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Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study

Harron, K; Wade, A; Muller-Pebody, B; Goldstein, H; Parslow, R; Gray, J; Hartley, JC; ... Gilbert, R; + view all (2013) Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study. Intensive Care Medicine , 39 (6) pp. 1080-1087. 10.1007/s00134-013-2841-z. Green open access

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Abstract

PURPOSE: National monitoring of variation in the quality of infection control in paediatric intensive care units (PICUs) requires comparisons of risk-adjusted rates. To inform the development of a national monitoring system, we evaluated the effects of risk-adjustment and outcome definition on comparisons of blood-stream infection (BSI) rates in PICU, using linkage of risk-factor data captured by national audit (PICANet) with laboratory records of BSI. METHODS: Admission data for two children's hospitals 2003-2010 were extracted from PICANet and linked using multiple identifiers with laboratory BSI records. We calculated trends of PICU-acquired BSI, defined as BSI occurring between at least 2 days after admission until up to 2 days following discharge. In one PICU, we compared rates of all PICU-acquired BSI with clinically significant PICU-acquired BSI submitted to the national surveillance system. RESULTS: Of 20,924 admissions, 1,428 (6.8 %) were linked to 1,761 PICU-acquired BSI episodes. The crude incidence rate-ratio for PICU-acquired BSI between PICUs was 1.15 [95 % confidence interval (CI) 1.05-1.26] but increased to 1.26 (1.14-1.39) after risk-adjustment. Rates of PICU-acquired BSI were 13.44 (95 % CI 12.60-14.28) per 1,000 bed-days at PICU 1 and 18.05 (95 % CI 16.80-19.32) at PICU 2. Of PICU-acquired BSI at PICU 2, 41 % was classified as clinically significant. Rates of PICU-acquired BSI decreased by 10 % per year between 2003 and 2010 for skin organisms and 8 % for non-skin organisms. CONCLUSIONS: Risk-adjustment and standardisation of outcome measures are essential for fair comparisons of BSI rates between PICUs. Linkage of risk-factor data and BSI surveillance is feasible and could allow national risk-adjusted monitoring.

Type: Article
Title: Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00134-013-2841-z
Publisher version: http://dx.doi.org/10.1007/s00134-013-2841-z
Language: English
Additional information: The final publication is available at Springer via http://dx.doi.org/10.1007/s00134-013-2841-z.
Keywords: Bacteremia, Child, Child, Preschool, Cross Infection, Female, Great Britain, Humans, Infant, Infant, Newborn, Infection Control, Intensive Care Units, Pediatric, Male, Population Surveillance, Quality Assurance, Health Care, Risk Adjustment, Risk Factors
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1385896
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