Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?
Abstract Background In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-022-07571-4 |
| _version_ | 1811323558789382144 |
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| author | Khouloud Abdulrhman Al-Sofyani Mohammed Shahab Uddin |
| author_facet | Khouloud Abdulrhman Al-Sofyani Mohammed Shahab Uddin |
| author_sort | Khouloud Abdulrhman Al-Sofyani |
| collection | DOAJ |
| description | Abstract Background In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access. Methods A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results. Results We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis. Conclusions So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies. |
| first_indexed | 2024-04-13T13:57:22Z |
| format | Article |
| id | doaj.art-2119ad8ac68b4295a2be5f110e245157 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-13T13:57:22Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-2119ad8ac68b4295a2be5f110e2451572022-12-22T02:44:08ZengBMCBMC Infectious Diseases1471-23342022-07-0122111210.1186/s12879-022-07571-4Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?Khouloud Abdulrhman Al-Sofyani0Mohammed Shahab Uddin1Department of Pediatric, Pediatric Intensive Care Unit, King Abdulaziz University Hospital, Faculty of Medicine and Clinical Skills and Simulation Center, King Abdulaziz UniversityPediatric Department, Ministry of National Guard Health AffairsAbstract Background In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access. Methods A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results. Results We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis. Conclusions So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.https://doi.org/10.1186/s12879-022-07571-4Catheter related blood stream infection (CRBSI)Central linesCausal inferenceInverse probability treatment weightingPropensity scoreChildren |
| spellingShingle | Khouloud Abdulrhman Al-Sofyani Mohammed Shahab Uddin Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? BMC Infectious Diseases Catheter related blood stream infection (CRBSI) Central lines Causal inference Inverse probability treatment weighting Propensity score Children |
| title | Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? |
| title_full | Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? |
| title_fullStr | Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? |
| title_full_unstemmed | Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? |
| title_short | Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? |
| title_sort | can inverse probability treatment weighting iptw be used to assess differences of crbsi rates between non tunneled femoral and jugular cvcs in picu patients |
| topic | Catheter related blood stream infection (CRBSI) Central lines Causal inference Inverse probability treatment weighting Propensity score Children |
| url | https://doi.org/10.1186/s12879-022-07571-4 |
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