Incidents and sanctioning of illegal and dangerous ruck cleanouts during the 2015 to 2019 under 18 Craven Week Rugby Tournament

Thesis (M Sport Sc)--Stellenbosch University, 2021.ENGLISH ABSTRACT: Rugby union is one of the most popular team sports worldwide, but because of its physical nature it has a very high injury risk. The high injury risk is a concern for rugby stakeholders, coaches, referees, players and parents. The increased frequency of exposure to rucks and associated injury risk raises serious concerns regarding player safety. Research on ruck cleanouts are limited, with no research performed on ruck cleanouts at elite school level. To date the current study was the first to investigate legal and illegal (both not dangerous and dangerous) ruck cleanouts in order assess player and referee behaviour at elite school level. This thesis followed an article format where two articles were compiled. Article one’s aim was to investigate player behaviour by looking at the incident rates for legal and illegal ruck cleanouts, whereas article two aimed to investigate the sanctioning and non-sanctioning rates of illegal ruck cleanouts. Research article one investigated a total of 35 545 cleanouts of which 91.8 % were legal and 8.16% were illegal. Of the illegal cleanouts 7.5% were regarded not dangerous and 0.6% were dangerous. The majority of illegal not dangerous ruck cleanouts were “not supporting own body weight” (f=2 498; 93%; p=0.01), and illegal dangerous were the “neck roll ” (f=147; 100.0%; p=0.02). The attacking team (f=147; 64.0%, p=0.02) was responsible for more illegal ruck cleanouts when compared to the defending team (f=352; 3.6%). The importance plot of the Classification and Regression Tree Model indicated that the cleaner techniques (1.0) and year (0.3) were the best predictors to classify the ruck cleanout outcomes. When analysing ruck cleanout techniques executed by the attacking and defending teams, the attacking team’s “ clearing and protecting” techniques were significant (p=0.04) for illegal ruck cleanouts both dangerous and not dangerous when compare to other cleanout techniques. When investigating the defending team, the “jackal” executed significant (p≤0.0) more legal cleanouts when compared to the other defending ruck cleanout activities. A big concern highlighted by the current study was that player behaviour worsened during the 2018 and 2019 rugby seasons because of an increase in illegal not dangerous ruck cleanouts from 7 to 21% was found. Player behaviour needs to be addressed, emphasised and improved through correct and effective technique drills during training. The risk of injury during the ruck can be reduced through the implementation of safe and effective techniques by coaches during training. Majority of the sanctioned and not sanctioned ruck cleanouts all took place in Zone B and Channel 3 on the field. Research article two investigated the sanctioning rate by on-field referees and revealed that 5.0% (f=139) of all illegal (not dangerous and dangerous) ruck cleanouts were sanctioned compared to 95.0% (f=2 765) that were not sanctioned. This study revealed a significant increase (p=0.03) from 2015 to 2016 and a significant decrease (p=0.02) from 2016 to 2017 for sanctioned illegal ruck cleanouts. This is compared to a significant decrease (p=0.03) from 2016 to 2017 and a significant increase (p=0.04) from 2017 to 2018 in illegal not sanctioned ruck cleanouts. The attacking teams made more infringements but were sanctioned less than the defending team. The attacking teams were responsible for 2 362 illegal cleanouts where 1.0% (f=314) were sanctioned and 80.0% (f=2 323) were not sanctioned compared to the defending team that made 314 illegal cleanouts where 3.0% (f=89) were sanctioned and 8.0% (f=225) were not sanctioned by the on-field referee. When investigating player