Definition Of Injury Research Articles

Acute kidney injury definition following PCI and cardiovascular outcomes

Abstract Background Acute kidney injury (AKI) is a complication of percutaneous coronary intervention (PCI), known to increase rates of adverse medical events. We aimed to identify the optimal definition of AKI in predicting of adverse cardiovascular outcomes and mortality post PCI. Methods From a large registry of patients undergoing PCI between 2006–2018 (n=25,690) at two hospitals, consecutive patients were assessed for the presence of AKI according to four different definitions: a relative elevation of ≥25% or ≥50%; or an absolute elevation of ≥0.3 mg/dL or ≥0.5 mg/dL in serum creatinine at 48 hours post PCI. We assessed the calculated rates of AKI according to the different definitions. The discriminant capacity for 30-day and 1-year mortality and MACE (MACE: all-cause death, myocardial infarction, target-vessel revascularization and coronary artery bypass graft surgery) of each definition was calculated using ROC curves and AUCs. Results Data of 15,153 patients was available for final analysis. Rates of AKI were 12.1%, 3.2%, 8.1% and 3.9% according to the four definitions, respectively. The discriminant capacity of adverse outcomes was highest among those defined as AKI according to the third definition - an absolute elevation of ≥0.3 mg/dL in serum creatinine with an AUC of 0.82 (95% CI 0.80–0.84) for 30-day mortality (P value = 0.036) and an AUC of 0.78 (CI 0.76–0.79) for 30 days MACE. Conclusions An absolute elevation of ≥0.3 mg/dL in serum creatinine 48 hours post PCI predicts overall mortality and MACE most accurately. Funding Acknowledgement Type of funding sources: None.

Association between pre-participation characteristics and risk of injury amongst pre-professional dancers

Study designProspective Cohort Study. BackgroundFew investigations utilize evidence-informed pre-participation evaluation, inclusive injury definitions, and prospective surveillance to identify risk factors for dance-related injuries. ObjectiveTo evaluate pre-participation characteristics that may be associated with greater odds of dance-related musculoskeletal complaints in pre-professional dancers. MethodsFull-time pre-professional ballet [n = 85, 77 females, median (range) age 15-years (11–19)] and contemporary [n = 60, 58 females, 19-years (17–30)] dancers underwent pre-participation evaluation: baseline questionnaire, coping skills, body mass index, bone mineral density, ankle range-of-motion, active standing turnout, lumbopelvic control, and balance tests. Self-reported complaints (any physical problem making dance participation difficult, irrespective of medical attention or time-loss) were captured weekly via online questionnaires for one academic year. Self-reported musculoskeletal complaints were recorded weekly (yes/no). Potential risk factors were identified a-priori through systematic review. Associations between potential risk factors and musculoskeletal complaints were examined with generalized linear mixed method regression models. ResultsResponse rate was 99%, with 81% of dancers reporting at least one musculoskeletal complaint. Of 1521 complaints (19% first-time, 81% ongoing), the ankle (22%), knee (21%), and foot (12%) accounted for the majority. Injury history [odds ratio (OR) 7.37 (95% CI 3.41, 15.91)] and previous week's dance hours [OR 1.02 (1.01, 1.03)] were associated with dance-related musculoskeletal complaints. ConclusionsPrevalence of musculoskeletal complaints amongst pre-professional dancers is high and associated with injury history and training volume. Further understanding of the relationship between training load and injury is needed, with particular consideration of the dynamic and recursive nature of dance injury etiology. Level of EvidenceTherapy / Prevention, Aetiology / Harm, level 2b.

Intraoperative Neuromonitoring During Lateral Lumbar Interbody Fusion.

