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Identifying acute kidney injury in children: comparing electronic alerts with health record data
Lucy Plumb1,2, Manuela Savino3, Anna Casula4
1UK Renal Registry, UK Kidney Association, Building 20A1, Filton 20, Filton, Bristol, BS34 7RR, UK. lucy.plumb@nhs.net.
Insights
Electronic alerts for acute kidney injury (AKI) in children are poorly correlated with hospital coding. This suggests AKI is under-recognized, impacting patient care and research accuracy.
Area of Science:
- Pediatric Nephrology
- Clinical Informatics
- Health Services Research
Background:
- Electronic (e-)alerts for rising creatinine identify potential acute kidney injury (AKI).
- AKI is a significant concern in hospitalised children.
- Accurate coding is crucial for monitoring incidence and outcomes.
Purpose of the Study:
- To assess the correlation between e-alert identified AKI episodes and their coding in hospital records for children.
- To examine if AKI coding aligns with 30-day mortality in a national cohort.
Main Methods:
- Analysis of 6272 AKI alert episodes in hospitalised children (<18 years) in England (2017).
- Linked e-alerts to hospital records for coding status.
- Used multivariable logistic regression to identify factors associated with AKI coding.
- Examined hospital-level agreement between coding and 30-day mortality.
Main Results:
- Poor overall coding of AKI episodes (19.7%).
- Higher AKI stage, older age, and lower deprivation were associated with increased coding likelihood.
- AKI during birth admissions had significantly lower coding rates.
- No correlation found between AKI coding and 30-day mortality.
Conclusions:
- Low coding rates for e-alert identified AKI suggest under-recognition and underestimation of incidence.
- Further investigation into coding disparities and the role of alerts in clinical recognition is necessary.
- Understanding variations in coding across hospitals is essential for improving AKI surveillance.
Background:
Electronic (e-)alerts for rising serum creatinine values are increasingly used as clinical indicators of acute kidney injury (AKI). The aim of this study was to investigate to what degree AKI episodes, as identified using e-alerts, correlated with coding for AKI in the hospital record for a national cohort of hospitalised children and examine whether coding corresponded with 30-day mortality after an AKI episode.
Methods:
A cross-section of AKI episodes based on alerts issued for children under 18 years in England during 2017 were linked to hospital records. Multivariable logistic regression was used to examine patient and clinical factors associated with AKI coding. Agreement between coding and 30-day mortality was examined at hospital level.
Results:
6272 AKI episodes in 5582 hospitalised children were analysed. Overall, coding was poor (19.7%). Older age, living in the least deprived quintile (odds ratio (OR) 1.4, 95% Confidence Interval (CI) 1.1, 1.7) and higher peak AKI stage (stage 1 reference; stage 2 OR 2.0, 95% CI 1.7, 2.4; stage 3 OR 8.6, 95% CI 7.1, 10.6) were associated with higher likelihood of coding in the hospital record. AKI episodes during birth admissions were less likely to be coded (OR 0.4, 95% CI 0.3, 0.5). No correlation was seen between coding and 30-day mortality.
Conclusions:
The proportion of AKI alert-identified episodes coded in the hospital record is low, suggesting under-recognition and underestimation of AKI incidence. Understanding the reasons for inequalities in coding, variation in coding between hospitals and how alerts can enhance clinical recognition is needed.
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