Predicting outcomes in central venous catheter salvage in pediatric central line-associated bloodstream infection

Lorne W. Walker, Andrew J. Nowalk, Shyam Visweswaran

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Central line-associated bloodstream infections (CLABSIs) are a common, costly, and hazardous healthcare-associated infection in children. In children in whom continued access is critical, salvage of infected central venous catheters (CVCs) with antimicrobial lock therapy is an alternative to removal and replacement of the CVC. However, the success of CVC salvage is uncertain, and when it fails the catheter has to be removed and replaced. We describe a machine learning approach to predict individual outcomes in CVC salvage that can aid the clinician in the decision to attempt salvage. MATERIALS AND METHODS: Over a 14-year period, 969 pediatric CLABSIs were identified in electronic health records. We used 164 potential predictors to derive 4 types of machine learning models to predict 2 failed salvage outcomes, infection recurrence and CVC removal, at 10 time points between 7 days and 1 year from infection onset. RESULTS: The area under the receiver-operating characteristic curve varied from 0.56 to 0.83, and key predictors varied over time. The infection recurrence model performed better than the CVC removal model did. CONCLUSIONS: Machine learning-based outcome prediction can inform clinical decision making for children. We developed and evaluated several models to predict clinically relevant outcomes in the context of CVC salvage in pediatric CLABSI and illustrate the variability of predictors over time.

Original languageEnglish (US)
Pages (from-to)862-867
Number of pages6
JournalJournal of the American Medical Informatics Association : JAMIA
Volume28
Issue number4
DOIs
StatePublished - Mar 18 2021

Keywords

  • central venous catheters
  • machine learning
  • medical informatics infectious disease
  • pediatrics

ASJC Scopus subject areas

  • Health Informatics

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