Summary of finding table for meta-analyses of CDSSs compared with standard care for antibiotic prescribing
| Outcomes . | Anticipated absolute effectsa (95% CI) . | Relative effect (95% CI) . | Participants (studies) . | Certainty of the evidence (GRADE) . | |
|---|---|---|---|---|---|
| risk with standard care . | risk with CDSS . | ||||
| Appropriateness of antibiotic therapy | 643 per 1000 | 698 per 1000 (639–750) | OR 1.24 (0.95–1.62) | 1161 (2 RCTs) | ⨁⨁⨁◯ MODERATEb |
| 507 per 1000 | 729 per 1000 (673–778) | OR 2.45 (1.95–3.08) | 8197 (18 NRSs) | ⨁⨁◯◯ LOWc,d | |
| Mortality | 109 per 1000 | 104 per 1000 (90–121) | OR 0.95 (0.81–1.12) | 8369 (3 RCTs) | ⨁⨁⨁◯ MODERATEe |
| 49 per 1000 | 35 per 1000 (31–40) | OR 0.72 (0.63–0.82) | 42 364 (9 NRSs) | ⨁⨁◯◯ LOWc | |
| Outcomes . | Anticipated absolute effectsa (95% CI) . | Relative effect (95% CI) . | Participants (studies) . | Certainty of the evidence (GRADE) . | |
|---|---|---|---|---|---|
| risk with standard care . | risk with CDSS . | ||||
| Appropriateness of antibiotic therapy | 643 per 1000 | 698 per 1000 (639–750) | OR 1.24 (0.95–1.62) | 1161 (2 RCTs) | ⨁⨁⨁◯ MODERATEb |
| 507 per 1000 | 729 per 1000 (673–778) | OR 2.45 (1.95–3.08) | 8197 (18 NRSs) | ⨁⨁◯◯ LOWc,d | |
| Mortality | 109 per 1000 | 104 per 1000 (90–121) | OR 0.95 (0.81–1.12) | 8369 (3 RCTs) | ⨁⨁⨁◯ MODERATEe |
| 49 per 1000 | 35 per 1000 (31–40) | OR 0.72 (0.63–0.82) | 42 364 (9 NRSs) | ⨁⨁◯◯ LOWc | |
The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Imprecision in point estimates due to small sample size and a small number of events.
Serious concerns encountered across the body of evidence in domains such as selection bias, performance bias and attrition bias. The study quality ranges from moderate to low. On the basis of study weights, sample size and number of outcome events, the overall quality of evidence is identified to be low.
The overall I2 value is 84.7% which indicates a serious variance in the point estimate. The results are statistically heterogeneous due to the different types of CDSSs used in different studies as well as conflicting results in uptake of the system.
Unclear risk of bias for allocation concealment encountered throughout the body of evidence. There was also a lack of blinding of participants and outcome assessors in included studies.
Summary of finding table for meta-analyses of CDSSs compared with standard care for antibiotic prescribing
| Outcomes . | Anticipated absolute effectsa (95% CI) . | Relative effect (95% CI) . | Participants (studies) . | Certainty of the evidence (GRADE) . | |
|---|---|---|---|---|---|
| risk with standard care . | risk with CDSS . | ||||
| Appropriateness of antibiotic therapy | 643 per 1000 | 698 per 1000 (639–750) | OR 1.24 (0.95–1.62) | 1161 (2 RCTs) | ⨁⨁⨁◯ MODERATEb |
| 507 per 1000 | 729 per 1000 (673–778) | OR 2.45 (1.95–3.08) | 8197 (18 NRSs) | ⨁⨁◯◯ LOWc,d | |
| Mortality | 109 per 1000 | 104 per 1000 (90–121) | OR 0.95 (0.81–1.12) | 8369 (3 RCTs) | ⨁⨁⨁◯ MODERATEe |
| 49 per 1000 | 35 per 1000 (31–40) | OR 0.72 (0.63–0.82) | 42 364 (9 NRSs) | ⨁⨁◯◯ LOWc | |
| Outcomes . | Anticipated absolute effectsa (95% CI) . | Relative effect (95% CI) . | Participants (studies) . | Certainty of the evidence (GRADE) . | |
|---|---|---|---|---|---|
| risk with standard care . | risk with CDSS . | ||||
| Appropriateness of antibiotic therapy | 643 per 1000 | 698 per 1000 (639–750) | OR 1.24 (0.95–1.62) | 1161 (2 RCTs) | ⨁⨁⨁◯ MODERATEb |
| 507 per 1000 | 729 per 1000 (673–778) | OR 2.45 (1.95–3.08) | 8197 (18 NRSs) | ⨁⨁◯◯ LOWc,d | |
| Mortality | 109 per 1000 | 104 per 1000 (90–121) | OR 0.95 (0.81–1.12) | 8369 (3 RCTs) | ⨁⨁⨁◯ MODERATEe |
| 49 per 1000 | 35 per 1000 (31–40) | OR 0.72 (0.63–0.82) | 42 364 (9 NRSs) | ⨁⨁◯◯ LOWc | |
The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Imprecision in point estimates due to small sample size and a small number of events.
Serious concerns encountered across the body of evidence in domains such as selection bias, performance bias and attrition bias. The study quality ranges from moderate to low. On the basis of study weights, sample size and number of outcome events, the overall quality of evidence is identified to be low.
The overall I2 value is 84.7% which indicates a serious variance in the point estimate. The results are statistically heterogeneous due to the different types of CDSSs used in different studies as well as conflicting results in uptake of the system.
Unclear risk of bias for allocation concealment encountered throughout the body of evidence. There was also a lack of blinding of participants and outcome assessors in included studies.
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