目的:电子算法的使用,临床决策支持系统,和其他临床信息学干预措施在重症监护中正在增加。小儿急性呼吸窘迫综合征(PARDS)是一种复杂的,与大量临床数据和床边频繁决策相关的动态状况。新颖的数据驱动技术,可以帮助屏幕,提示,并支持临床医生的决策可能对患者预后产生重大影响.我们试图确定并总结与PARDS和成人呼吸窘迫综合征(ARDS)的临床信息学干预相关的证据。第二届小儿急性肺损伤共识会议。
方法:MEDLINE(Ovid),Embase(Elsevier),和CINAHL完成(EBSCOhost)。
方法:我们纳入了对患有ARDS或有ARDS风险的儿科或成人危重症患者的研究,这些研究检查了自动筛查工具,电子算法,或临床决策支持系统。
方法:标题/摘要评论,全文回顾,和使用标准化的数据提取表单进行数据提取。
结果:建议评估的分级,使用开发和评估方法来识别和总结证据并提出建议。确定了26项研究用于全文提取,以解决患者/干预/比较/结果问题。和14个用于建议/声明。产生了两个临床建议,与使用电子筛查工具和自动监控最佳实践指南的遵守情况有关。产生了两个研究陈述,与多中心数据协作的开发以及可通用算法和电子工具的设计有关。生成了一个政策声明,与医疗机构提供物质和人力资源有关,以授权临床医生开发临床信息学干预措施,以改善PARDS患者的护理。
结论:我们在文献系统综述和专家共识的基础上,针对PARDS患者使用电子算法和临床信息学工具,提出了两项临床建议和三项声明(两项研究一项政策)。
The use of electronic algorithms, clinical decision support systems, and other clinical informatics interventions is increasing in critical care. Pediatric acute respiratory distress syndrome (PARDS) is a complex, dynamic condition associated with large amounts of clinical data and frequent decisions at the bedside. Novel data-driven technologies that can help screen, prompt, and support clinician decision-making could have a significant impact on patient outcomes. We sought to identify and summarize relevant evidence related to clinical informatics interventions in both PARDS and adult respiratory distress syndrome (ARDS), for the second Pediatric Acute Lung Injury
Consensus Conference.
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
We included studies of pediatric or adult critically ill patients with or at risk of ARDS that examined automated screening tools, electronic algorithms, or clinical decision support systems.
Title/abstract review, full text review, and data extraction using a standardized data extraction form.
The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-six studies were identified for full text extraction to address the Patient/Intervention/Comparator/Outcome questions, and 14 were used for the recommendations/statements. Two clinical recommendations were generated, related to the use of electronic screening tools and automated monitoring of compliance with best practice
guidelines. Two research statements were generated, related to the development of multicenter data collaborations and the design of generalizable algorithms and electronic tools. One policy statement was generated, related to the provision of material and human resources by healthcare organizations to empower clinicians to develop clinical informatics interventions to improve the care of patients with PARDS.
We present two clinical recommendations and three statements (two research one policy) for the use of electronic algorithms and clinical informatics tools for patients with PARDS based on a systematic review of the literature and expert
consensus.