474
Bibliographic record
Abstract
Introduction: Acute kidney injury (AKI) is a common adverse event in hospitalized patients, associated with increased mortality, length of stay, and resource utilization. Rates of AKI in paediatric populations, based on the RIFLE criteria, which uses changes in glomerular filtration rate (GFR) and urine output to classify AKI severity, vary in the literature. These variations can significantly affect the estimated incidence of AKI. Hypothesis: We aimed to quantify the incidence of AKI within a large, academic paediatric intensive care unit (ICU). Methods: All children admitted to The Hospital for Sick Children’s Critical Care Unit between January 2006 and June 2009 were studied, excluding readmissions to the ICU, newborns, patients with short ICU stays (<6 hours), preexisting renal failure, and those with no creatinine and urine output measurements in the ICU. AKI severity was assessed according to the RIFLE criteria (None, ‘Risk’, ‘Injury’ or ‘Failure’) using both the full criteria (changes in both serum creatinine and urine output) and the GFR criteria alone. Descriptive statistics of patient outcomes were reported for both outcome definitions. Results: During the study period, 3,865 patients (56.0% male; median age 4.4 years, IQR 11.1) met the inclusion criteria. 915 patients (23.7%) experienced AKI (maximum severity: 66.0% ‘Risk’, 27.5% ‘Injury’, 6.5% ‘Failure’). 164 patients (17.9%) met both the GFR and urine output criteria, while 22.3% (n=204) experienced only an increase in serum creatinine and 59.8% (n=547) had declining urine output. Based solely on creatinine, the incidence of AKI was 9.5% (n=368; maximum severity: 59.5% ‘Risk’, 29.4% ‘Injury’, 11.1% ‘Failure’). The median ICU length of stay (LOS) for patients with RIFLE-defined AKI was 1 day (IQR=1); based creatinine alone, this increased to 8 days (IQR=11). ICU mortality was 7.2% (95% CI: 5.6–9.1%) for RIFLE-based AKI and 10.6% (95% CI: 7.7–14.2%) using creatinine alone. Conclusions: The RIFLE criteria are inconsistently applied in the literature. Defining AKI solely by creatinine changes may drastically underestimate the incidence of AKI. This definition of AKI also results in higher ICU LOS and mortality, implying that it captures more severe illness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.612 | 0.465 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".