British journal of neurosurgery
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Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. ⋯ The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.
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Meta Analysis Comparative Study
Comparison of early and late decompressive craniectomy on the long-term outcome in patients with moderate and severe traumatic brain injury: a meta-analysis.
Several studies have searched whether early decompressive craniectomy (DC) can improve the long-term outcome of patients with moderate and severe traumatic brain injury (TBI). However, the effects of early DC remain unclear. The purpose of this meta-analysis was to assess whether early DC (time to surgery after injury <24 h) is better than late DC (>24 h) after moderate and severe TBI. ⋯ Bilateral pupil abnormality is positive related to unfavourable outcome and mortality in the patients following DC after moderate and severe TBI. Early DC may be more helpful to improve the long-term outcome of patients with refractory raised intracranial cerebral pressure after moderate and severe TBI. However, more RCTs with better control of patients with bilateral pupil abnormality divided into the early and late groups are needed in the future.
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Observational Study
Cranioplasty outcomes and associated complications: A single-centre observational study.
The resurgence of decompressive craniectomy has led to recent published reviews of the safety of cranioplasties. To date there is a wide range of reported mortality and morbidity. This observational study reports the outcomes of the cranioplasty operations from a single centre and evaluates the factors involved in their management. ⋯ Some potentially preventable complications have been addressed with a resulting rate of complications lower than other published reports. We use two standard adjuncts: the presence of a senior surgeon and strict antimicrobial regimens. We believe that our results could be transferrable to other units by following similar guidelines.
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Comparative Study
A comparison of the Full Outline of UnResponsiveness (FOUR) score and Glasgow Coma Score (GCS) in predictive modelling in traumatic brain injury.
To compare the performance of multivariate predictive models incorporating either the Full Outline of UnResponsiveness (FOUR) score or Glasgow Coma Score (GCS) in order to test whether substituting GCS with the FOUR score in predictive models for outcome in patients after TBI is beneficial. ⋯ Results showed that FOUR score and GCS perform equally well in multivariate predictive modelling in TBI.
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Intra-cranial and spinal surgery is associated with significant morbidity (23.6% and 11.2%) (5) . Fully informed consent, shared decision-making and optimal peri-operative care are essential to ensure excellent surgical outcome. There is evidence to support the use of formal pre-operative risk assessment to facilitate this in non-cardiac surgery but little is published on best practice for neurosurgery. Our aim was to establish current practice in pre-operative risk assessment at UK Neurosciences centres. ⋯ Our survey is the first of its kind in the UK for neurosciences. As expected, formal risk assessment and multi-disciplinary team discussion is not routine. Neurosurgery has a high risk of morbidity and mortality, and pre-operative risk assessment should therefore be considered in line with national recommendations. Further work is required to establish best practice in neurosurgery to ensure that patients are appropriately consented, and to improve standards of care and support surgical outcome data.