ObjectiveTo review the evidence for the use of electromyography (EMG), motor-evoked potentials (MEPs), and somatosensory-evoked potentials (SSEPs) intraoperative neuromonitoring (IONM) strategies during lateral lumbar interbody fusion (LLIF), as well as discuss the limitations associated with each technique. MethodsA comprehensive review of the literature and compilation of findings relating to clinical studies investigating the efficacy of EMG, MEP, SSEP, or combined IONM strategies during LLIF. ResultsThe evidence for the use of EMG is mixed with some studies demonstrating the efficacy of EMG in preventing postoperative neurologic injuries and other studies demonstrating a high rate of postoperative neurologic deficits with EMG monitoring. Multimodal IONM strategies utilizing MEPs or saphenous SSEPs to monitor the lumbar plexus may be promising strategies based on results from a limited number of studies. ConclusionThe use of traditional EMG during LLIF remains without consensus. There is a growing body of evidence utilizing multimodal IONM with MEPs or saphenous SSEPs demonstrating a possible decrease in postoperative neurologic injuries after LLIF. Future prospective studies, with clear definitions of neurologic injury, that evaluate different multimodal IONM strategies are needed to better assess the efficacy of IONM during LLIF.

A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention.

Background: Contrast-associated acute kidney injury (CA-AKI) is responsible for a substantial proportion of the observed mortality that occurs after percutaneous coronary intervention (PCI), particularly in elderly patients. However, there has been significant and debate over whether the optimal definition of CA-AKI persists over prolonged periods due to variations in the prevalence and effects on prognosis. In this study, we aimed to identify whether different definitions of CA-AKI exert differential impacts on long-term mortality when compared between elderly and non-elderly patients receiving elective PCI.Methods: We prospectively investigated 5,587 consenting patients undergoing elective PCI between January 2012 and December 2018. We considered two classical definitions of CA-AKI from the European Society of Urogenital Radiology (ESUR) and the Acute Kidney Injury Network (AKIN). Multivariable Cox regression analysis was used to investigate the association between CA-AKI and long-term mortality. We also performed interaction and stratified analyses according to age (≤75 or >75 years).Results: The incidence of CA-AKI according to the ESUR and AKIN definitions was 18.7 and 6.1%, respectively. After a median follow-up of 2.1 years, multivariable Cox regression analysis indicated that CA-AKI according to the AKIN definition was a risk factor for long-term mortality in the overall population [hazard ratio (HR) = 2.20; 95% confidential interval (CI): 1.51–3.22; p < 0.001]; however, this was not the case for the ESUR definition (HR = 1.27; 95% CI: 0.92–1.76; p = 0.153). Further interaction analysis identified a significant interaction between age and the ESUR definition (p = 0.040). Stratified analyses also found an association between the ESUR definition and long-term mortality in patients >75 years of age (p = 0.011), but not in patients ≤75 years of age (p = 0.657).Conclusion: As a stringent definition of CA-AKI, the AKIN definition was significantly associated with long-term mortality in both non-elderly and elderly patients. However, in elderly patients, the more lenient definition provided by the ESUR was also significantly correlated with long-term mortality, which could sensitively identify high-risk elderly patients and may provide a better alternative.

The LiverTox Paradox-Gaps between Promised Data and Reality Check.

The LiverTox database compiles cases of idiosyncratic drug-induced liver injury (iDILI) with the promised aims to help identify hepatotoxicants and provide evidence-based information on iDILI. Weaknesses of this approach include case selection merely based on published case number and not on a strong causality assessment method such as the Roussel Uclaf Causality Assessment Method (RUCAM). The aim of this analysis was to find out whether the promised aims have been achieved by comparison of current iDILI case data with those promised in 2012 in LiverTox. First, the LiverTox criteria of likelihood categories applied to iDILI cases were analyzed regarding robustness. Second, the quality was analyzed in LiverTox cases caused by 46 selected drugs implicated in iDILI. LiverTox included iDILI cases of insufficient quality because most promised details were not fulfilled: (1) Standard liver injury definition; (2) incomplete narratives or inaccurate for alternative causes; and (3) not a single case was assessed for causality with RUCAM, as promised. Instead, causality was arbitrarily judged on the iDILI case number presented in published reports with the same drug. All of these issues characterize the paradox of LiverTox, requiring changes in the method to improve data quality and database reliability. In conclusion, establishing LiverTox is recognized as a valuable effort, but the paradox due to weaknesses between promised data quality and actual data must be settled by substantial improvements, including, for instance, clear definition and identification of iDILI cases after evaluation with RUCAM to establish a robust causality grading.

