Submitted Ideas - Project Call 2021
Thank you to those who have submitted a project idea to this year's BNTRC Project Call. Below are the submitted ideas arranged (top to bottom) in alphabetical order of the titles.
Please vote in the link here for your top two choices. Closing date for the vote is 17th October 2021 23:59.
Advice on re-initiating anti-coagulants/anti-platelets post traumatic haemorrhage
P: Patients over 65 on anticoagulants/antiplatelets with conservatively managed traumatic intracranial haemorrhage. I: development of scoring matrix to help standardise and guide advice on restarting anticoagulants/antiplatelets, incl advice on the need for re-imaging. C: Unit/consultant based led decision, that are typically based on anecdotal experience, compared to evidence based and standardised guidelines. O: Consistency and confidence in evidence based advice, which is standardised across the country.
Audit of conservatively managed patients with intracranial bleed due to trauma
P: Patients referred to neurosurgery with any intracranial bleed due to trauma but advised for observation only. I: Type of intracranial bleed. C: Age, sex, mechanism of injury, GCS, co-morbidities. O: Requiring neurosurgical admission, seizures, antithrombotic management, duration of hospital stay.
Audit of surgical procedures for treatment-resistant trigeminal neuralgia (TGN)
P: All adult patients underwent any surgical procedure for TGN. I: Timing of first intervention, type of first intervention. C: Pain medications, age, sex, neurovascular conflict. O: 1-year pain on VAS as primary outcome. Others: 6-month pain, requirement of medications, surgical complications.
Comparing frailty scores for stratifying risk in neurosurgical patients – a prospective cohort study
P: All adult patients aged ≥60 undergoing cranial operations excluding surgery for major trauma or for congenital malformation. I: Exposures include Clinical Frailty Scale, modified 5-item frailty index, and Hospital Frailty Risk Score. C: Confounders include underlying pathology, type of operation, length of operation, occurrence of complications. O: Primary: 90-day modified Rankin Scale. Secondary: 90-day mortality, 6-month 36-item short form survey, 6-month mortality, length of hospital stay.
Identifying predictors of metastatic disease for patients with newly diagnosed brain lesions to guide CTChest/Abd/Pel and CTChest selection.
P: Patients with newly diagnosed brain lesions on CTH. Identify through local MDTs. I: Currently no guidelines on when to do screening CTCAP. To collect patient and imaging features that could predict metastases. C: Patients who had a CTCAP as a result of a CTH finding but did not have metastatic disease vs those who did have metastatic disease. O: Metastatic disease as diagnosed on CTCAP or MDT outcome or histology. Perform multiple regression to identify predictors from CT head.
National audit of thoracolumbar injury management
P: All adults with traumatic thoracolumbar injury referred to neurosurgical or spinal units. I: Main exposures: TLICS classification and operative approach (if surgically managed). Audit standard = NICE NG 41. C: Confoundings: cervical spine injuries, other injuries, co-morbidities, age. O: Primary: 6-month ASIA; secondary: 1-year Functional Independence Measure, 1-year pain VAS, 1-year ASIA
Optimising investigation of possible shunt dysfunction: a national audit
P: All paediatric and adult patients with any form of shunt referred to neurosurgery for possible shunt dysfunction. I: Initial management (bloods, imaging, fasting instructions) before referral. C: Type of shunt, time since shunt insertion, age, underlying cause. O: Time from referral to discharge. Other outcomes: proportion without shunt dysfunction, incomplete initial investigations, operative procedures.
Pharmacological VTE prophylaxis after elective cranial surgery: a cohort study determining optimal time of initiation, regimen and duration (PRECISE)
P: Adult patients undergoing elective cranial surgery. Patients with coagulopathy, previous VTE excluded. Identify high-risk groups e.g. tumours. I: VTE prophylaxis factors: anticoagulant regimen, duration and pre-op use, mechanical IPC use, patient and surgical factors. C: This would be a prospective observational cohort study and rare event data analysis without a control arm. O: clinical = return to theatre for clot evacuation, Well’s score, mortality; radiological = post-op imaging rebleed or VTE.
Prospective national audit of the management of brain abscesses (in collaboration with NITCAR) and brain abscess registry
P: Adult and Paediatric patients with brain abscesses. I: Prospective audit, in collaboration with the National Infection Trainee Collaborative for Audit and Research (NITCAR). C: Incidence, all aspects of surgical and microbiological management. e.g. duration of IV Abx varies from 2 to 6 weeks between units, impact on resources. O: A national audit to identify differences in practices and highlight areas for future studies that will inform guidelines and practices.
Timing of surgery in foot drop secondary to lumbar degenerative disease: when do we intervene?
P: Adults (aged ≥ 18) with foot drop (MRC ≤ 3 in ankle dorsiflexion) treated at spinal units (neurosurgical/orthopaedic) in the United Kingdom. I: Lumbar decompression performed within 7 days of onset of foot drop for degenerative pathologies. C: Decompression performed after 7 days of onset. Secondary comparison will be with those managed non-operatively. O: Recovery of foot drop, defined as MRC ≥ 4 in ankle dorsiflexion, at 3- to 6-month follow-up.