中心静脉导管相关血流感染 (CLABSI) 是最常见的儿科医疗保健相关感染之一，用于衡量医院绩效。随着时间的推移，儿科患者的敏锐度和复杂性不断增加。现有的风险调整方法无法控制患者的个体特征，而个体患者特征是 CLABSI 风险的有力预测因素，并且会随着时间的推移而变化。我们的目标是开发住院儿童 CLABSI 的风险调整模型，并将随时间推移观察到的发生率与预期发生率进行比较。我们利用四级儿童医院的电子健康记录数据进行了一项前瞻性队列研究。我们纳入了接受中心导管的住院儿童。风险因素根据双变量分析和专家输入中与 CLABSI 风险的关联，考虑将从已发表文献中确定的数据纳入多变量模型中。我们计算了观察到的和预期的（风险模型调整后的）年度 CLABSI 率。在 520,209 行天数的 16,411 名患者中，633 名患者经历了 796 次 CLABSI。最终模型包括年龄、行为健康状况、非英语能力、肿瘤服务、端口导管类型、导管停留时间、淋巴状况、全肠外营养以及需要 ICU 级别护理的器官系统数量。对于接受 ICU 级别护理的每个器官系统，CLABSI 的比值比为 1.24 (95% CI 1.12-1.37)。虽然没有统计学上的差异，但观察到的比率低于后来几年的预期比率。未能调整患者因素，特别是疾病的严重性和复杂性，可能会错过 CLABSI 比率的临床显着差异，并可能导致对质量影响的不准确解释改进努力。

Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.We conducted a prospective cohort study using electronic health record data at a quaternary Children's Hospital.We included hospitalized children with central catheters.Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12-1.37). Although not statistically different, observed rates were lower than expected rates for later years.Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.