Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study
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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.
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.
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.
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.
KeywordsBlood-stream infection Surveillance Data linkage Paediatric intensive care Risk-adjustment Bacteraemia
The authors would like to thank Tom Fleming (PICANet), Paul Lock and Joanna Bell (Great Ormond Street Hospital), Ollie Bagshaw and Adrian Bigland (Birmingham Children’s Hospital) for helpful advice, contribution of data and facilitation of data retrieval for this paper. We would like to thank all the staff in participating hospitals who have collected data for PICANet. We are grateful to the UK Paediatric Intensive Care Society for continued support and to the members of the PICANet Steering Group and Clinical Advisory Group who are listed on our website http://www.picanet.org.uk/participants.html. This work was supported by funding from the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (Project number 08/13/47). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. The authors state no conflicts of interest. PICANet is funded by the National Clinical Audit and Patient Outcomes Programme via Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, Our Lady’s Children’s Hospital, Crumlin, Children’s University Hospital, Temple Street and The Harley Street Clinic, London.
Collection of personally identifiable data has been approved by the National Information Governance Board (Formerly the Patient Information Advisory Group) http://www.nigb.nhs.uk/s251/registerapp and ethical approval granted by the Trent Medical Research Ethics Committee, ref. 05/MRE04/17. Consent for the use of the data in this study was obtained by the PICANet unit leads.
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