Pediatric Acute Kidney Injury (AKI) Retrospective, Real-Time and Repository Research

Study Overview
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Brief Summary
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This proposal will incorporate statistical models developed by the investigators to predict risk for acute kidney injury into our electronic medical record system, enabling an alert to notify providers of the risk status. Pediatric inpatients will be randomly assigned to be in the intervention group, for whom the notification will be implemented, or in the control group, who will receive usual care (no notification). The investigators believe the notification will increase appropriate screening for acute kidney injury and reduce the severity of acute kidney injury in the intervention group.

Detailed Description
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This proposal will incorporate a logistic regression models developed by the investigators to predict risk for acute kidney injury in pediatric intensive care unit and pediatric ward patients into the electronic medical record system, enabling personalized decision support. Real-time surveillance using the risk prediction models will identify pediatric inpatients at increased risk for acute kidney injury. When patients exceed the threshold risk for acute kidney injury, the electronic medical record system will notify providers. Patients will be randomly assigned to be in the intervention group, for whom the notification will be implemented, or in the control group, for whom the notification will not display. The risk notification will be assessed for its impact on outcomes including rates of screening for acute kidney injury and the severity of acute kidney injury.

Official Title
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Pediatric Acute Kidney Injury (AKI) Retrospective, Real-Time and Repository Research

Conditions
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Acute Kidney Injury, Renal Injury, Kidney Disease

Intervention / Treatment
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* Other: AKI Risk Notification


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All admissions to the pediatric intensive care unit or pediatric wards at the Monroe Carell Junior Children's Hospital at Vanderbilt Exclusion Criteria: Prior diagnosis of chronic renal disease, including dialysis and transplant Admission to the Neonatal Intensive Care Unit during the current admission

Ages Eligible for Study
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Minimum Age: 28 Days
Maximum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: AKI Risk Notification<br>Patients randomized to this arm will be eligible for an acute kidney injury risk notification, if their calculated risk exceeds the threshold during their inpatient encounter. | Other: AKI Risk Notification<br>* When a patient's calculated acute kidney injury risk exceeds the threshold value, the electronic medical record will notify the provider of the risk and that appropriate screening (BMP including serum creatinine) may be indicated.<br>|
| No Intervention: Usual Care<br>These patients will receive usual clinical care, with no acute kidney injury risk notification. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Serum Creatinine Tests Ordered | Measure of efficacy of the clinical decision support to lead to increased screening for acute kidney injury. | Admission through Discharge (approximately 2 days to 1 week) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of Stay (days) | Number of days in hospital for admission. | Admission through Discharge (approximately 2 days to 1 week) | 
| Acute Kidney Injury Severity (as measured by Kidney Disease Improving Global Outcomes [KDIGO] stage 1, 2 or 3) | Worst stage of AKI during hospital stay. | Admission through Discharge (approximately 2 days to 1 week) | 
| In-hospital Mortality | If any in cohort. | Admission through Discharge (approximately 2 days to 1 week) | 
| Renal Replacement Therapy (number requiring RRT) | Determined by ICD10 and CPT codes during admission. | Admission through Discharge (approximately 2 days to 1 week) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatrics