型.
主要成果:
- 现有的工具仅在55%的警报中确定了相关的肝功能障碍.
- 不包括INR和白蛋白的模型减少了27%的警报量,但错过了30%的相关病例.
- 没有任何替代模型能够显著优于现有系统,而不会丢失相关患者.
结论:
- 目前的肝功能障碍预警系统的准确性有限.
- 提高警报相关性需要平衡敏感性和特异性.
- 需要进一步的研究来开发更有效的肝功能障碍预警工具.
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