CLABSI rate in children increased according to condition complexity
WASHINGTON — Central line-associated bloodstream infection rates can be determined by condition groups, and reporting can reflect differences in condition complexity, according to study results presented at the 2013 Pediatric Academic Societies Annual Meeting.
“We feel that it is extremely important to establish rates for central line-associated bloodstream infections (CLABSI) that can be utilized by using routinely collected and universally available administrative data as CMS and other governmental agencies require,” John Neff, MD, clinical director for the Center for Children with Special Needs at Seattle Children’s Research Institute, told Infectious Diseases in Children. “Without reporting rates according to patient complexity, Children’s Hospitals will appear in publically reported data to be performing very poorly compared to other non-children’s hospitals that care for less complex patients and therefore have less CLABSIs.”
The study included 11,536 discharges from Seattle Children’s Hospital with 56 CLABSIs in 2010 (0.5%). Participants were classified by 3M Clinical Risk Groups into five condition groups: non-chronic; noncomplex chronic; complex chronic; progressive chronic or bone marrow/solid organ transplant or technology dependent; and malignancies.
According to researchers, 20.4% of the CLABSI participants died during or within a month of the discharge date.
Researchers found that CLABSI rates increased according to condition complexity from 0% in nonchronic to 1.8% in progressive chronic or technology dependent children. According to researchers, rates of the other categories were less than 0.1% in nonchronic complex, 0.6% in complex chronic and 1.4% in malignancies.
“In the past, CLABSI rates have been established using line days as denominators,” Neff said. “While such measures add value, it is impossible to collect line days in administrative data. There are no ICD-9 codes that can measure that. Ideally, one would establish denominators that reflect both line days and patients complexity, but until line day measures can be instituted in public reporting data, it is preferable to report according to patient complexity. That is a big step in accurately reflecting the experiences in children’s hospitals.”
For more information:
Neff J. #2216.221. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.Disclosure: Neff reports being a consultant for classification research at the Children’s Hospital Association and has a no-cost research license to use Clinical Risk Groups at 3M Health Information Systems.