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.

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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.

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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.

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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.

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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.

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National audit of thoracolumbar injury management

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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

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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.

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Pharmacological VTE prophylaxis after elective cranial surgery: a cohort study determining optimal time of initiation, regimen and duration (PRECISE)

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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. 

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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.

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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.