Electronic Health Record Identification of Nephrotoxin Exposure and Associated Acute Kidney Injury
Electronic Health Record Identification of Nephrotoxin Exposure and Associated Acute Kidney Injury
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DOI：
10.1542/peds.2013-0794
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发表时间：
2013-09-01
期刊：
影响因子：
8
通讯作者：
Muething, Stephen
中科院分区：
文献类型：
--
作者：
Goldstein, Stuart L.;Kirkendall, Eric;Muething, Stephen
背景和目的：肾毒性药物暴露是住院儿童急性肾损伤（肾毒素-AKI）的常见原因。系统性血清肌酐（SCr）筛查尚未在接受肾毒素的儿童中常规进行，可能导致低估肾毒素-AKI率。我们的目的是准确地确定肾毒素暴露和肾毒素AKI率，以推动适当的干预措施，在非危重病住院children.METHODS：我们进行了一个前瞻性的质量改进项目，实施系统的电子健康记录（EHR）筛选和决策支持过程（触发器）在一个单一的四级儿科医院。患者均为非危重住院儿童，接受静脉注射氨基糖苷类药物≥ 3天或同时接受≥ 3种肾毒素（暴露）。药剂师建议对暴露患者进行每日SCr监测。阿基的定义是根据改良的儿科风险、损伤、衰竭、损失和终末期肾病标准（肌酐清除率估计值下降>= 25%）。我们开发了4个新指标：每1000患者日的暴露率，每1000患者日的阿基率，每次高肾毒素入院的阿基率（%），以及每100暴露日的阿基天数（阿基强度）。共有726例（3.3%）独特暴露患者住院945次（6713患者-天）。25%的单独暴露患者和31%的暴露入院（1974患者-天）发生阿基。我们的EHR驱动的SCr肾毒素AKI监测过程与阿基intensity.Conclusions的42%的减少相关：肾毒素AKI率在非危重病儿童中很高;通过基于EHR的触发工具可靠地完成了肾毒性药物暴露和阿基检测的系统筛查。
BACKGROUND AND OBJECTIVE: Nephrotoxic medication exposure represents a common cause of acute kidney injury (nephrotoxin-AKI) in hospitalized children. Systematic serum creatinine (SCr) screening has not been routinely performed in children receiving nephrotoxins, potentially leading to underestimating nephrotoxin-AKI rates. We aimed to accurately determine nephrotoxin exposure and nephrotoxin-AKI rates to drive appropriate interventions in non-critically ill hospitalized children.METHODS: We conducted a prospective quality improvement project implementing a systematic electronic health record (EHR) screening and decision support process (trigger) at a single quaternary pediatric hospital. Patients were all noncritically ill hospitalized children receiving an intravenous aminoglycoside for >= 3 days or >= 3 nephrotoxins simultaneously (exposure). Pharmacists recommended daily SCr monitoring in exposed patients. AKI was defined by the modified pediatric Risk, Injury, Failure, Loss and End-stage Renal Disease criteria (>= 25% decrease in estimated creatinine clearance). We developed 4 novel metrics: exposure rate per 1000 patient-days, AKI rate per 1000 patient-days, AKI rate (%) per high nephrotoxin admission, and AKI days per 100 exposure days (AKI intensity).RESULTS: This study included 21 807 patients accounting for 27 711 admissions. A total of 726 (3.3%) unique exposed patients accounted for 945 hospital admissions (6713 patient-days). AKI occurred in 25% of unique exposed patients and 31% of exposure admissions (1974 patient-days). Our EHR-driven SCr nephrotoxin-AKI surveillance process was associated with a 42% reduction in AKI intensity.CONCLUSIONS: Nephrotoxin-AKI rates are high in noncritically ill children; systematic screening for nephrotoxic medication exposure and AKI detection was accomplished reliably through an EHR based trigger tool.