RT Journal Article
SR Electronic
T1 The National Early Warning Score and its subcomponents recorded within ±24 h of emergency medical admission are poor predictors of hospital-acquired acute kidney injury
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 47
OP 53
DO 10.7861/clinmedicine.18-1-47
VO 18
IS 1
A1 Muhammad Faisal
A1 Andy Scally
A1 Musab Ahmed Elgaali
A1 Donald Richardson
A1 Kevin Beatson
A1 Mohammed A Mohammed
YR 2018
UL http://www.rcpjournals.org/content/18/1/47.abstract
AB Hospital-acquired acute kidney injury (H-AKI) is a common cause of avoidable morbidity and mortality. Therefore, in the current study, we investigated whether vital signs data from patients, as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. We analysed all emergency admissions (n=33,608) to York Hospital with NEWS data over a 24-month period. Here, we report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3), and similarly for maximum NEWS (models B0,B1,B2,B3). Of the total emergency admissions, 4.05% (1,361/33,608) had H-AKI. Models using the index NEWS had lower AUCs (0.59–0.68) than models using the maximum NEWS AUCs (0.75–0.77). The maximum NEWS model (B3) was more sensitive than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Based on these results, we suggest that the index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but appears to be unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload, albeit with improved sensitivity.