Administrative data misclassifies and fails to identify nephrotoxin-associated acute kidney injury in hospitalized children.
Administrative data misclassifies and fails to identify nephrotoxin-associated acute kidney injury in hospitalized children.
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DOI：
10.1542/hpeds.2013-0116
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发表时间：
2014-05-01
影响因子：
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通讯作者：
Goldstein, Stuart L
中科院分区：
文献类型：
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作者：
Schaffzin, Joshua K;Dodd, Caitlin N;Goldstein, Stuart L
注意事项：肾毒素暴露是住院儿童急性肾损伤（阿基）的常见原因。阿基检测依赖于暴露患者的定期血清肌酐（SCr）筛查。我们试图确定如何以及管理数据识别住院非危重病患儿肾毒性药物相关阿基的不完全和完全screening.METHODS的背景下：我们进行了一项单中心回顾性队列研究，非危重病住院儿童。我们比较了管理数据的敏感性，在一个单独的队列中，充分的筛选定义为每日SCr测量。对于原始队列，肾毒素暴露定义为一次暴露于≥3种肾毒素或氨基糖苷类治疗≥3天。阿基由SCr（儿科改良风险损伤衰竭丧失终末期肾病[pRIFLE]标准）或出院代码的变化定义。充分的SCr筛选定义为间隔≤96小时获得2次测量值。结果：1472例肾毒素暴露患者中有747例（50.7%）进行了充分筛查; 82例（11.0%）按pRIFLE标准诊断为阿基，52例（7.0%）按出院代码诊断。与pRIFLE标准相比，通过出院代码诊断肾毒素相关阿基的灵敏度为23.2%（95%置信区间= 14.0-32.3）。在对照队列中，70例（26.8%）患者根据pRIFLE标准诊断为阿基，26例（10.0%）患者根据出院代码诊断为AKI;敏感性为21.4%（95%置信区间= 11.8%-31.0%）。通过出院代码识别肾毒素相关阿基患者，即使在存在完整阿基检测的情况下，也不能充分代表住院儿童中肾毒素相关阿基的真实发生率。
OBJECTIVES: Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening.METHODS: We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria.RESULTS: 747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0-32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%-31.0%).CONCLUSIONS: pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.