Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation

Holmes, Michael W.; Rathbone, John; Littlewood, Chris; Rawdin, Andrew; Stevenson, Matt; Stevens, John; Archer, Rachel; Evans, Peter William; Wang, Jenny

doi:10.3310/hta18160

Cited by 36 publications

(35 citation statements)

References 10 publications

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“…It is also noteworthy that not all documents identified from "policy sources" should be considered "policy documents, " under any conventional definition. Four citing "policy documents" in this sample were clearly standard peer-reviewed journal articles, but were categorized as policy documents citing the research articles by Moreno-Serra, 2012 (Hendriks et al, 2014) Lomas, Woodward, 2009(MacDicken, 2015, and Brazier, 2005 (Armstrong et al, 2013;Holmes et al, 2014). The quality of ascribed policy sources might potentially be an issue of concern, very much like that of predatory journals where argument can ensue as to the authenticity and credibility of a journal (Cartwright, 2016).…”

Section: Discussion Identification Of Relevant Policy Documents By Almentioning

confidence: 99%

What Can Altmetric.com Tell Us About Policy Citations of Research? An Analysis of Altmetric.com Data for Research Articles from the University of Sheffield

Tattersall

2018

Front. Res. Metr. Anal.

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Section: Discussion Identification Of Relevant Policy Documents By Almentioning

confidence: 99%

What Can Altmetric.com Tell Us About Policy Citations of Research? An Analysis of Altmetric.com Data for Research Articles from the University of Sheffield

Tattersall

2018

Front. Res. Metr. Anal.

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“…Although ECG, Holter‐ECG, continuous heart rhythm monitoring, and the implantation of cardiac event recorders are able to identify atrial fibrillation as sources of cardioembolic stroke, structural diseases of the heart or the aorta may be missed with this approach. Echocardiography is considered the diagnostic gold standard for detection of these disorders …”

Section: Discussionmentioning

confidence: 99%

“…Echocardiography is often performed as part of the diagnostic workup in patients with acute cerebral ischemia . Compared to transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) is more sensitive for the detection of cardioembolic sources .…”

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confidence: 99%

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Diagnostic Impact of Transesophageal Echocardiography in Patients with Acute Cerebral Ischemia

et al. 2016

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“…The theoretical basis of this method is described in detail in the literature [86][87][88] and examples of its use in HTAs are also available. 89,90 In common with previous applications of this method, generalised additive models were used for non-parametric regression, 91 implemented in R (The R Foundation for Statistical Computing, Vienna, Austria) using the 'mcgv package' and a 'n = 5000' PSA sample. [92][93][94] Individual EVPPI was initially calculated for each model input separately.…”

Section: Expected Value Of Information Methodologymentioning

confidence: 99%

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

Lecky

Russell

Fuller

et al. 2016

Health Technol Assess

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BackgroundReconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence – with regard to ‘early neurosurgery’ in this cohort – which we sought to address.MethodsPilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). Primary outcomes: recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. ‘Open-label’ secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions.ResultsOverall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%;p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury.ConclusionsCurrent NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating ‘early neurosurgery through bypass’ and address the challenge of reliable TBI diagnosis at the scene of injury.Trial registrationCurrent Controlled Trials ISRCTN68087745.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.

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Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation

Cited by 36 publications

References 10 publications

What Can Altmetric.com Tell Us About Policy Citations of Research? An Analysis of Altmetric.com Data for Research Articles from the University of Sheffield

What Can Altmetric.com Tell Us About Policy Citations of Research? An Analysis of Altmetric.com Data for Research Articles from the University of Sheffield

Diagnostic Impact of Transesophageal Echocardiography in Patients with Acute Cerebral Ischemia

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

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