Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun 29;7(2):596-603.
doi: 10.4338/ACI-2015-12-RA-0183. eCollection 2016.

Derivation and Validation of a Search Algorithm to Retrospectively Identify CRRT Initiation in the ECMO Patients

Pramod K Guru  1 , Tarun D Singh  2 , Melissa Passe  3 , Kianoush B Kashani  4 , Gregory J Schears  3 , Rahul Kashyap  3
Affiliations

Derivation and Validation of a Search Algorithm to Retrospectively Identify CRRT Initiation in the ECMO Patients

Pramod K Guru et al. Appl Clin Inform. .

Abstract

Background: The role of extracorporeal membrane oxygenation (ECMO) in refractory cardiorespiratory failure is gaining momentum with recent advancements in technology. However, the need for dialysis modes such as continuous renal replacement therapy (CRRT) has also increased in the management for acute kidney injury. Establishing the exact timing of CRRT initiation in these patients from the electronic medical record is vital for automated data extraction for research and quality improvement efforts.

Objectives: We aimed to derive and validate an automated Electronic Health Records (EHR) search strategy for CRRT initiation in patients receiving ECMO.

Methods: We screened 488 patients who received ECMO and a total of 213 patients underwent CRRT. We evaluated random 120 patients, 60 for derivation and 60 for validation cohorts. Following implementation of eligibility criteria, the algorithm was derived in 55 out of 120 ECMO/CRRT patients. The search algorithm was developed using first-time chart entry of 'access pressure drop' at CRRT initiation. The algorithm was then validated in an independent subset of 52 patients from the same time period. The overall agreement between electronic search algorithm and a comprehensive manual medical record review in the derivation and validation subsets, using 'access pressure drop' as the reference standard, was compared to assess CRRT initiation time.

Results: In the derivation subset (N=55), the automated electronic search strategy achieved an excellent agreement with manual search (κ =0.99, 54 were identified electronically, and 55 upon manual review). There was no time difference observed in 49/54(89%) patients, while in the remaining 5 (9%) patients time difference was within 15 minutes. In the validation cohort (N=52), agreement was 100 % (κ = 1.0, both methods identified 52 patients). Out of 52 patients, 47 (90%) had no time difference between the methods, for the remaining 5 (10%) patients, differences were within 15 minutes.

Conclusions: The use of an electronic search strategy resulted in determining an accurate CRRT initiation time among ECMO patients.

Keywords: Continuous renal replacement therapy; data extraction; electronic health record; extracorporeal membrane oxygenation; quality improvement; research.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflicts of interest in the research.

Figures

Fig. 1
Fig. 1
Electronic search strategy flow-diagram of patients in the ICU DataMart from January 1, 2001, through December 31, 2014.
Fig. 2
Fig. 2
Overall agreement for derivation and validation of the manual and electronic search algorithms.
See this image and copyright information in PMC

References

    1. Combes A, Pellegrino V. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1)-associated acute respiratory distress syndrome. Seminars in respiratory and critical care medicine 2011; 32: 188-194. - PubMed
    1. Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, Patroniti N, Antonelli M, Pesenti A, Pappalardo F. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Critical care and resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2013; 15: 172-178. - PubMed
    1. Askenazi DJ, Ambalavanan N, Hamilton K, Cutter G, Laney D, Kaslow R, Georgeson K, Barnhart DC, Dimmitt RA. Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation. Pediatric Critical Care Medicine : A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2011; 12: e1-e6. - PubMed
    1. Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. The New England Journal of Medicine 2010; 363: 501-504. - PubMed
    1. Kutney-Lee A, Kelly D. The effect of hospital electronic health record adoption on nurse-assessed quality of care and patient safety. The Journal of Nursing Administration 2011; 41: 466-472. - PMC - PubMed

Publication types