The National Early Warning Score and its subcomponents recorded within ±24 hours of emergency medical admission are poor predictors of hospital-acquired acute kidney injury

YesBackground: Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. Aim: To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. 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). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity 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. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity.The Health Foundatio

The incidence and nature of dysphagia following botulinum toxin injections for torticollis

A prospective study of 123 consecutive patients with spasmodic torticollis (ST) receiving botulinum toxin (BTX) investigated the incidence of dysphagia and other side effects by means of questionnaire. Eighty-one (66%) completed questionnaires. Of the 42 patients who did not respond, 38 reported no side effects on follow-up. Four were lost to follow-up. Dysphagia was reported by 12 patients (9.7%) onset averaged 5.4 days postinjection (range: 1 day-2 weeks). Duration averaged 10 days (range: 2 days-3 weeks). Videofluoroscopy conducted on 2 patients with reported severe problems swallowing both solids and liquids demonstrated 2 different forms of dysphagia, 2-weeks and 3-months postinjection. Dysphagia may be present prior to treatment in some cases of spasmodic torticollis (ST). Swallowing competence should be checked before treatment with BTX injections

Non-natives: 141 scientists object [Letter]

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