The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

Abstract

Objective: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalised patients. The objectives in this study were (i) to investigate the incidence of AKI using the National Health Services (NHS) AKI e-alert algorithm as a means of identifying AKI; and (ii) in a randomly selected sub-group of children with AKI identified using the algorithm, to evaluate the recognition and management of AKI. Patients and Methods:Retrospective cross-sectional study with initial electronic retrieval of creatinine measurements at six hospitals in England over a six-month period. Results were evaluated using the NHS AKI e-alert algorithm with recognition and management of AKI stages 1, 2 and 3 reviewed in a sub-set of randomly selected patient case notes. Patients aged 29 to 17 years were included. AKI stage 1 was defined as a rise of 1.5 -≤2x baseline creatinine level; AKI stage 2 a rise of ≤ 2.0 and < 3.0; AKI stage 3 a rise of ≥ 3.0. Urine output was not considered for AKI staging.Results: 57,278 creatinine measurements were analysed. 5,325 (10.8%) AKI alerts were noted in 1,112 patients with AKI 1 (62%), AKI 2 (16%) and AKI 3 (22%). There were 222 (20%) <1y, 432 (39%) 1 ≤ 6y, 192 (17%) 6 ≤ 11y, 207 (19%) 11 ≤ 16y, and 59 (5%) 16-17y. Case notes of 123 of 1,112 [11.1%] children with AKI alerts were reviewed. Confirmed AKI was recognised with a documented management plan following its identification in n = 32 [26%] patients only. Conclusions:In this first multicentre study of the incidence of AKI in children admitted to selected hospitals across England, the incidence of AKI was 10.8% with most patients under the age of 6 years and with AKI stage 1. Recognition and management of AKI was seen in just over 25% children. These data highlight the need to improve recognition of AKI in hospitalised children in the UK.

AKI in Hospitalized Children: Poorly Documented (and Underrecognized)

“…The incidence and the severity of AKI in this study is consistent with other studies of AKI among hospitalized pediatric patients ( 1 , 2 , 10 ). A few studies have demonstrated the poor sensitivity of billing/discharge codes in identifying AKI in pediatric patients, both in the US ( 15 ) and internationally ( 10 , 16 ).…”

“…The incidence and the severity of AKI in this study is consistent with other studies of AKI among hospitalized pediatric patients ( 1 , 2 , 10 ). A few studies have demonstrated the poor sensitivity of billing/discharge codes in identifying AKI in pediatric patients, both in the US ( 15 ) and internationally ( 10 , 16 ). Schaffzin et al examined a cohort of non-ICU pediatric patients exposed to nephrotoxins who developed AKI and found that billing codes identified <50% of AKI episodes ( 15 ).…”

“…Nephrology follow-up has been associated with improved outcomes after severe kidney injury in adults ( 7 ), but outpatient nephrology follow-up after AKI in pediatric patients is uncommon ( 8 , 9 ). This lack of appropriate follow-up is driven in part by a lack of AKI recognition ( 10 ). Understanding the scope of and clinical factors associated with AKI underrecognition in children is critical to developing strategies to improve detection and the management of those affected.…”

Quality improvement goals for pediatric acute kidney injury: pediatric applications of the 22nd Acute Disease Quality Initiative (ADQI) conference

“…The goals of these alert systems are not only to enhance provider awareness but also to reduce AKI severity and duration. However, the benefits of these AKI alert tools remain to be determined [44,45].…”

Outcome and Incidence of Acute Kidney Injury among Hospitalized Children

“…The median hospitalization time was significantly longer in participants with stage 3 AKI (stage 1 = 2 [1][2][3][4] days; stage 2 = 4 [3][4][5] days; stage 3 = 7 [5][6][7][8][9][10][11] days; p = 0.031 and with hospital acquired AKI (community acquired = 4 [2][3][4][5][6] days; inpatient 9 (6)(7)(8)(9)(10)(11)] days; p = 0.032).…”