Abstract：
BACKGROUND: Children with established kidney failure may have additional medical conditions influencing kidney care and outcomes. This cross-sectional study aimed to examine the prevalence of co-existing diseases captured in the electronic hospital record compared to UK Renal Registry (UKRR) data and differences in coding.
METHODS: The study population comprised children aged < 18 years receiving kidney replacement therapy (KRT) in England and Wales on 31/12/2016. Comorbidity data at KRT start was examined in the hospital record and compared to UKRR data. Agreement was assessed by the kappa statistic. Associations between patient and clinical factors and likelihood of coding were examined using multivariable logistic regression.
RESULTS: A total of 869 children (62.5% male) had data linkage for inclusion. UKRR records generally reported a higher prevalence of co-existing disease than electronic health records; congenital, non-kidney disease was most commonly reported across both datasets. The highest sensitivity in the hospital record was seen for congenital heart disease (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.51, 0.78) and malignancy (OR 0.63, 95% CI 0.41, 0.85). At best, moderate agreement (kappa ≥ 0.41) was seen between the datasets. Factors associated with higher odds of coding in hospital records included age, while kidney disease and a higher number of comorbidities were associated with lower odds of coding.
CONCLUSIONS: Health records generally under-reported co-existing disease compared to registry data with fair-moderate agreement between datasets. Electronic health records offer a non-selective overview of co-existing disease facilitating audit and research, but registry processes are still required to capture paediatric-specific variables pertinent to kidney disease.
METHODS: The study population comprised children aged < 18 years receiving kidney replacement therapy (KRT) in England and Wales on 31/12/2016. Comorbidity data at KRT start was examined in the hospital record and compared to UKRR data. Agreement was assessed by the kappa statistic. Associations between patient and clinical factors and likelihood of coding were examined using multivariable logistic regression.
RESULTS: A total of 869 children (62.5% male) had data linkage for inclusion. UKRR records generally reported a higher prevalence of co-existing disease than electronic health records; congenital, non-kidney disease was most commonly reported across both datasets. The highest sensitivity in the hospital record was seen for congenital heart disease (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.51, 0.78) and malignancy (OR 0.63, 95% CI 0.41, 0.85). At best, moderate agreement (kappa ≥ 0.41) was seen between the datasets. Factors associated with higher odds of coding in hospital records included age, while kidney disease and a higher number of comorbidities were associated with lower odds of coding.
CONCLUSIONS: Health records generally under-reported co-existing disease compared to registry data with fair-moderate agreement between datasets. Electronic health records offer a non-selective overview of co-existing disease facilitating audit and research, but registry processes are still required to capture paediatric-specific variables pertinent to kidney disease.
摘要：
背景：患有肾功能衰竭的儿童可能会有其他疾病影响肾脏护理和预后。这项横断面研究旨在研究与英国肾脏注册（UKRR）数据和编码差异相比，电子医院记录中捕获的共存疾病的患病率。
方法：研究人群包括2016年12月31日在英格兰和威尔士接受肾脏替代治疗（KRT）的18岁以下儿童。在医院记录中检查KRT开始时的合并症数据，并与UKRR数据进行比较。Kappa统计数据评估了协议。使用多变量逻辑回归检查患者与临床因素之间的关联以及编码的可能性。
结果：共有869名儿童（62.5%为男性）有数据关联。UKRR记录通常报告的共存疾病患病率高于电子健康记录；先天性，在两个数据集中,非肾脏疾病最常报告.医院记录中敏感性最高的是先天性心脏病（比值比（OR）0.65，95％置信区间（CI）0.51，0.78）和恶性肿瘤（OR0.63，95％CI0.41，0.85）。充其量，数据集之间存在中度一致性(kappa≥0.41).与医院记录中编码几率较高相关的因素包括年龄，而肾脏疾病和较高数量的合并症与较低的编码几率相关。
结论：与注册表数据相比，健康记录通常未报告共存疾病，数据集之间的一致性相当。电子健康记录提供了对共存疾病的非选择性概述，以促进审计和研究，但仍需要注册流程来捕获与肾脏疾病相关的儿科特异性变量.
方法：研究人群包括2016年12月31日在英格兰和威尔士接受肾脏替代治疗（KRT）的18岁以下儿童。在医院记录中检查KRT开始时的合并症数据，并与UKRR数据进行比较。Kappa统计数据评估了协议。使用多变量逻辑回归检查患者与临床因素之间的关联以及编码的可能性。
结果：共有869名儿童（62.5%为男性）有数据关联。UKRR记录通常报告的共存疾病患病率高于电子健康记录；先天性，在两个数据集中,非肾脏疾病最常报告.医院记录中敏感性最高的是先天性心脏病（比值比（OR）0.65，95％置信区间（CI）0.51，0.78）和恶性肿瘤（OR0.63，95％CI0.41，0.85）。充其量，数据集之间存在中度一致性(kappa≥0.41).与医院记录中编码几率较高相关的因素包括年龄，而肾脏疾病和较高数量的合并症与较低的编码几率相关。
结论：与注册表数据相比，健康记录通常未报告共存疾病，数据集之间的一致性相当。电子健康记录提供了对共存疾病的非选择性概述，以促进审计和研究，但仍需要注册流程来捕获与肾脏疾病相关的儿科特异性变量.
