News Does Not Accurately Predict Aki
NEWS DOES NOT ACCURATELY PREDICT AKI
Aled P Williams, Vijaya Ramasamy, David Davies, Georgina Williams, Benjamin Thomas
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board
INTRODUCTION: Both NCEPOD report and the recently published NICE Guidelines on AKI rightly places great emphasis on early identification of patients at risk of developing AKI.Currently, adults admitted to UK hospitals are monitored by National Early Warning Scores (NEWS) – a physiological observations monitoring system which is weighted to allow a graded response to a deteriorating clinical condition.However, we are not convinced NEWS reliably predicts or identifies patients at risk of developing AKI. The aim of this study is to establish whether NEWS accurately predicts the risk of developing AKI by comparing with ‘CRASHED score’ – a scoring system we had devised based on 6 of the top 10 individual risk factors for developing AKI identified by NCEPOD report, which could be realistically applied in an unscheduled care setting.
DESIGN: All patients admitted with an AKI on consecutive days over a two-week period were studied. AKI was diagnosed according to International Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A Standardised proforma was used to collect admission demographics, baseline observations including NEWS, and AKI risk factors assessment in the first 24 hours of admission. A ‘CRASHED score’ was retrospectively applied to each patient.
RESULTS: 93 patients were identified and there were no exclusions. The mean age of presentation was 74.9 years with 65% patients over the age of 75 years. 60% had an AKI on pre-existing renal disease and 38% had an AKI alone. The average NEWS score for all patients was 3.3.CRASHED SCORE / NUMBER OF PATIENTS / AVERAGE NEWS SCORE
0 / 1 / 6
1 / 12 / 2.1
2 / 16 / 2.1
3 / 19 / 3.5
4 / 29 / 3.7
5 / 12 / 3.9
6 / 3 / 5.3
DISCUSSION:AKI was seen more commonly amongst the elderly. In both this cohort and also amongst the younger population who developed AKI, there was no significant correlation betweenthe number of well-established risk factors to develop AKI, which in our case is called the ‘CRASHED Score’ and the NEWS.Therefore, NEWS does not predict risk of developing AKI.
CONCLUSION: Patients admitted with AKI wouldn’t necessarily be identified according to track and trigger response of NEWS, thereby potentially missing an opportunity for early identification and management of these patients.‘CRASHED score’ needs to be piloted in all unscheduled admissions to hospital to evaluate its purposefulness as a AKI risk stratification tool in a larger and more general population group.