Clinical decision support systems for neonatal care

  • Review
  • Intervention

Authors


Abstract

Background

Clinical decision support systems (CDSS) are computer-based information systems used to integrate clinical and patient information to provide support for decision-making in patient care. They may be useful in aiding the diagnostic process, the generation of alerts and reminders, therapy critiquing/planning, information retrieval, and image recognition and interpretation. CDSS for use in adult patients have been evaluated using randomised control trials and their results analysed in systematic reviews. There is as yet no systematic review on CDSS use in neonatal medicine.

Objectives

To examine whether the use of clinical decision support systems has an effect on
1. the mortality and morbidity of newborn infants and
2. the performance of physicians treating them

Search methods

The standard search method of the Cochrane Neonatal Review Group was used. Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (from 1966 to July 2007), EMBASE (1980 - July 2007), CINAHL (1982 to July 2007) and AMED (1985 to July 2007).

Selection criteria

Randomised or quasi-randomised controlled trials which compared the effects of CDSS versus no CDSS in the care of newborn infants. Trials which compared CDSS against other CDSS were also considered. The eligible interventions were CDSS for computerised physician order entry, computerised physiological monitoring, diagnostic systems and prognostic systems.

Data collection and analysis

Studies were assessed for eligibility using a standard pro forma. Methodological quality was assessed independently by the different investigators.

Main results

Two studies fitting the selection criteria were found for computer aided prescribing and one study for computer aided physiological monitoring.

Computer-aided prescribing: one study (Cade 1997) examined the effects of computerised prescribing of parenteral nutrition ordering. No significant effects on short-term outcomes were found and longer term outcomes were not studied. The second study (Balaguer 2001) investigated the effects of a database program in aiding the calculation of neonatal drug dosages. It was found that the time taken for calculation was significantly reduced and there was a significant reduction in the number of calculation errors.

Computer-aided physiological monitoring: one eligible study (Cunningham 1998) was found which examined the effects of computerised cot side physiological trend monitoring and display. There were no significant effects on mortality, volume of colloid infused, frequency of blood gases sampling (samples per day) or severe intraventricular haemorrhage (Papile Grade IV). Published data did not permit us to analyse effects on long-term neurodevelopmental outcome.

Authors' conclusions

There are very limited data from randomised trials on which to assess the effects of clinical decision support systems in neonatal care. Further evaluation of CDSS using randomised controlled trials is warranted.

摘要

背景

應用於新生兒照護的臨床決策支持系統

臨床決策支持系統(CDSS)是以電腦為基礎的資訊系統,用於整合臨床和病人資料,以提供照護病患決策決定的支持。他們可能有助於診斷過程,產生警訊與提醒,治療評論與計畫,資訊檢索,影像判斷與解釋。CDSS用於成人患者的部份已採用隨機對照試驗及其結果分析做系統性回顧。但目前還沒有針對新生兒醫學的CDSS做系統性回顧。

目標

要檢驗使用了臨床決策支持系統有下列影響:1. 新生兒死亡率和發病率。2. 醫生治療他們的成果。

搜尋策略

使用Cochrane新生兒審查小組使用的標準搜索方法。透過Cochrane對照試驗中心註冊試驗(CENTRAL, The Cochrane Library,2007年,第2期),MEDLINE(從 1966年至2007年7月),EMBASE(1980  2007年7月),CINAHL(1982年至2007年7月)和AMED(1985年至2007年7月)完成搜索。

選擇標準

隨機或半隨機對照試驗比較了CDSS與非CDSS在照顧新生兒的成效。這次試驗也比較了CDSS與其他CDSS。符合的CDSS是要包括電腦化醫囑輸入,電腦化生理監測,診斷系統和預後系統。

資料收集與分析

透過使用標準慣例,評估該研究是否合乎我們要求。由不同的調查者獨立評估是否合乎方法學品質。

主要結論

有找到一些研究符合選擇標準,兩個是有關電腦輔助開立處方,一個是與電腦輔助生理學監測有關。電腦輔助開立處方:第一項試驗(Cade 1997年)研究了電腦開立有關靜脈營養處方的效果。短期結果發現沒有顯著影響而長期的結果並沒有被研究。第二項試驗(Balaguer 2001)調查了協助計算新生兒藥物劑量的資料庫程式的效果。結果發現,計算所花的時間顯著降低,而計算數量產生的錯誤有顯著減少。而電腦輔助生理監測:發現有一個符合資格的研究(Cunningham 1998年),其結果顯示了電腦輔助床邊生理趨勢監測和顯示的效果。在死亡率,膠體溶液輸液量,血液氣體分析取樣頻率(次/天)或嚴重腦室內出血(Papile第四級)沒有顯著效果。公佈的數據並沒有辦法讓我們分析其對長期神經發展結果的影響。

作者結論

相關評估臨床決策支持系統使用在新生兒照護效果的隨機試驗,是非常有限的。需要更多隨機對照試驗來評估CDSS是必要的。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

臨床決策支持系統(CDSS)是一套電腦系統,匯集了醫療和病人的資訊以幫助醫生下何種健康照護的決定。支持系統在處理頭28天新生兒疾病和存活可能會有所幫助。他們也可能影響醫生治療這些新生嬰兒的成果。這次回顧的作者搜索了醫學文獻和聯繫專家來找應用於新生兒的CDSS相關研究。他們發現了三個隨機對照研究符合本次回顧的標準。其中2個研究是電腦輔助開立處方而另1個是與電腦輔助生理學監測有關。有其中1個電腦輔助開立處方研究發現,CDSS可下降藥量計算錯誤的發生,這些研究沒有發現其他好處。這些研究沒有考慮新生兒長期的結果,只有評估其短期的影響。此外,隨著資訊技術的迅速發展,當前的CDSS是比這三項研究中的CDSS更先進的。Cochrane Review的作者得出結論,認為目前沒有足夠的數據來確定CDSS對新生兒照護是否有利。

Plain language summary

Clinical decision support systems for neonatal care

Clinical decision support systems (CDSS) are computer systems that bring together medical and patient information to help doctors make decisions about health care. Support systems may be helpful for managing illness and the survival of newborns in the first 28 days of life. They may also influence the performance of doctors treating these newborn infants. The review authors searched the medical literature and contacted experts to find studies on CDSS used with newborns. They identified three randomised controlled studies that met the criteria for the review. Two of these three studies were on computer-aided drug prescribing and one was on computerized physiological monitoring of newborns. One of the studies on computer-aided prescribing showed that the CDSS used resulted in fewer drug dosage errors. The studies found no other benefits. The studies did not consider long-term outcomes in the newborns, just short-term effects. Also, with rapid changes in computer technology, current CDSS are more advanced than those used in the three studies. The Cochrane review authors conclude that there is not enough data to determine whether or not CDSS are beneficial for newborn care.

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