Hi Chris
Whatever the algorithm is doing the result should flag as AKI - you have a change >26 within 48h (from 102 to 130).
However your query raises some ambiguities that would be useful to address.
Who is your LIMS supplier in case anyone else using the same one can help.
Have you asked them exactly what is programmed in for the 26 arm?
I would assume they have a way of checking whether any creat result within 48h is 26 or more lower than current.
If you keep times the same and use the sequence
100, 101, 110, 130 then I would not expect to flag by the algorithm (although likely AKI) but to go to the auth q - does it do that?
Best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist
Clinical Lead UCLH Clinical Biochemistry
Tel 020 344 72954 direct dial
-----Original Message-----
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of ACB-AKI-ALGORITHM automatic digest system
Sent: 23 May 2015 00:04
To: [log in to unmask]
Subject: ACB-AKI-ALGORITHM Digest - 19 May 2015 to 22 May 2015 (#2015-28)
There are 4 messages totaling 1536 lines in this issue.
Topics of the day:
1. AKI scenario (4)
----------------------------------------------------------------------
Date: Fri, 22 May 2015 12:25:53 +0100
From: "Hughes Christopher (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION
TRUST)" <[log in to unmask]>
Subject: AKI scenario
Hoping for some clarification if possible..
We are still in the process of testing the AKI algorithm in our LIMS and thus far all scenarios listed in the Renal Registry test script have passed. I have, however, found a scenario that isn't covered by the test script and it appears to be failing when I run it through my LIMS. I have requested 4 test creatinines over a 7 day period and the results are 100 umol/L (5 days ago), 101 (3 days ago), 102 (2 days ago) and 130 (today). This means that the RV ratio is 1.3 i.e. 130/100 (<50% increase). As the change has not occurred within the last 48 hours but the difference is >26 umol/L, as I understand it, no comment should be added and the report should be sent for authorisation. My LIMS, however, incorrectly adds an AKI1 alert (I'm assuming because it has identified a creatinine result in the last 48 hours). I haven't found an example in the test script that addresses the scenario where the lowest creatinine is found on a sample <7 days and >48 hours ago but where other creatinine results have subsequently been reported.
I'm hoping someone can let me know how their algorithm interprets this scenario and whether my logic is sound.
Thanks in advance
Chris Hughes
Specialist Biomedical Scientist and IT Supervisor Biochemistry Dept.
Royal United Hospital
Bath
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Date: Fri, 22 May 2015 12:36:26 +0000
From: "Hayden Katharine (RW3) CMFT Manchester" <[log in to unmask]>
Subject: Re: AKI scenario
Hi Chris,
I would say that you are right in your assumption that it should report without an alert (or in our Apex system it reports a stage 0) if the next closest result is >48hrs. See below comment for our system.
Apex UDF
Internal Meaning and Action
Common reported text in Apex
Reported comment
6
AKI Stage = 0. Send to authorisation queue if increased > [26] umol/L in < [7] days. Consider requesting repeat if CKD unlikely
AKI Stage 0
No current indication of AKI
That said however if the result that you said is 2 days ago is actually within 48hrs (is it?) then this would give you a Stage 1 alert because if you follow the algorithm down the previous result <7 days part, then the ratio as you say is 1.3 so this is a No for the 'Is the RV ratio >1.5' and then goes to 'Has change occurred within 48 hrs?' and if yes 'Is D >26 umol/L?' then report AKI Stage 1 Alert.
So if your result from 2 days ago of 102 is within 48hrs in your system as the booked in time then it is correctly reporting a Stage 1 alert.
If the result from 2 days ago is over 48hrs then it is incorrect and you would need to go back to your IT supplier.
That is my understanding though that the 'Has change occurred within 48hrs' doesn't go back to the lowest result you found in 7days but to anything that is within 48hrs.
Happy to be corrected if I'm wrong.
Regards,
Kath
Katharine Hayden FRCPath
Consultant Clinical Biochemist & Head of Service Dept of Clinical Biochemistry Manchester Royal Infirmary Oxford Road, Manchester M13 9WL
Tel: 0161 701 1106
Fax: 0161 276 4586
www.cmft.nhs.uk<http://www.cmft.nhs.uk> Central Manchester University Hospitals NHS Foundation Trust includes: Manchester Royal Infirmary, Manchester Royal Eye Hospital, Royal Manchester Children's Hospital, Saint Mary's Hospital, University Dental Hospital of Manchester, Trafford Hospitals and Community Services.
________________________________
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Hughes Christopher (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST)
Sent: 22 May 2015 12:26
To: [log in to unmask]
Subject: AKI scenario
Hoping for some clarification if possible..