activity at ruck cleanouts, “ clearing and protecting” was sanctioned significantly (p=0.04) more compared to other attacking techniques and the same was evident for non-sanctioning (p=0.03). With defending player activity, the “jackal” was significantly sanctioned (p=0.03) and not sanctioned (p=0.04) compared to other defending activities. The illegal cleanout technique most used was “not supporting own bodyweight ” for the illegal not dangerous cleanouts, where 96.7% (2 416 out of 2 513) were not sanctioned and 3.3% (82 out of 2 513) were sanctioned. This is compared to the illegal dangerous technique, “neck roll”, where 95.2% (140 out of 147) were not sanctioned and 4.8% (7 out of 147) were sanctioned by on-field referees. On-field referees need to be stricter and abide by the Laws of The Game in order to prevent dangerous and foul play. The results found in this study can be used to guide further research around this topic, injury prevention programmes, technique training by focusing on the techniques that cause the majority of illegal not dangerous and illegal dangerous cleanouts, improve referee decision making, modify laws around the ruck cleanout and help players and referees improve their behaviour on the field. Players need to abide by the laws of the game and referees need to be stricter with the enforcement of the laws because this will make the game safer for all involved and lead to an improvement in player behaviour, and therefore, result in a decrease injury risk.AFRIKAANSE OPSOMMING: Rugby unie is een van die mees populêre spansporte wereldwyd, maar as gevolg van die fisieke aard van die spel het dit ’n baie hoe beseringsrisiko. Hierdie hoe beseringsrisiko wek rede tot kommer vir rugby deelhebbers, afrigters, skeidsregters, spelers en ouers. Die toenemende blootstelling aan losskrums en die daarmee gepaardgaande beseringsrisiko hou groot kommer in vir die veiligheid van spelers. Oor die algemeen is navorsing oor die skoonmaak van losskrums beperk, met geen navorsing wat op elite skoolvlak gedoen is. Tot op datum was die huidige studie die eerste navorsing wat die wettige en onwettige (beide nie gevaarlik en gevaarlik) skoonmaak van die losskrum ondersoek het in ’n poging om speler en skeidsregter gedrag op elite skoolvlak te bepaal. Die tesis, wat in artikel formaat saamgestel is, bevat twee artikels. Die doel van artikel een was om speler gedrag te ondersoek deur te fokus op frekwensie voorvalle vir die wettige en onwettige skoonmaak van losskrums, terwyl artikel twee die bekragtiging en nie-bekragtiging frekwensie voorvalle van die onwettige skoonmaak van losskrums ondersoek het. Navorsingartikel een het die skoonmaak van 35 545 losskrums ondersoek, waarvan 91.8 % wettig en 8.2% onwettig was. 7.5% van die onwettige skoonmaak prosesse was beskou as nie gevaarlik en 0.64% was gevaarlik. Die oorgrote meerderheid van die onwettige nie gevaarlike skoonmaak prosesse by losskrums was “ondersteun nie eie liggaamsgewig” (f=2 498; 93% ; p=0.01) en onwettig gevaarlik was die “nek rol” (f=147; 100%; p=0.02). Die aanvallende span (f=147; 64%; p=0.02) was verantwoordelik vir meer onwettige losskrum skoonmaak prosesse in vergelyking met die verdedigende span (f=352; 3.6%). Die “Classification and Regression Tree Model” het aangedui dat die skoonmaak tegniek (1.0) en jaar (0.3) was die beste voorspellers om die losskrum skoonmaak uitkomste te bepaal. ’n Analise van die losskrum skoonmaak tegnieke van die aanvallende en verdedigende spanne het getoon dat die aanvallende span se “skoonmaak en beskerm” tegnieke tydens die spel betekenisvol was (p=0.04) vir onwettige losskrum skoonmaak aktiwiteite, beide gevaarlik en nie gevaarlik, in vergelyking met ander skoonmaak tegnieke. Met die ondersoek gerig op die verdedigende span, het die “jackal” betekenisvol meer (p≤0.00) wettige skoonmaak prosesse uitgevoer in vergelyking