Association Between Urine Output and Mortality in Critically Ill Patients: A Machine Learning Approach.

Current definitions of acute kidney injury use a urine output threshold of less than 0.5 mL/kg/hr, which have not been validated in the modern era. We aimed to determine the prognostic importance of urine output within the first 24 hours of admission to the ICU and to evaluate for variance between different admission diagnoses. Retrospective cohort study. One-hundred eighty-three ICUs throughout Australia and New Zealand from 2006 to 2016. Patients greater than or equal to 16 years old who were admitted with curative intent who did not regularly receive dialysis. ICU readmissions during the same hospital admission and patients transferred from an external ICU were excluded. One hundred and sixty-one thousand nine hundred forty patients were included with a mean urine output of 1.05 mL/kg/hr and an overall in-hospital mortality of 7.8%. A urine output less than 0.47 mL/kg/hr was associated with increased unadjusted in-hospital mortality, which varied with admission diagnosis. A machine learning model (extreme gradient boosting) was trained to predict in-hospital mortality and examine interactions between urine output and survival. Low urine output was most strongly associated with mortality in postoperative cardiovascular patients, nonoperative gastrointestinal admissions, nonoperative renal/genitourinary admissions, and patients with sepsis. Consistent with current definitions of acute kidney injury, a urine output threshold of less than 0.5 mL/kg/hr is modestly predictive of mortality in patients admitted to the ICU. The relative importance of urine output for predicting survival varies with admission diagnosis.

Definitions of acute renal dysfunction: an evolving clinical and biomarker paradigm.

The current definition and classification of acute kidney injury (AKI) has limitations and shortcomings, which impact clinical management. The aim of this review is to highlight recent advances in our understanding of the pathophysiology and epidemiology of AKI, which impacts management and offers opportunities. Kidney damage varies according to the type of primary insult, secondary effects and mitigating responses and leads to distinct molecular, cellular and functional changes. Different sub-types of AKI with varying clinical phenotypes, recovery patterns and responses to therapeutic interventions have been identified. New tools to identify and characterize these AKI sub-types are available with the potential opportunity for individualized timely aetiology-based management of AKI. The identification of different sub-phenotypes of AKI based on genetic, molecular, cellular and functional pathophysiological changes following potential nephrotoxic exposures is possible with new technologies. This offers opportunities for personalized management of AKI and supports the call for a refinement of the existing AKI criteria.

The Functional Movement Screen and Injury Risk in Sporting Populations: An Evidence-to-Practice Review

The Functional Movement Screen (FMS) is a functional test, which aims to identify dysfunctional, asymmetrical, and painful movements that could contribute to future injuries. Medical professionals can clinically use this information to implement appropriate, specialized prehabilitation training aimed at reducing the dysfunctional, asymmetrical, and painful movements, to help prevent injury risk. Research on this tool, however, has contradictory findings regarding FMS composite score and future risk of injury. It is unclear to what extent FMS can predict those with future injury risk, and whether there are factors, such as age, sex, or sport-type, which may be contributing to these varying findings. Therefore, the purpose of this review was to identify which factors, if any, may contribute to the contradictory findings regarding the relationship between FMS composite score and subsequent injury risk in physically active populations. The review aimed to include any study which performed an FMS test at baseline on physically active individuals competing at any level, and determined risk groups based on composite scores, using odds ratios, sensitivity, and specificity as outcome measures. Subgroups were assessed based on athlete age, sex, sport-type, injury definition and injury mechanism. Reviewed participants were split into two age groups, senior (18+ years old) and junior (9-18 years old) athletes. It was found that age, sex, and sport-type explained some of the variable findings in the literature, however, effect sizes were often small in magnitude. Functional Movement Screen composite scores and asymmetry seemed to be the most useful in estimating injury risk for senior athletes, as well as individuals participating in rugby, American football, and ice hockey. There were many gaps identified in the research that may help get a consensus on optimal populations and uses for FMS. Thus, we recommend utilizing appropriate clinical judgment when determining if FMS would be a beneficial tool for identifying those with higher injury risk at your clinical site and with your patient population.

Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection

BackgroundMyocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. MethodsConsecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. ResultsA total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. ConclusionElevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.

Upper Limb Injuries In Irish Schoolboy Rugby Union

School Rugby in many countries is representative of a highly competitive, elite game yet, there is limited rigorous research into the potential risk of injury to the upper limb. The nature of the Rugby tackle coupled with the physical and skeletal immaturity of school age players may predispose this cohort to an increased risk of severe injury to the upper limb. PURPOSE: To characterize the incidence, mechanism and severity of upper limb injuries in Irish Schoolboy Rugby Union players. METHODS: Twenty three school Rugby teams were recruited across two seasons 2018-2020, representing a total of 665 players aged 17-19 yrs. Nature, location, mechanism, occurrence, severity of injury and playing position were recorded by a nominated ‘injury recorder’ onto a web-based injury recording system (IRISWeb). Final injury diagnoses were verified at return to play. A 24 hr time loss injury definition was utilised (per World Rugby consensus) for injury incidence calculations. RESULTS: Seventy-five match injuries and seven training injuries involved the upper limb, representing 36% of total injuries. The match injury incidence of upper limb injuries was 19.4 per 1,000 player hours (h). The most commonly reported upper limb injury was shoulder dislocations (4.4/1,000 h), also accounting for the most burdensome (296 days absence/1,000 h). The tackle event was responsible for 76% of all match upper limb injuries, while 51% of match upper limb injuries were severe quantified by days absent from play (>28 days). Forwards (13/1000 h) suffered twice as many upper limb injuries as backs (6.5/1000 h), while the largest percentage (41%) of upper limb injuries were sustained in the 3rd quarter. CONCLUSIONS: This study reports a notably higher upper limb injury incidence in school Rugby compared to the adult amateur and professional game. Forwards were at a higher risk of sustaining an upper limb injury which may be attributed to the greater physical forces typically experienced by forwards compared to backs. The incidence of severe injuries so early in a playing career is of particular concern. Thus, future research into potential risk factors and mechanisms of upper limb injuries in School Rugby is warranted, particularly to inform the development of appropriate education and injury risk reduction programmes.

Optimization of Acute Kidney Injury (AKI) Time Definitions Using the Electronic Health Record: A First Step in Automating In-Hospital AKI Detection.

Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) definitions were evaluated for cases detected and their respective outcomes using expanded time windows to 168 h. AKI incidence and outcomes with expanded time intervals were identified in the electronic health records (EHRs) from 126,367 unique adult hospital admissions (2012–2014) and evaluated using multivariable logistic regression with bootstrap sampling. The incidence of AKI detected was 7.4% (n = 9357) using a 24-h time window for both serum creatinine (SCr) criterion 1a (≥0.30 mg/dL) and 1b (≥50%) increases from index SCr, with additional cases of AKI identified: 6963 from 24–48 h.; 2509 for criterion 1b from 48 h to 7 days; 3004 cases (expansion of criterion 1a and 1b from 48 to 168 h). Compared to patients without AKI, adjusted hospital days increased if AKI (criterion 1a and 1b) was observed using a 24-h observation window (5.5 days), 48-h expansion (3.4 days), 48-h to 7-day expansion (6.5 days), and 168-h expansion (3.9 days); all are p < 0.001. Similarly, the adjusted risk of in-hospital death increased if AKI was detected using a 24-h observation window (odds ratio (OR) = 16.9), 48-h expansion (OR = 5.5), 48-h to 7-day expansion (OR = 4.2), and 168-h expansion (OR = 1.6); all are p ≤ 0.01. Expanding the time windows for both AKI SCr criteria 1a and 1b standardizes and facilitates EHR AKI detection, while identifying additional clinically relevant cases of in-hospital AKI.

