ArticleAntimicrobial stewardship & healthcare epidemiology : ASHE2025
Development of a feasible and portable electronic flag for near-real-time identification of renal replacement therapy in the Veterans Health Administration.
Article in Antimicrobial stewardship & healthcare epidemiology : ASHE, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05020418 (Promoting De-Implementation of Inappropriate Antimicrobial Use in Cardiac Device Procedures By Expanding Audit and Feedback), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Promoting De-Implementation of Inappropriate Antimicrobial Use in Cardiac Device Procedures By Expanding Audit and Feedback
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Authors and funding
10 authors.
Funding
Abstract
Background: Chronic kidney disease (CKD) is prevalent among US Veterans. Identifying patients undergoing dialysis in real-time is crucial for implementing patient safety measures, including stewardship interventions, such as medication dosing adjustments. Limited feasible and accurate tools exist for near-real-time identification. This study aimed to develop a renal replacement therapy (RRT) flag using structured data in the Veterans Health Administration (VHA) electronic health record (EHR). Methods: Data from Veterans who underwent cardiovascular implantable electronic device (CIED) procedures (9/2015-12/2019) were linked to US Renal Data Systems (USRDS) data. Potential identifiers included outpatient hemodialysis procedure records, community care hemodialysis consults, ICD-10 diagnoses, and serum creatinine (SCr) >4 mg/dL. USRDS served as the comparison standard, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Logistic regression determined the area under the curve (AUC). Results: Among 37,706 CIED procedures on 34,994 Veterans, 967 patients (2.6%) were identified by USRDS as ever receiving RRT (hemodialysis and peritoneal dialysis or transplant), with 520 (1.4%) actively receiving RRT at the time of CIED. The RRT flag, combining ≥4 outpatient procedures in the prior 30 days, ≥1 consult in the prior year, and/or SCr >4 mg/dL, achieved an AUC of 0.976 (95% CI: 0.97-0.98), with high sensitivity (0.96; 95% CI: 0.94-0.97) and specificity (0.99; 95% CI: 0.99-1.00). The PPV was 0.70 (95% CI: 0.67-0.74). Performance was slightly lower when consults were replaced with ICD codes. Conclusions: We developed an accurate electronic flag using structured data to identify active RRT within VHA among Veterans undergoing invasive procedures, supporting patient safety and care adjustments. This flag addresses a crucial patient safety gap and supports expansion of stewardship efforts.
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