Loading ...

TOPLINE: 

An analysis of 6272 alert-identified acute kidney injury (AKI) episodes in 5582 hospitalised children in the United Kingdom revealed poor coding rates of 19.7% in hospital records. Older age, residence in less deprived areas, and an elevated peak AKI stage were associated with an increased likelihood of documentation.

METHODOLOGY:

• Researchers conducted a cross-sectional study to investigate the percentage of AKI episodes identified by alerts that matched the coding in hospital records for children younger than 18 years in England.
• They analysed 6272 AKI episodes in 5582 hospitalised children.
• Episodes were classified as community acquired if they began within the first 2 days of admission (46.8%) and as hospital-acquired if they occurred from day 3 onwards (41.6%). Children who experienced AKI during their birth hospitalisation were referred to as the "birth cohort" (11.7%).
• Multivariable logistic regression was employed to analyse the patient and clinical factors linked to AKI coding.

TAKEAWAY:

• Overall, the coding rate was only 19.7% across all episodes and increased with the peak AKI stage: 14.5% for stage I, 22.3% for stage II, and 41.4% for stage III.
• Children living in the least deprived regions had higher odds of coding (OR, 1.4; 95% CI, 1.1-1.7) than those living in the most deprived areas; older age groups also had higher odds of coding in hospital records.
• Children with AKI during birth admission were less likely to be coded than those with hospital-acquired episodes (OR, 0.4; 95% CI, 0.3-0.5); however, coding rates were similar between community-acquired and hospital-acquired AKI.
• No correlation, however, was observed between coding and 30-day mortality rates.

IN PRACTICE:

"Further work is now required to understand how e-alerts can be used to improve clinical recognition of AKI in children to enhance care and outcomes," the authors wrote.

SOURCE:

The study was led by Lucy Plumb, UK Renal Registry, Bristol, United Kingdom. It was published online on February 13, 2025, in BMC Nephrology.

LIMITATIONS:

The researchers noted that not all laboratories across England submitted data in time for linkage, leading to the report reflecting data from approximately 66% of National Health Service laboratories. Analysis was restricted to clinical codes for AKI using the N17.x code, potentially missing cases classified using procedural or other diagnostic codes. The study defined AKI on the basis of relative changes in serum creatinine, potentially leading to the misclassification of spurious values in children and the missing of cases that relied on alternative measures such as urine output. The extent to which alerts truly reflect AKI, particularly stage I, should be evaluated further.

DISCLOSURES:

The study was completed without external funding. Three authors declared receiving funds or having other ties with various institutions and some pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.