Developing an AKI Consensus Definition for Database Research: Findings From a Scoping Review and Expert Opinion Using a Delphi Process

The KDIGO (Kidney Disease: Improving Global Outcomes) definition of acute kidney injury (AKI) is frequently used in studies to examine the epidemiology of AKI. This definition is variably interpreted and applied to routinely collected health care data. The aim of this study was to examine this variation and to achieve consensus in how AKI should be defined for research using routinely collected health care data. Scoping review via searching Medline and EMBASE for studies using health care data to examine AKI by using the KDIGO creatinine-based definition. An international panel of experts formed to participate in a modified Delphi process to attempt to generate consensus about how AKI should be defined when using routinely collected laboratory data. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews was followed. For the Delphi process, 2 rounds of questions were distributed via internet-based questionnaires to all participants with a prespecified cutoff of 75% agreement used to define consensus. The scoping review found 174 studies that met the inclusion criteria. The KDIGO definition was inconsistently applied, and the methods for application were poorly described. We found 58 (33%) of papers did not provide a definition of how the baseline creatinine value was determined, and only 34 (20%) defined recovery of kidney function. Of 55 invitees to the Delphi process, 35 respondents participated in round 1, and 25 participated in round 2. Some consensus was achieved in areas related to how to define the baseline creatinine value, which patients should be excluded from analysis of routinely collected laboratory data, and how persistent chronic kidney disease or nonrecovery of AKI should be defined. The Delphi panel members predominantly came from the United Kingdom, the United States, and Canada, and there were low response rates for some questions in round1. The current methods for defining AKI using routinely collected data are inconsistent and poorly described in the available literature. Experts could not achieve consensus for many aspects of defining AKI and describing its sequelae. The KDIGO guidelines should be extended to include a standardized definition for how AKI should be defined when using routinely collected data.

Discussions on the causes and evaluation of mangled injury and the optimization of its repair strategy

Many reasons can cause damage to a certain part of body, with the damaged tissue showing some corresponding characteristics. There are many uncertainties in the repair of damaged body parts, making it difficult to achieve the ideal function and appearance. In recent years, the repair of mangled injury has made significant progress, but it still faces many challenges. Based on the clinical practice and the current progress in the assessment and repair of mangled injury, this paper summarizes the causes, clinical features, injury assessment, treatment options, repair measures, and the risks of limb salvage, and then puts forward some personal opinions on the definition of mangled injury and treatment strategy optimization for reference.

The Occupational Military Neuromusculoskeletal Injury Matrix.

Neuromusculoskeletal injuries (NMSKIs) are the primary cause of ambulatory visits, lost duty days, and disability discharges in the U.S. Military. Methods for accurately grouping injury diagnoses are required to allow for surveillance and research identifying risk factors and prevention strategies. The CDC method of grouping these diagnoses includes only the S and T codes (Injury, poisoning, and certain other consequences of external causes) from the ICD-10-CM. However, this does not include the majority of the NMSKI depleting soldier readiness; the M (Disease of the musculoskeletal system and connective tissue) and G (Diseases of the nervous system) codes should be included as these also contain injuries. The goal was to develop a new matrix that would comprehensively capture all NMSKIs experienced by military personnel. This paper details the development of the Occupational Military Neuromusculoskeletal Injury (OMNI) Matrix and characterizes the number and rates of active duty U.S. Army injuries as measured by the OMNI compared to other matrices. A team of researchers including physical therapists, physician assistants, occupational therapists, physicians, and epidemiologists developed the OMNI. The OMNI utilizes the commonly accepted injury definition inclusive of any anatomical complaint resulting in pain or dysfunction and categorizes injuries from the G, M, S, and T codes. The OMNI follows the CDC's matrix structure with three body region levels, each becoming more specific, and adds two levels called Description of the Injury. Additionally, the OMNI categorizes injuries as Injury Type (Acute, Overuse, Either, or Not Applicable), NMSKI-Type (NMSKI, NMSKI that could be caused by occupational/training tasks, and not an NMSKI), and a miscellaneous category that demarks injuries as Superficial, Blood Vessels, and/or Internal Organs. The different grouping methods in the OMNI provide standardization for many possible injury case definitions. The OMNI allows these injury categories to be included/excluded in a standardized fashion to meet the researchers' scientific questions. To enumerate the number of NMSKI that would be captured by the available matrices, the OMNI, the CDC's matrix, and the U.S. Army Public Health Center's (APHC) Taxonomy of Injuries were applied to active duty Army outpatient population data and all incident NMSKI diagnostic codes entered in electronic medical provider encounters for calendar years 2017 and 2018. Using the OMNI resulted in the capture of over 800,000 more injuries than the CDC's matrix and over 200,000 more than the APHC Taxonomy. The NMSKI rate utilizing the OMNI was 193 per 100 soldier-years in 2017 (892,780 NMSKI) compared to 23 per 100 soldier-years for the CDC's matrix, and 141 per 100 soldier-years for the APHC Taxonomy. The OMNI provides an updated standardized method of assessing injuries, particularly in occupational military injury research, that can be utilized for Military Performance Division of injury across many countries and still allow for replication of methods and comparison of results. Additionally, the OMNI has the capacity to capture a greater burden of injury beyond what is captured by other available matrices.