met die ander verdedigende losskrum skoonmaak aktiwiteite. Wat groot kommer wek is dat die studie bevind het dat speler gedrag tydens die 2018 en 2019 rugby seisoene versleg het in die sin dat daar ’n toename van 7 to 21% in onwettige nie gevaarlike skoonmaak aktiwiteite was. Die gedrag van spelers moet deur korrekte en effektiewe tegnieke gedurende inoefeningsessies aangespreek en beklemtoon word en besluitneming moet verbeter word. Die risiko van beserings tydens die losskrum kan verminder word deur die implementering van veilige en effektiewe tegnieke deur afrigters tydens inoefening. Die meeste gesanksioneerde en nie gesanksioneerde losskrum skoonmaak aktiwiteite het almal in Sone B and Kanaal 3 op die veld plaasgevind. Navorsingartikel twee het die sanksioneringstempo van op-die- veld skeidsregters ondersoek en gevind dat 5.0% (f=139) van alle onwettige (nie gevaarlik en gevaarlik) losskrum skoonmaak aktiwiteite gesanksioneer was in vergelyking met 95.0% (f=2 765) wat nie gesanksioneer was nie. Die huidige studie het ’n betekenisvolle toename (p=0.03) from 2015 tot 2016 gevind en ’n betekenisvolle afname (p=0.02) vanaf 2016 tot 2017 vir gesanksioneerde onwettige losskrum skoonmaak aktiwiteite. Dit is in vergelyking met ’n betekenisvolle afname (p=0.03) van 2016 tot 2017 en ’n betekenisvolle toename (p=0.04) vanaf 2017 tot 2018 in onwettige nie gesanksioneerde losskrum skoonmaak aktiwiteite. Die aanvallende spanne het meer oortredings begaan, maar is minder gestraf as die verdedigende span. Die aanvallende span was verantwoordelik vir 2 362 onwettige skoonmaak aktiwiteite waarvan 1.0% (f=314) gesanksioneer was en 80.0% (f=2 323) nie gesanksioneer was in vergelyking met die verdedigende span wat 314 onwettige skoonmaak aktiwiteite uitgevoer het waarvan 3.0% (f=89) gesanksioneer was en 8.0% (f=225) nie deur deur die op-die-veld skeidsregter gesanksioneer was nie. Met die ondersoek van speler tegnieke by losskrums, “ clearing and protecting” was betekenisvol meer gesanksioneer (p=0.04) in vergelyking met ander aanvallende aktiwiteite en dieselfde neiging was meer vergelykbaar aan ander aanvallende tegnieke en dieselfde was voor-die- handliggend vir nie gesanksioneerde aktiwiteite (p=0.03). Met verdedigende speler aktiwiteite was die “jackal ” betekenisvol gesanksioneer (p=0.03) en nie gesanksioneer (p=0.04) in vergelyking met ander verdedigende aktiwiteite. Die onwettige skoonmaak tegniek wat die meeste gebruik is, was “not supporting ow n bodyweight” vir die onwettige nie gevaarlike skoonmaak tegnieke waartydens 96.7% (2 416 uit of 2 513) nie gesanksioneer was nie. Dit is in vergelyking met die onwettige gevaarlike tegnieke, “neck roll”, waar 95.2% (140 uit 147) nie gesanksioneer was nie en 4.8% (7 uit 147) deur op-die-veld skeidsregters gesanksioneer was. Op-die-veld skeidsregters moet strenger wees met die toepassing van die Reels van die Spel om sodoende gevaarlike en ongewensde spel te voorkom. Die resultate wat deur die studie voortgebring is kan gebruik word om om toekomstige navorsing aangaande die resulate van die huidige onderwerp te stimuleer soos byvoorbeeld, besering voorkomende programme, tegniek inoefening met die fokus op tegnieke wat die meeste onwettige nie gevaarlike en wettig gevaarlike skoonmaak tegnieke insluit, fokus op die tegnieke wat die meeste van die onwettige nie gevaarlike en onwettige gevaarlike losskrum skoonmaak aktiwiteite, verbeter skeidsregter besluitneming, pas reëls aan rondom die losskrum skoonmaak aan en help spelers en skeidsregters om hulle gedrag op die veld te verbeter. Spelers moet die reëls van die spel gehoorsaam en skeidsregter moet strenger wees met die toepassing van die reëls aangesien dit die spel veiliger sal maak vir almal betrokke en aanleiding sal gee tot ‘n verbetering in speler gedrag en daarom sal lei tot ’n afname in die risiko van beserings.Master

