Aim: The epidemiology of acute kidney injury (AKI) diagnosed in the emergency department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI).Methods: A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016. In total, 20 421 adult patients attended the ED and had a serum creatinine measurement. The incident ED-AKI patient episodes were compared with a randomly selected cohort of non-AKI ED patients.Results: A total of 572 patients had confirmed eAlert ED-AKI (548 incident cases), incidence 2.8% (of all ED attendances). ED-AKI was associated with a 24.4% in-patient mortality (non-AKI 3.2%, P < .001) of which 22.3% of deaths occurred within 24 hours and 58% within 7 days. Progression of the admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared with a 21.4% mortality in those who did not progress (P < .001). In multivariate analysis, ED-AKI was an independent risk for mortality (hazard ratio, 6.293; 95% confidence interval, 1.887-20.790, P = .003). For those discharged from hospital, 20.4% of ED-AKI patients re-attend for acute assessment within 30-days post-discharge (non-AKI 7.6%, P < .001). At 90-days post-discharge, 10.0% of ED-AKI patients died (non-AKI 1.4%, P < .001). Twelve months post-discharge 17.8% of ED-AKI patients developed CKD progression or de-novo CKD (non-AKI 6.0%). Conclusion:The ED-AKI is an independent predictor of death. Mortality is predominantly in the early stages of hospital admission, but for those who survive to discharge have significant long-term morbidity and mortality. K E Y W O R D S acute kidney injury, emergency departments, epidemiology Acute kidney injury (AKI) is a common medical emergency, complicating 6% to 18% of all hospital admissions.

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Specialist in acute care might facilitate discharge in a higher proportion of patients.

Objective Wrist fractures constitute the most frequently occurring upper limb fracture. Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which patients are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarize effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation. Methods A comprehensive search of 7 databases (including MEDLINE, EMBASE, and the Physiotherapy Evidence Database [PEDro]) was performed for randomized controlled trials involving adults &gt;50 years of age who sustained wrist fracture and had received 1 or more conservative treatments (eg, exercise/manual therapy, lifestyle, diet, or other advice). Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers. Results of included trials were summarized in a narrative synthesis. Results A total of 3225 titles were screened, and 21 studies satisfying all eligibility criteria were reviewed. Over half of included studies (n = 12) comprised physical therapist and/or occupational therapist interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1 year after wrist fracture. However, effects were small, and home exercises were found to be comparable to physical therapist–led exercise therapy. Evidence for the effects of other nonexercised therapy (including electrotherapy, whirlpool) was equivocal and limited to the short term (&lt; 3 months). Only 2 studies explored potential moderators, and they did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation. Conclusion Effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on subgroup effects with sufficient precision. To aid clinical practice and optimize effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analyses using individual participant data. Impact. Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Effectiveness of current rehabilitation protocols after wrist fracture is limited and may be due to insufficient targeting of specific rehabilitation to patients who are likely to benefit most. However, evidence for effect moderators is lacking within currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in patients with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.