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

Journal article


Harron, Katie, Wade, Angie, Muller-Pebody, Berit, Goldstein, Harvey, Parslow, Roger, Gray, Jim, Hartley, John, Mok, Quen and Gilbert, Ruth. (2013). Risk-adjusted monitoring of blood-stream infection in paediatric intensive care : A data linkage study. Intensive Care Medicine. 39(6), pp. 1080 - 1087. https://doi.org/10.1007/s00134-013-2841-z
AuthorsHarron, Katie, Wade, Angie, Muller-Pebody, Berit, Goldstein, Harvey, Parslow, Roger, Gray, Jim, Hartley, John, Mok, Quen and Gilbert, Ruth
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.

Year2013
JournalIntensive Care Medicine
Journal citation39 (6), pp. 1080 - 1087
ISSN0342-4642
Digital Object Identifier (DOI)https://doi.org/10.1007/s00134-013-2841-z
Page range1080 - 1087
Research GroupInstitute for Learning Sciences and Teacher Education (ILSTE)
Publisher's version
File Access Level
Controlled
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