Electronic health record identification of nephrotoxin exposure and associated acute kidney injury

Stuart L. Goldstein, Eric Kirkendall, Hovi Nguyen, Joshua K. Schaffzin, John Bucuvalas, Tracey Bracke, Michael Seid, Marshall Ashby, Natalie Foertmeyer, Lori Brunner, Anne Lesko, Cynthia Barclay, Carole Lannon, Stephen Muething

Research output: Contribution to journalArticlepeer-review

208 Scopus citations

Abstract

BACKGROUND AND OBJECTIVE: Nephrotoxic medication exposure represents a common cause of acute kidney injury (nephrotoxin-AKI) in hospitalized children. Systematic serum creatinine (SCr) screening has not been routinely performed in children receiving nephrotoxins, potentially leading to underestimating nephrotoxin-AKI rates. We aimed to accurately determine nephrotoxin exposure and nephrotoxin-AKI rates to drive appropriate interventions in non-critically ill hospitalized children. METHODS: We conducted a prospective quality improvement project implementing a systematic electronic health record (EHR) screening and decision support process (trigger) at a single quaternary pediatric hospital. Patients were all noncritically ill hospitalized children receiving an intravenous aminoglycoside for ≥3 days or ≥3 nephrotoxins simultaneously (exposure). Pharmacists recommended daily SCr monitoring in exposed patients. AKI was defined by the modified pediatric Risk, Injury, Failure, Loss and End-stage Renal Disease criteria (≥25% decrease in estimated creatinine clearance). We developed 4 novel metrics: exposure rate per 1000 patient-days, AKI rate per 1000 patient-days, AKI rate (%) per high nephrotoxin admission, and AKI days per 100 exposure days (AKI intensity). RESULTS: This study included 21 807 patients accounting for 27 711 admissions. A total of 726 (3.3%) unique exposed patients accounted for 945 hospital admissions (6713 patient-days). AKI occurred in 25% of unique exposed patients and 31% of exposure admissions (1974 patient-days). Our EHR-driven SCr nephrotoxin-AKI surveillance process was associated with a 42% reduction in AKI intensity. CONCLUSIONS: Nephrotoxin-AKI rates are high in noncritically ill children; systematic screening for nephrotoxic medication exposure and AKI detection was accomplished reliably through an EHR based trigger tool.

Original languageEnglish
Pages (from-to)e756-e767
JournalPediatrics
Volume132
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

Keywords

  • Acute kidney injury
  • Children
  • Electronic health record
  • Nephrotoxic medications

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