The Incidence of Paediatric Acute Kidney Injury Identified Using an AKI E-Alert Algorithm in Six English Hospitals

Abstract

Objective: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalised patients. The objectives in this study were (i) to investigate the incidence of AKI using the National Health Services (NHS) AKI e-alert algorithm as a means of identifying AKI; and (ii) in a randomly selected sub-group of children with AKI identified using the algorithm, to evaluate the recognition and management of AKI. Patients and Methods: Retrospective cross-sectional study with initial electronic retrieval of creatinine measurements at six hospitals in England over a six-month period. Results were evaluated using the NHS AKI e-alert algorithm with recognition and management of AKI stages 1, 2 and 3 reviewed in a sub-set of randomly selected patient case notes. Patients aged 29 to 17 years were included. AKI stage 1 was defined as a rise of 1.5 - ≤2x baseline creatinine level; AKI stage 2 a rise of ≤ 2.0 and < 3.0; AKI stage 3 a rise of ≥ 3.0. Urine output was not considered for AKI staging. Results: 57,278 creatinine measurements were analysed. 5,325 (10.8%) AKI alerts were noted in 1,112 patients with AKI 1 (62%), AKI 2 (16%) and AKI 3 (22%). There were 222 (20%) <1y, 432 (39%) 1 ≤ 6y, 192 (17%) 6 ≤ 11y, 207 (19%) 11 ≤ 16y, and 59 (5%) 16-17y. Case notes of 123 of 1,112 [11.1%] children with AKI alerts were reviewed. Confirmed AKI was recognised with a documented management plan following its identification in n = 32 [26%] patients only. Conclusions: In this first multicentre study of the incidence of AKI in children admitted to selected hospitals across England, the incidence of AKI was 10.8% with most patients under the age of 6 years and with AKI stage 1. Recognition and management of AKI was seen in just over 25% children. These data highlight the need to improve recognition of AKI in hospitalised children in the UK.

Keywords: acute kidney injury; alerts; algorithm; epidemiology; hospital.

Figure 1

Distribution of n = 1,112 children with AKI alerts shown as percentage of children in each age band by worst stage of AKI. Data by worst stage of AKI as indicated by maximal change in creatinine level from baseline using the National Health Service (NHS) AKI e-alert algorithm (16).

Figure 2

Incidence of AKI alerts in n = 1,112 patients shown by percentage of children in each centre* by worst stage of AKI. Data by worst stage of AKI as indicated by maximal change in creatinine level from baseline using the National Health Service (NHS) AKI e-alert algorithm (16). *Centre #1, Leicester Royal Infirmary hospital; Centre #2, North Middlesex Hospital; Centre #3, Worcestershire Acute Hospitals; Centre #4, Bristol Royal Hospital for Children; Centre #5, Evelina London Children's Hospital; Centre #6, Royal Manchester Children's Hospital.