Abstract: FR-PO0136
A Clinical Decision Support System for Community-Acquired AKI in Children: Maintenance Phase
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Maffei, Salvador R, Baylor College of Medicine, Houston, Texas, United States
- O'Neil, Erika R, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, Texas, United States
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Cruz, Andrea T, Baylor College of Medicine, Houston, Texas, United States
- Selby, Nicholas M., University of Nottingham, Nottingham, England, United Kingdom
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background
Community-acquired acute kidney injury (CA-AKI) is a common yet underrecognized condition in the pediatric emergency center (EC), associated with increased morbidity and prolonged hospitalization. Early identification facilitates management and follow up, often guided by nephrology consultation. We implemented a clinical decision support system (CDSS) that improved recognition of CA-AKI in the first year after implementation, and now report on the sustainability of our CDSS.
Methods
We conducted a prospective study from 2021 to 2024, examining clinician behaviors in the Texas Children’s Hospital EC before and after implementation of our CDSS, co-designed with our EC colleagues. Our implementation outcomes were AKI documentation in the medical record, order set utilization, nephrology consultation, renal ultrasound, and urinalysis completed prior to disposition. We hypothesized that each outcome would increase post-implementation, with peak uptake in the first year following implementation. CA-AKI was defined by KDIGO creatinine criteria.
Results
CA-AKI documentation improved sustainably (58% pre-implementation, 88% year 1, 90% year 4, p-value < 0.01). CDSS performed consistently across all age groups (Table). Despite co-design and iterative refinement, adoption of the order set remained low (26% year 1, 27% year 4) and clinician behaviors remained unchanged (no significant differences in ultrasound ordered, nephrology consultation, or urinalysis completed).
Conclusion
Our CDSS facilitated AKI recognition and was maintained despite lack of additional interventions to reinforce behaviors. The low rates of order-set adoption warrant exploration of alternative strategies to promote evidence-based CA-AKI management practices in the pediatric population.
Table: Demographics and Outcomes