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Holton P, Zolnourian A, Bulters D. Time to evacuation of acute subdural and extradural haematoma: prospective study before and after implementation of a major trauma centre. Br J Neurosurg 2023:1-8. [PMID: 36750795 DOI: 10.1080/02688697.2023.2173723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 02/09/2023]
Abstract
Purpose: Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network.Methods: Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included.Results: The median time (IQR) for decompression was 4.8h (3.9-6.6) in 2006-7 and 4.4h (3.4-5.9) in 2014-16, p = 0.386. The proportion treated within 4 hours was 32% in 2006-7, and 33% in 2014-16 (p = 1.000). Analysis showed a decrease in time for CT scan (p = 0.01) and acceptance by neurosurgery (p < 0.001). There were increases in time for transferring to hospital (p = 0.005), awaiting operating theatre (p = 0.005), and operative time (p = 0.018).Conclusions: Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven't. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult.
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Affiliation(s)
- Patrick Holton
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ardalan Zolnourian
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Myers M, Hall S, Sadek AR, Dare C, Griffith C, Shenouda E, Nader-Sepahi A. Differences in management of isolated spinal fractures between neurosurgery and orthopaedics: a 6-year retrospective study. Br J Neurosurg 2020; 35:68-72. [PMID: 32441143 DOI: 10.1080/02688697.2020.1763256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The acute management of spinal fractures is traditionally split between neurosurgeons and orthopaedic surgeons and the specialities have varying approaches to management. This study investigates differences between neurosurgeons and spinal orthopaedic surgeons in the management of spinal fractures at a single trauma centre in the United Kingdom. METHODS A retrospective study at a single trauma centre of patients identified using the Trauma Audit and Research Network (TARN). Case notes and radiological investigations were reviewed for demographics, fracture classification, clinical management and outcomes. Polytrauma cases and patients managed by non-neurosurgical/orthopaedic specialties were excluded. RESULTS A total of 465 patients were included in this study (neurosurgery n = 266, orthopaedics n = 199). There were no significant differences between groups for age, gender, Charlson co-morbidity score or distribution of fractures using the AO spine classification. Patients admitted and managed under the orthopaedic surgeons were more likely to undergo a surgical procedure when compared to those admitted under the neurosurgeons (n = 71; 35.7% vs n = 71; 26.8%, p = 0.042, OR 1.56 95%CI 1.056 to 2.31). The median overall length of stay was 8 days and there was no significant difference between teams; however, the neurosurgical cohort were more likely to be admitted to an intensive care unit (24.3% vs 16.2%, p = 0.04). CONCLUSION This study is the first in the United Kingdom to compare neurosurgical and orthopaedic teams in their management of spinal fractures. It demonstrates that differences may exist both in operating rates and outcomes.
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Affiliation(s)
- Matthew Myers
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Samuel Hall
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Ahmed-Ramadan Sadek
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Dare
- Department of Trauma and Orthopaediacs, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Colin Griffith
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Emad Shenouda
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Ali Nader-Sepahi
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain and Northern Ireland.,Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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