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Cited by 200Acute Kidney Injury ResearchElectronic Health Records SystemsNursing Diagnosis and Documentation

Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial

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Wilson, F Perry, Martin, Melissa, Yamamoto, Yu, Partridge, Caitlin, Moreira, Erica, Arora, Tanima, Biswas, Aditya, Feldman, Harold +13 more·2021·BMJ
DOI 10.1136/bmj.m4786PMC PMC8034420
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Abstract

Abstract Objective To determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury. Design Double blinded, multicenter, parallel, randomized controlled trial. Setting Six hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers. Participants 6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. Interventions An electronic health record based “pop-up” alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient’s medical record. Main outcome measures A composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury. Results 6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes. Conclusions Alerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury. Trial registration ClinicalTrials.gov NCT02753751 .

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  • AI algorithms may be harmful when prematurely deployed without adequate control.

    “AI algorithms may be harmful when prematurely deployed without adequate control [9, 15–17].”

    From Implementing Artificial Intelligence in Critical Care Medicine: a consensus of 22. (2025) · cites this paper as [15]

    The Results report worse outcomes in two non-teaching hospitals that received acute kidney injury alerts, and the Discussion (Comparisons with other studies) says seemingly benign alerts should not be implemented without robust evidence of safety and efficacy. This supports the warning about harm from insufficiently evaluated deployment, but the intervention was an electronic health record alert; the paper does not establish the claim specifically for AI algorithms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Wilson, F. P., Martin, M., Yamamoto, Y., Partridge, C., Moreira, E., Arora, T., Biswas, A., Feldman, H., Garg, A. X., Greenberg, J. H., Hinchcliff, M., Latham, S., Li, F., Lin, H., Mansour, S. G., Moledina, D. G., Palevsky, P. M., Parikh, C. R., Simonov, M., Testani, J., & Ugwuowo, U.
Affiliations
  • Yale University (US)
  • University of Pennsylvania (US)
  • Western University (CA)
  • Rutgers, The State University of New Jersey (US)
  • University of Pittsburgh (US)
  • Johns Hopkins University (US)
Corresponding author
Wilson, F Perry
ORCID
Venue
BMJ
Publisher
BMJ
Published
2021-01-18
Volume
372
Pages
m4786
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.m4786
PMC
PMC8034420
OpenAlex
W3123501659
Cited by
200
References
3
Citations by year
2026: 23 · 2025: 39 · 2024: 34 · 2023: 45 · 2022: 35 · 2021: 24
FWCI
23.63
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1TR001863)
  • National Heart, Lung, and Blood Institute (R01HL085757)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113191, U01DK082185, K23DK117065, P30DK079310)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
Keywords
acute kidney injury, electronic health record alerts, clinical decision support, mortality, dialysis, acute kidney injury progression, heterogeneous effects
MeSH terms
Aged, Aged, 80 and over, Double-Blind Method, Female, Renal Dialysis, Humans, Male, Middle Aged, Medical Records Systems, Computerized, Treatment Outcome, Disease Progression, Electronic Health Records, Acute Kidney Injury

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