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Risk assessment and standardized nosocomial infection rate in critically ill children
N Singh-Naz1, B M Sprague, K M Patel
1George Washington University School of Medicine and Health Sciences, and the Center for Health Services and Clinical Research, Children's National Medical Center, Washington, DC 20010, USA. nsingh@cnmc.org
Insights
A new pediatric nosocomial infection risk (PNIR) model identifies invasive devices and parenteral nutrition as key risk factors in the pediatric intensive care unit (ICU). This model aids in assessing infection risk and comparing outcomes across hospitals.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Health services research
Background:
- Nosocomial infections (NIs) are a significant concern in pediatric intensive care units (PICUs).
- Accurate risk assessment is crucial for effective prevention and management strategies.
- Existing models may not fully capture the dynamic risk factors in critically ill children.
Purpose of the Study:
- To develop and validate a Pediatric Nosocomial Infection Risk (PNIR) assessment model.
- To compare daily trends in risk factors between infected (cases) and non-infected (controls) patients in the PICU.
- To identify independent risk factors for nosocomial infections in a pediatric ICU population.
Main Methods:
- Prospective cohort study design.
- Development and validation of the PNIR model using logistic regression.
- Analysis of risk factor trends over time in cases versus controls.
- Inclusion of patients admitted between May 1992-April 1993 and May 1995-December 1995.
Main Results:
- Invasive device use, parenteral nutrition, and a composite score of illness severity and postoperative care were independent risk factors for nosocomial infection.
- The PNIR model demonstrated good performance and internal validity in both training and validation datasets.
- Severity of illness and invasive device use showed similar trends in the first week of PICU stay, with no significant differences after 7 days.
Conclusions:
- The PNIR model effectively integrates intrinsic and extrinsic factors to assess nosocomial infection risk in critically ill children.
- The methodology provides a framework for adjusting nosocomial infection rates in interhospital comparisons.
- The model supports quality assessment, intervention strategy development, and evaluation of treatment modalities.
Objectives:
To develop and validate a pediatric nosocomial infection risk (PNIR) assessment model, and to compare the daily trends in risk factors between patients with nosocomial infection (cases) and without nosocomial infection (controls) in the pediatric intensive care unit (ICU).
Design:
Prospective cohort.
Setting:
A 16-bed pediatric ICU in an urban, university-affiliated, multidisciplinary, regional referral center.
Patients:
Patients available for study included consecutive admissions to the unit between May 1, 1992, and April 30, 1993, and between May 9, 1995, and December 11, 1995. Patients from both data collection periods were pooled and randomly divided into training (70%) and validation (30%) samples.
Measurements And Main Results:
In the logistic regression analysis using admission day data, three factors were shown to remain as independent risk factors. Invasive device use, parenteral nutrition, and the interaction between severity of illness-modified Pediatric Risk of Mortality III-24 score and postoperative care were associated with 2, 6, and 1.5 times the risk of developing nosocomial infection, respectively. This PNIR model performed well in both the training and validation samples as indicated by the goodness-of-fit test, which evaluated standardized nosocomial infection rates (observed vs. predicted nosocomial infection rates). The internal validity of the PNIR model was good. In trend analysis, severity of illness and invasive device use appear to have similar trend patterns, during the first week of pediatric ICU stay. There was no difference in any of these risk factors between cases and controls after 7 days of pediatric ICU stay.
Conclusions:
The PNIR assessment model incorporates intrinsic factors, such as patient severity of illness, and extrinsic factors contributing to the development of nosocomial infection in this high-risk population. The methodology using intrinsic and extrinsic factors to adjust for nosocomial infections should be taken into consideration when evaluating interhospital comparison of nosocomial infection rates, quality assessment, intervention strategies, and use of treatment modalities.