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

“Turn that frown upside-down”: A contextual account of emoticon usage on different virtual platforms

Evidence highlights the prevalent usage of emoticons within digital forms of textual communication and the impact on the recipient. However, little evidence demonstrates the interpersonal functions for the user and whether this varies as a product of virtual platform. This formed the basis for the current study in which participants (N = 92) provided open-ended accounts of their reasons for using emoticons across three virtual platforms (email, text message, and social networking site), and their general emoticon usage across these. Responses revealed a number of themes on reasons for emoticon usage. The first was; “aiding personal expression”, with sub-themes of; “establishing emotional tone”; and “to lighten the mood”. Other themes were “reducing ambiguity of discourse” and “appropriateness of context”. Overall, there was consistency across platforms, on both the personal and interpersonal functions which emoticons served. However, some disparity was identified as email platforms were deemed inappropriate for emoticon use, regardless of the fact that emoticons were recognised as important emotional aids for communication. Taken together these findings highlight the importance of emoticon usage for the user, through a contextual lens to recognise the influential factors upon these behaviours and the implications this has for digital text-based communication. In this regard, this contributes further conceptualisation of one aspect of hyperpersonal communication within virtual interactions, and how different platforms may permit these self-presentational efforts to a greater or lesser extent

Africa needs context-relevant evidence to shape its clean energy future

Aligning development and climate goals means Africa’s energy systems will be based on clean energy technologies in the long term, but pathways to get there are uncertain and variable across countries. Although current debates about natural gas and renewables in Africa are heated, they largely ignore the substantial context specificity of the starting points, development objectives and uncertainties of each African country’s energy system trajectory. Here we—an interdisciplinary and majority African group of authors—highlight that each country faces a distinct solution space and set of uncertainties for using renewables or fossil fuels to meet its development objectives. For example, Ethiopia is headed for an accelerated green-growth pathway, but Mozambique is at a crossroads of natural gas expansion with implicit large-scale technological, economic, financial and social risks and uncertainties. We provide geopolitical, policy, finance and research recommendations to create firm country-specific evidence to identify adequate energy system pathways for development and to enable their implementation

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation

Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial

Background: There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI). Methods: We conducted a secondary analysis of the STandard versus Accelerated Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial to compare outcomes among patients who initiated RRT with either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD). We generated a propensity score for the likelihood of receiving CRRT and used inverse probability of treatment with overlap-weighting to address baseline inter-group differences. The primary outcome was a composite of death or RRT dependence at 90-days after randomization. Results: We identified 1590 trial participants who initially received CRRT and 606 who initially received IHD. The composite outcome of death or RRT dependence at 90-days occurred in 823 (51.8%) patients who commenced CRRT and 329 (54.3%) patients who commenced IHD (unadjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.75-1.09). After balancing baseline characteristics with overlap weighting, initial receipt of CRRT was associated with a lower risk of death or RRT dependence at 90-days compared with initial receipt of IHD (OR 0.81; 95% CI 0.66-0.99). This association was predominantly driven by a lower risk of RRT dependence at 90-days (OR 0.61; 95% CI 0.39-0.94). Conclusions: In critically ill patients with severe AKI, initiation of CRRT, as compared to IHD, was associated with a significant reduction in the composite outcome of death or RRT dependence at 90-days

Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.

ObjectivesAmong patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.DesignSecondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).SettingOne hundred-fifty-three ICUs in 13 countries.PatientsAltogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).InterventionsNone.Measurements and main resultsTotal mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p p p p p p p p = 0.007).ConclusionsAmong STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions