Rationalising neurosurgical head injury referrals: development and validation of the Liverpool Head Injury Tomography Score (Liverpool HITS) for mild TBI

Gillespie, Conor S; McLeavy, C.M.; Islim, Abdurrahman I; Prescott, Sarah; McMahon, Catherine

doi:10.1080/02688697.2019.1710825

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…Our findings elsewhere indicate the majority of patient HCP interactions in CSDH, are by HCP without a specialist interest in CSDH [ 31 ]. For example, most patients present with CSDH at non-specialist hospitals without access to a neurosurgical unit and are referred to a tertiary external neurosurgery unit (NSU) for advice, guidance, and potential transfer [ 10 ]. Not only do they often provide the direct and long-term care, but they will also facilitate shared decision making.…”

Section: Discussionmentioning

confidence: 99%

Is information provided within chronic subdural haematoma education resources adequate? A scoping review

et al. 2023

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Background Chronic subdural haematoma (CSDH) is becoming increasingly prevalent, due to an aging population with increasing risk factors. Due to its variable disease course and high morbidity, patient centred care and shared decision making are essential. However, its occurrence in frail populations, remote from specialist neurosurgeons who currently triage treatment decisions, challenges this. Education is an important component of enabling shared decisions. This should be targeted to avoid information overload. However, it is unknown what this should be. Objectives Our objectives were to conduct analysis of the content of existing CSDH educational materials, to inform the development of patient and relative educational resources to facilitate shared decision making. Methods A literature search was conducted (July 2021) of MEDLINE, Embase and grey literature, for all self-specified resources on CSDH education, and narrative reviews. Resources were classified into a hierarchical framework using inductive thematic analysis into 8 core domains: Aetiology, epidemiology and pathophysiology; natural history and risk factors; symptoms; diagnosis; surgical management; nonsurgical management; complications and recurrence; and outcomes. Domain provision was summarised using descriptive statistics and Chi-squared tests. Results 56 information resources were identified. 30 (54%) were resources designed for healthcare professionals (HCPs), and 26 (46%) were patient-orientated resources. 45 (80%) were specific to CSDH, 11 (20%) covered head injury, and 10 (18%) referenced both acute and chronic SDH. Of 8 core domains, the most reported were aetiology, epidemiology and pathophysiology (80%, n = 45) and surgical management (77%, n = 43). Patient orientated resources were more likely to provide information on symptoms (73% vs 13%, p<0.001); and diagnosis (62% vs 10%, p<0.001) when compared to HCP resources. Healthcare professional orientated resources were more likely to provide information on nonsurgical management (63% vs 35%, p = 0.032), and complications/recurrence (83% vs 42%, p = 0.001). Conclusion The content of educational resources is varied, even amongst those intended for the same audience. These discrepancies indicate an uncertain educational need, that will need to be resolved in order to better support effective shared decision making. The taxonomy created can inform future qualitative studies.

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Section: Discussionmentioning

confidence: 99%

Is information provided within chronic subdural haematoma education resources adequate? A scoping review

et al. 2023

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“…Given the limited access to neurosurgical expertise in most countries, generalists are expected to care for an expanding volume of both pre-operative, post-operative and non-operative neurosurgical patients; for example, a recent study of traumatic brain injury patients in the UK revealed that only 17% of patients referred to the neurosurgical center were transferred for specialist management. [26][27][28] This can be particularly true in LMICs where neurosurgical provision is scarce. 4,5 Estimates show that the poorest third of the world's population receive only 3•5% of all major surgeries undertaken worldwide.…”

Section: Importance Of Exposure To Neurosurgical Education In Medical Schoolmentioning

confidence: 99%

133 Neurosurgery Education in The Medical School Curriculum: A Scoping Review

Lee

Zhang

Alamri

et al. 2021

British Journal of Surgery

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Introduction Worldwide, there is no specific medical school curriculum in neurosurgery despite a high burden of neurosurgical disease that is often assessed, investigated and managed by generalists. This scoping review was carried out to map available evidence pertaining to the provision of neurosurgery education in the medical school curriculum across the world. Method This review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Results Ten studies were included. Six were from the United Kingdom, two from the United States, and one each from Canada and Ireland. Two studies evaluated perceptions of both medical students and practicing clinicians, five studies evaluated the perceptions of medical students and three studies reported perceptions of clinicians only. Three main themes were identified. Neurosurgery was perceived as an important part of the general medical student curriculum. Exposure to neurosurgery teaching was varied but when received, deemed useful and students were keen to receive more. Interest in a neurosurgical career amongst medical students was high. Conclusions There is a lack of a specialty-specific medical school curriculum and variability of medical students’ exposure to neurosurgery teaching exists. Our findings highlight the need to systematically assess specialty-specific teaching and determine adequacy.

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“…In addition, patients with traumatic brain injury are frequently complicated with hyponatremia, which may trigger neurological dysfunction or even death and disability in severe cases due to damages to the patients' nerve cells. It has been found clinically that the understanding of the causes of traumatic brain injury complicated by hyponatremia serves to a better prognosis of patients and drives down mortality (9)(10)(11). In addition, the clinical treatment of this disease is mainly gastrointestinal sodium supplementation, which has obvious limitations and poor efficacy (12), so it is also urgent to explore more ideal treatment methods.…”

Section: Introductionmentioning

confidence: 99%

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia

Zhang

Wei²,

Dou³

et al. 2022

Front. Surg.

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ObjectiveTo explore the etiology and diagnosis and treatment strategy of traumatic brain injury complicated with hyponatremia.Methods90 patients with traumatic brain injury admitted to our hospital from December 2019 to December 2020 were retrospectively analyzed and divided into hyponatremic group (50 patients) and non-hyponatremic group (40 patients) according to the patients' concomitant hyponatremia, and the clinical data of the two groups were collected and compared. In addition, patients in the hyponatremia group were divided into a control group and an experimental group of 25 patients each according to their order of admission, with the control group receiving conventional treatment and the experimental group using continuous renal replacement therapy (CRRT). Hemodynamic indices, mortality and serum neuron-specific enolase (NSE) indices before and after treatment were compared between the control and experimental groups. The Glasgow coma scale (GCS) was used to assess the degree of coma before and after the treatment in the two groups, and the patients' disease status was assessed using the Acute Physiological and Chronic Health Evaluation Scoring System (APACHE II).ResultsThe etiology of traumatic brain injury complicated with hyponatremia is related to the degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture (P < 0.05). After the treatment, the hemodynamic indexes, APACHE II scores, death rate, and NSE levels of the experimental group were significantly lower than those of the control group (P < 0.001); The experimental group yielded remarkably higher GAC scores as compared to the control group (P < 0.001).ConclusionThe degree of brain injury, ventricular hemorrhage, cerebral edema, and skull base fracture were considered to be the main factors for traumatic brain injury complicated with hyponatremia. Continuous renal replacement therapy can effectively improve the clinical indicators of the patients with a promising curative effect, which merits promotion and application.

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Rationalising neurosurgical head injury referrals: development and validation of the Liverpool Head Injury Tomography Score (Liverpool HITS) for mild TBI

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 5 publications

References 36 publications

Is information provided within chronic subdural haematoma education resources adequate? A scoping review

Is information provided within chronic subdural haematoma education resources adequate? A scoping review

133 Neurosurgery Education in The Medical School Curriculum: A Scoping Review

Etiology Analysis and Diagnosis and Treatment Strategy of Traumatic Brain Injury Complicated With Hyponatremia

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