Advances in management of hepatorenal syndrome.

Hepatorenal syndrome (HRS) is encountered frequently in patients with end-stage liver disease and remains an important cause of morbidity and mortality in this patient population. This review will focus and provide updates on pathophysiology, assessment of kidney function, new definitions, and treatment and prevention of HRS. Pathophysiology of HRS has been elucidated more recently and in addition to hemodynamic changes, the role of systemic inflammatory response contributes significantly to this process. Assessment of kidney function in patients with liver cirrhosis remains challenging. Novel glomerular filtration rate equations have been developed in patients with liver disease to better estimate kidney function and changes made in the definition of acute kidney injury (AKI), which are more aligned with KDIGO criteria for AKI. Vasoconstrictors, especially terlipressin, along with albumin remain the mainstay of pharmacological treatment of HRS-AKI. Biomarkers have been useful in differentiating ATN from HRS at an early stage. HRS remains a significant cause of morbidity and mortality for patients with end-stage liver disease. Newer understanding of mechanisms in development and pathophysiology of HRS have helped with elucidation of the disease process.

Direct Measurement of Creatinine Clearance over a Short Interval in Intensive Care Settings.

BackgroundThe definition of acute kidney injury (AKI), based on serum creatinine and urine output, bears significant limitations in intensive care units (ICUs). Serum creatinine has significant lag-time as it needs to be accumulated and stabilized at a new level whereas urine output is affected by diuresis, antidiuresis, and antinatriuresis. Direct measurement of creatinine clearance (CrCldirect = urine creatinine × urine flow rate/serum creatinine) over a short interval (3–6 hours) was explored to identify patients with AKI.Materials and methodsWe reanalyzed a previous published dataset. We included 11 patients who had serial daily urine collections over 0 to 3 days of stay in ICU and baseline (day -1) serum creatinine levels.ResultThe ratio of CrCldirect on day 0 to baseline creatinine clearance predicted the progression of AKI over the subsequent 1 to 3 days of ICU stay [area under receiver operating characteristic curve = 0.933 and 95% confidence interval (CI) = 0.780–1.000].DiscussionCrCldirect over a short interval may be an alternative marker of kidney function. Future studies may explore its use to identify patients with AKI who may benefit from early renal replacement therapy.How to cite this articleLaw LSC, Lo EAG, Yeoh SF. Direct Measurement of Creatinine Clearance over a Short Interval in Intensive Care Settings. Indian J Crit Care Med 2021;25(7):800–802.

Acute kidney injury and continuous renal replacement therapy: A nursing perspective for my shift today in the intensive care unit.