We are still in the process of testing the AKI algorithm in our LIMS and thus far all scenarios listed in the Renal Registry test script have passed. I have, however, found a scenario that isn't covered by the test script and it appears to be failing when I run it through my LIMS. I have requested 4 test creatinines over a 7 day period and the results are 100 umol/L (5 days ago), 101 (3 days ago), 102 (2 days ago) and 130 (today). This means that the RV ratio is 1.3 i.e. 130/100 (<50% increase). As the change has not occurred within the last 48 hours but the difference is >26 umol/L, as I understand it, no comment should be added and the report should be sent for authorisation. My LIMS, however, incorrectly adds an AKI1 alert (I'm assuming because it has identified a creatinine result in the last 48 hours). I haven't found an example in the test script that addresses the scenario where the lowest creatinine is found on a sample <7 days and >48 hours ago but where other creatinine results have subsequently been reported.
I'm hoping someone can let me know how their algorithm interprets this scenario and whether my logic is sound.
Thanks in advance
Chris Hughes
Specialist Biomedical Scientist and IT Supervisor Biochemistry Dept.
Royal United Hospital
Bath
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------------------------------
Date: Fri, 22 May 2015 16:25:55 +0100
From: Anna Barton <[log in to unmask]>
Subject: Re: AKI scenario
Hello,
If you '2 day' blood sample was taken within 48hrs of the last 130 creat results then yes it is AKI and the algorithm is correct.
You need to be careful how you set up your testing examples, the sampling time is used and so if your day 2 sample was taken 46hr apart from the 130= AKI, but if was say taken 49 hours then= no AKI as per the computer software.
Kind regards,
Anna
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>>> "Hughes Christopher (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION
TRUST)" <[log in to unmask]> 22/05/2015 12:25 >>>
Hoping for some clarification if possible..
We are still in the process of testing the AKI algorithm in our LIMS and thus far all scenarios listed in the Renal Registry test script have passed. I have, however, found a scenario that isn’t covered by the test script and it appears to be failing when I run it through my LIMS. I have requested 4 test creatinines over a 7 day period and the results are 100 umol/L (5 days ago), 101 (3 days ago), 102 (2 days ago) and 130 (today). This means that the RV ratio is 1.3 i.e. 130/100 (<50% increase). As the change has not occurred within the last 48 hours but the difference is >26 umol/L, as I understand it, no comment should be added and the report should be sent for authorisation. My LIMS, however, incorrectly adds an AKI1 alert (I’m assuming because it has identified a creatinine result in the last 48 hours). I haven’t found an example in the test script that addresses the scenario where the lowest creatinine is found on a sample <7 days and >48 hours ago but where other creatinine results have subsequently been reported.
I’m hoping someone can let me know how their algorithm interprets this scenario and whether my logic is sound.
Thanks in advance
Chris Hughes
Specialist Biomedical Scientist and IT Supervisor Biochemistry Dept.
Royal United Hospital
Bath
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Thank you for your co-operation.
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------------------------------
Date: Fri, 22 May 2015 17:43:42 +0100
From: "Hughes Christopher (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION
TRUST)" <[log in to unmask]>
Subject: Re: AKI scenario
Thanks for the advice. I was having difficulty interpreting the algorithm. At the question “Has change occurred within 48 hours?”, I was assuming it meant “Has the difference between current result and previous lowest result over last 7 days been within the last 48 hours?” when it seemingly means any change within the last 48 hours.
Chris
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Anna Barton
Sent: 22 May 2015 16:26
To: [log in to unmask]
Subject: Re: AKI scenario
Hello,
If you '2 day' blood sample was taken within 48hrs of the last 130 creat results then yes it is AKI and the algorithm is correct.
You need to be careful how you set up your testing examples, the sampling time is used and so if your day 2 sample was taken 46hr apart from the 130= AKI, but if was say taken 49 hours then= no AKI as per the computer software.
Kind regards,
Anna
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>>> "Hughes Christopher (ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST)" <[log in to unmask]<mailto:[log in to unmask]>> 22/05/2015 12:25 >>>
Hoping for some clarification if possible..
We are still in the process of testing the AKI algorithm in our LIMS and thus far all scenarios listed in the Renal Registry test script have passed. I have, however, found a scenario that isn’t covered by the test script and it appears to be failing when I run it through my LIMS. I have requested 4 test creatinines over a 7 day period and the results are 100 umol/L (5 days ago), 101 (3 days ago), 102 (2 days ago) and 130 (today). This means that the RV ratio is 1.3 i.e. 130/100 (<50% increase). As the change has not occurred within the last 48 hours but the difference is >26 umol/L, as I understand it, no comment should be added and the report should be sent for authorisation. My LIMS, however, incorrectly adds an AKI1 alert (I’m assuming because it has identified a creatinine result in the last 48 hours). I haven’t found an example in the test script that addresses the scenario where the lowest creatinine is found on a sample <7 days and >48 hours ago but where other creatinine results have subsequently been reported.
I’m hoping someone can let me know how their algorithm interprets this scenario and whether my logic is sound.
Thanks in advance
Chris Hughes
Specialist Biomedical Scientist and IT Supervisor Biochemistry Dept.
Royal United Hospital
Bath
********************************************************************************************************************
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to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere
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End of ACB-AKI-ALGORITHM Digest - 19 May 2015 to 22 May 2015 (#2015-28)
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