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A Validation Study of Administrative Health Care Data to Detect Acute Kidney Injury in the Pediatric Intensive Care
David D'Arienzo1, Erin Hessey2, Rami Ali3,4
1Faculty of Medicine, McGill University, Montreal, QC, Canada.
Insights
Administrative health care data underestimates pediatric acute kidney injury (AKI) incidence but accurately identifies severe cases. This study assessed the diagnostic accuracy of administrative data for AKI in pediatric intensive care unit (PICU) patients.
Area of Science:
- Pediatric Nephrology
- Health Informatics
- Critical Care Medicine
Background:
- Large-scale studies on pediatric acute kidney injury (AKI) epidemiology and outcomes are limited, partly due to the underutilization of administrative health care data.
- Accurate identification of AKI in children is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the diagnostic accuracy of administrative health care data for identifying AKI in children admitted to the pediatric intensive care unit (PICU).
- To compare AKI definitions based on administrative codes (Admin-AKI) versus chart review using Kidney Disease: Improving Global Outcomes (KDIGO) criteria (Chart-AKI).
Main Methods:
- Retrospective cohort study involving 2051 children (0-18 years) admitted to two PICUs in Montreal, QC, between 2003 and 2005.
- AKI was defined using KDIGO criteria from chart data (Chart-AKI) and ICD-9 codes from administrative data (Admin-AKI).
- Sensitivity, specificity, and predictive values of Admin-AKI were calculated against Chart-AKI. Associations with hospital mortality were assessed.
Main Results:
- Overall, 52% of cardiac surgery patients and 24% of noncardiac surgery patients experienced AKI.
- Admin-AKI demonstrated low sensitivity but high specificity for detecting Chart-AKI in both patient groups.
- Sensitivity of Admin-AKI increased with AKI severity, and it was associated with higher hospital mortality.
Conclusions:
- Administrative health care data tend to underestimate the incidence of pediatric AKI.
- Despite underestimation, administrative data are valuable for identifying more severe AKI cases with high specificity.
- Future research should extend these findings to non-PICU pediatric populations.
Background:
Large studies evaluating pediatric acute kidney injury (AKI) epidemiology and outcomes are lacking, partially due to underuse of large administrative health care data.
Objective:
To assess the diagnostic accuracy of administrative health care data-defined AKI in children admitted to the pediatric intensive care unit (PICU).
Design:
Retrospective cohort study utilizing chart and administrative data.
Setting:
Children admitted to the PICU at 2 centers in Montreal, QC.
Patients:
Patients between 0 and 18 years old with a provincial health insurance number, without end-stage renal disease and admitted to the PICU between January 1, 2003, and March 31, 2005, were included.
Measurements:
The AKI was defined from chart data using the Kidney Disease: Improving Global Outcomes (KDIGO) definition (Chart-AKI). The AKI defined using administrative health data (Admin-AKI) was based on International Classification of Disease, Ninth Revision (ICD-9) AKI codes.
Methods:
Data available from retrospective chart review, including baseline and PICU patient characteristics, and serum creatinine (SCr) and urine output (UO) values during PICU admission, were merged with provincial administrative health care data containing diagnostic and procedure codes used for ascertaining Admin-AKI. Sensitivity, specificity, positive, and negative predictive value of Admin-AKI compared with Chart-AKI (reference standard) were calculated. Univariable associations between Admin-AKI and hospital mortality were evaluated.
Results:
A total of 2051 patients (55% male, mean age at admission 6.1 ± 5.8 years, 355 cardiac surgery, 1696 noncardiac surgery) were included. The AKI defined by SCr or UO criteria occurred in 52% of cardiac surgery patients and 24% of noncardiac surgery patients. Overall, Admin-AKI detected Chart-AKI with low sensitivity, but high specificity in cardiac and noncardiac surgery patients. Sensitivity increased by 1.5 to 2 fold with each increase in AKI severity stage. Admin-AKI was associated with hospital mortality (13% in Admin-AKI vs 2% in non-AKI, P < .001).
Limitations:
These data were generated in a PICU population; future research should study non-PICU populations.
Conclusions:
Use of administrative health care data to define AKI in children leads to AKI incidence underestimation. However, for detecting more severe AKI, sensitivity is higher, while maintaining high specificity.
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