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Acute kidney injury in children based on electronic alerts

Gubb, Samuel, Holmes, Jennifer, Smith, Graham, Geen, John, Williams, John, Donovan, Kieron and Phillips, Aled O. 2020. Acute kidney injury in children based on electronic alerts. Journal of Pediatrics 220 , 4-6.e1. 10.1016/j.jpeds.2019.11.019

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Abstract

Objective To define the incidence and outcome of acute kidney injury (AKI) in pediatrics using data collected from a national electronic alert system. Study design A prospective national cohort study was undertaken to collect data on all cases of pediatric AKI, excluding neonates, identified by an e-alert, from April 2015 to March 2019. Results There were 2472 alerts in a total of 1719 patients, giving an incidence of 77.3 per 100 000 person-years. Of the patients, 84.2% of all AKI were stage 1 and 58.3% occurred with a triggering creatinine within the reference range. The incidence of AKI was associated with measures of social deprivation. Thirty-day mortality was 1.7% but was significantly higher in hospital-acquired AKI (2.1%), compared with community-acquired AKI (0.8%, P < .001) and was associated with the severity of AKI at presentation. A significant proportion of patients had no repeat measure of creatinine (39.8%). This was higher in community-acquired AKI (69.7%) compared with hospital-acquired AKI (43.0%, P < .001), and higher in patients alerting with patients triggering with a creatinine within the reference range (48.4% vs 24.5%, P < .001). The majority of patients (84.7%) experienced only 1 AKI episode. Repeated episodes of AKI were associated with increased 30-mortaltiy (11.6% vs 4.6%, P < .001) and higher residual renal impairment (13.3% vs 5.4%, P < .001). Conclusions The results suggest that the significance of the alert is missed in many cases reflecting that a large proportion of cases represent modest elevations in serum creatinine (SCr), triggered by a SCr level that may be interpreted as being normal despite a significant increase from the baseline for the patient.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0022-3476
Date of First Compliant Deposit: 22 January 2020
Date of Acceptance: 13 November 2019
Last Modified: 06 Oct 2021 15:58
URI: http://orca.cardiff.ac.uk/id/eprint/128944

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