Researchers have uncovered a significant gap in the documentation of Acute Kidney Injury (AKI) episodes in children across English hospitals. A recent cross-sectional study revealed that only 19.7% of AKI episodes identified by alerts were accurately coded in hospital records for patients younger than 18 years. This comprehensive analysis examined 6,272 AKI episodes among 5,582 hospitalized children and highlighted disparities in coding practices linked to various factors.
The study, published online on February 13, 2025, in BMC Nephrology, revealed that the coding rate for AKI episodes increased with the severity of the condition. Stage I AKI episodes had a coding rate of 14.5%, while stage II and stage III episodes were coded at rates of 22.3% and 41.4%, respectively. The research classified episodes as community-acquired if they occurred within the first two days of admission, accounting for 46.8%, and as hospital-acquired if they developed from day three onwards, representing 41.6%. Additionally, 11.7% of the cases involved children experiencing AKI during their birth hospitalization, identified as the "birth cohort."
The study utilized multivariable logistic regression to assess patient and clinical factors influencing AKI coding. Findings indicated that children who developed AKI during their birth admission were less likely to be coded compared to those with hospital-acquired episodes, with an odds ratio (OR) of 0.4 and a 95% confidence interval (CI) of 0.3-0.5. Despite similarities in coding rates between community-acquired and hospital-acquired AKI, socio-economic factors played a role. Children from less deprived areas had higher odds of being coded (OR, 1.4; 95% CI, 1.1-1.7) than their counterparts from more deprived regions.
Furthermore, the study highlighted potential limitations in defining AKI based solely on serum creatinine changes, which may lead to the misclassification of spurious values and the omission of cases relying on alternative measures like urine output. It was noted that not all laboratories across England submitted data promptly, resulting in the analysis being based on approximately 66% of National Health Service laboratories.
"Further work is now required to understand how e-alerts can be used to improve clinical recognition of AKI in children to enhance care and outcomes," stated the authors.
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