Handover, clinical discussion, and care for patients in the Intensive Care Unit (ICU) require visual cues to a verbal "story" in an attempt to quickly understand the patient status. Continuous renal replacement therapy (CRRT) is often associated with sepsis or a toxic cause and "kidney attack" not apparent to the patient; "silent" with no pain, discomfort, or vital sign changes initially. Language, terminology, and definitions for this acute kidney injury (AKI) are a graded classification with guidelines. CRRT and dialysis techniques use the physiological principles of diffusion and or convection for solute removal providing a replacement for the basic kidney functions to sustain life until function returns. When to stop CRRT is based on clinical assessment of the patient overall status and urine production re-starting. The medical treatment is focused on the key interventions of resuscitation, remove the cause, support with CRRT or dialysis and monitor for recovery of function. CRRT requires a multidisciplinary team and quality process, local policies, education, and competency pathways to promote best outcomes and efficacy.

Abstracts of the 30th Annual Pediatric Pharmacy Association (PPA) Meeting April 21 to 25, 2021

Abstracts of the 30th Annual Pediatric Pharmacy Association (PPA) Meeting April 21 to 25, 2021

A Cross Sectional Survey of International Horse-Racing Authorities on Injury Data Collection and Reporting Practices For Professional Jockeys

Jockey injuries are common in professional horse-racing and can result in life-threatening or career-ending outcomes. Robust injury data are essential to understand the circumstances of injury occurrence and ultimately identify prevention opportunities. This study aimed to identify jockey injury surveillance practices of international horse-racing authorities (HRAs) and the specific data items collected and reported by each HRA. A cross-sectional survey of representatives (e.g. Chief Medical Officer) from international HRAs was conducted. An online and paper questionnaire was designed comprised of 32 questions. Questions considered the barriers and facilitators to data collection within each HRA, and where available, what data were collected and reported by HRAs. Representatives from 15 international racing jurisdictions were included, of which 12 reported collection of race day injuries or falls, using varied definitions of medical attention and time loss. Six HRAs did not have a definition for a jockey injury, and eight HRAs had no parameters for describing injury severity. Race day exposure was collected by two HRAs. Results were commonly presented by HRAs as the number of injuries (n = 9/15) or proportion of injured jockeys (n = 6/15). The lack of a designated role for collection, collation and reporting of data was the main barrier for injury surveillance. Twelve HRAs agreed that mandatory collection would be a strong facilitator to improving practice. Enhancement and standardization of international jockey injury surveillance is required to move forward with evidence informed prevention. Concurrent investigation of how reporting practices can be best supported within existing HRA structures is recommended.

Injury Characteristics in Pre-Professional Modern Dancers - Prospective Study of Differences Due to Sex, Training Year, and External Causal Mechanisms.

As efforts to improve surveillance and decrease injury rates in pre-professional dancer's progress, it is important to identify injury patterns and contexts. The aim of this study was to examine sex, training-based injury characteristics, and external causal mechanisms of injury among pre-professional modern dancers. Using a prospective cohort study design, 180 dancers (females = 140, males = 40, age 18.15 ± 0.68 years) were screened at freshman enrollment and followed for the 4 years of their college training. Injury, defined as medical attention injury (MAI) or time-loss injury (TLI), was classified by diagnosis, tissue category, body region, and incident event (action and dance environment). Negative binomial log-linear analyses evaluated injury rates by sex and training year. Multinomial regression compared injury characteristics and incident events, p < 0.05. Sex characteristics differed in height, mass, years of dance training, and previous injury (p ≤ 0.037). Total, traumatic, and overuse injuries per 1,000 hours decreased across training years for both injury definitions, p < 0.001, with no sex differences. In year 1, dancers were more likely to sustain muscle, tendon, and bone injuries (p ≤ 0.008) and to injure leg, ankle, foot, and hip, thigh, and knee regions (p ≤ 0.001). Jumping and running was the most commonly cited action mechanism in MAI and TLI in both sexes. Females were more likely to report alignment in MAI and TLI and jumping and running in TLI. Males were 1.4 times more likely to sustain muscle or tendon MAI (p = 0.006), while reporting partnering in MAI. Ballet class and rehearsals accounted for the majority of attributed dance environment mechanisms in MAI and TLI. Injury rates in pre-professional modern dancers decreased with training. Understanding sex, training, and external causal mechanisms will allow teachers to tailor programs to reduce injuries during training.