Summary of findings for the main comparison. Computer or human alerts interventions versus standard care.
| Computer or human alerts compared with standard care for VTE prophylaxis. | ||||||
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Patient or population: adult medical and surgical patients at risk for VTE Settings: hospital Intervention: automatic reminder systems, such as computer alerts or human alerts, designed to increase the implementation of thromboprophylaxis and/or decrease the incidence of symptomatic or asymptomatic VTE Comparison: standard care (no intervention) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Measures of effect (RD, RR) (95% CI; I²) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk* | Corresponding risk | |||||
| Control group | Intervention group | |||||
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Received prophylaxis** (Follow‐up: 3 months) |
Study population | RD 0.21 (0.15 to 0.27; 75%) | 5057 (3 studies) | ⊕⊕⊝⊝ Low1 | ||
| 178 per 1000 | 390 per 1000 (335 to 454) | |||||
| Low risk population | ||||||
| 145 per 1000 | 318 per 1000 (273 to 370) | |||||
| High risk population | ||||||
| 357 per 1000 | 782 per 1000 (671 to 910) | |||||
|
Received appropriate prophylaxis** (Follow‐up: 36 hours to 18 months) |
Study population | RD 0.16 (0.12 to 0.20; 0%) | 1820 (3 studies) | ⊕⊕⊕⊝ Moderate2 | ||
| 305 per 1000 | 460 per 1000 (305 to 616) | |||||
| Low risk population | ||||||
| 175 per 1000 | 249 per 1000 (175 to 354) | |||||
| High risk population | ||||||
| 663 per 1000 | 941 per 1000 (663 to 1000) | |||||
|
Symptomatic VTE (Follow‐up: 3 months) |
Study population | RR 0.64 (0.47 to 0.86; 15%) | 5353 (3 studies) | ⊕⊕⊝⊝ Low3 | ||
| 56 per 1000 | 36 per 1000 (26 to 48) | |||||
| Low risk population | ||||||
| 29 per 1000 | 19 per 1000 (14 to 25) | |||||
| High risk population | ||||||
| 82 per 1000 | 52 per 1000 (39 to 71) | |||||
| * Control risk was used as assumed risk (baseline risk), due to lack of well‐designed observational studies that measure this in detail to be presented as baseline risk for the population. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ** Clustered trials did not provide sufficient data (intraclass correlation (ICC) or adjusted confidence intervals) for us to pool cluster adjusted estimates. CI: confidence interval; I²: statistical index of heterogeneity; RD: risk difference; RR: risk ratio; VTE: venous thromboembolism | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
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1 We downgraded the level of certainty of evidence from high to low based on the following reasons: serious study limitations (quasi‐random sequence generation in 1/3 RCTs, no blinding of outcome assessment in 1/3 RCTs, selective reporting of safety outcomes in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of participants and personnel, and other potential biases were unclear in most studies). No indirectness of evidence; some inconsistency of pooled results; no imprecision of pooled results; and undetected publication bias. 2 We downgraded the level of certainty of evidence from high to moderate based on the following reasons: serious study limitations (no blinding of participants and personnel in 2/3 RCTs, incorrect analysis that did not account for the clustered nature of the data in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting, and other potential biases were unclear in most studies). No indirectness of evidence; no inconsistency and imprecision of pooled RD results; and undetected publication bias. 3 We downgraded the level of certainty of evidence from high to low based on the following reasons: serious study limitations (quasi‐random sequence generation in 1/3 RCTs, selective reporting of safety outcomes in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of participants and personnel, and other potential biases were unclear in most studies). No indirectness of evidence, no inconsistency of pooled RR results, some imprecision of pooled results related to the small number of events, and undetected publication bias. | ||||||