bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.680 “Avulsion of the Corona Mortis following low energy pubic rami fracture: a rare but life-threatening injury.”
Authors: Sinha Anurag , Kemp Mark , Rohra Satish 
Published: October 2021

Abstract
We describe the case of an 81 year old gentleman who presented after a trivial fall with haemodynamic instability and worsening abdominal pain and swelling. An initial trauma CT identified superior and inferior pubic rami fractures associated with a large intra-pelvic collection. A subsequent CT angiogram confirmed a large pelvic haematoma with an active arterial bleeding from a ruptured vessel adjacent to the superior pubic rami fracture. This was managed by resuscitating him with fluids and blood transfusions followed by fluoroscopic guided Internal Iliac artery embolisation. The “Corona Mortis” is an aberrant arterial connection between the inferior epigastric artery and obturator artery and is prevalent in the hemipelvis of more than 49.3% of the population. Very rarely it can be damaged during low energy pubic rami fractures leading to haemodynamic compromise and potential death. For this reason and the fact there is a high chance that it could be missed, we wish to highlight this case, and management and emphasise the need to consider this life-threatening complication even in cases when the mechanism of injury may seem trivial.
EP.FRI.704 Emergency colorectal surgery outcomes within a non-specialist split site service – a retrospective cohort study
Authors: Swan Rebecca , Ventham Nicholas , Damaskos Dimitrios 
Published: October 2021

Abstract

Aims
Within this region, Upper GI and Colorectal subspecialties are located at separate hospitals. This study aims to determine outcomes of critically unwell patients undergoing emergency colorectal surgery off-site at the non-colorectal specialist centre.

Methods
An observational retrospective study of emergency colorectal laparotomies at a major acute teaching hospital (non-colorectal specialist centre) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. The NELA predicted mortality risk was obtained from notes or retrospectively calculated. Subgroup analysis of colorectal surgeon involvement was performed.

Results
One hundred and eighteen patients were included (median age 64 years, 55% female). The median NELA mortality score was 5.8% (IQR 1.9 – 14.7%). The 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 31%. Patients having an anastomosis had a lower median NELA score compared those patients who did not (1.6% vs. 7.85%). Forty five (38%) patients had Clavien-Dindo grade IV-V complication. Colorectal Surgeon involvement in the operation (23/118), was associated with a lower 30-day mortality (17.4% colorectal surgeon vs. 23.2% emergency general surgeon alone) albeit in patients with a lower median NELA score (4.5% vs. 6.7%) and a similar rate of primary anastomosis was achieved (31.6% vs. 30.9%).

Conclusions
The high mortality rate highlights a specific group of acutely unwell patients unfit for transfer to the subspecialist unit. Good outcomes were seen where a colorectal surgeon was involved, however a similar rate of primary anastomosis was demonstrated.
EP.FRI.719 Gastric Perforation Leading to The Diagnosis of Classic Ehlers Danlos syndrome: A Case Report of an Unusual Presentation
Authors: Alotaibi Ahad , AlAamer Ohood , Bawazeer Mohammed , Alzahrani Ali 
Published: October 2021

Abstract

Background
Ehlers-Danlos syndromes (EDS) are clinically and genetically heterogeneous group of heritable connective tissue disorders caused by defective collagen synthesis or structure. Vascular subtype (EDS IV) is reported to be associated with a higher incidence of gastrointestinal ruptures. The Most reported site of perforation was the colon particularly the sigmoid colon followed by small bowel. It is very rare to have stomach perforation. There were no reported cases among classic type I and II. In addition, this patient presented with Marfanoid habitus which may develop acute gastric volvulus in combined with pre-existing EDS, perforation can occur.

Case description
A 14-year-old girl attended our Emergency Department (ED) with abdominal pain and vomiting. Initially diagnosed with gastroenteritis and discharged once her condition improved. 24 hours later, she developed severe abdominal pain with recurrent vomiting with peritonitis evident on clinical examination. Initial KUB failed to show any free air, however, enhanced Computed Tomography (CT) revealed free air and proximal gut contrast extravasation. During exploratory laparotomy, an ischemia anterior and posterior gastric wall with gastric perforation was encountered. A free-hand partial gastrectomy was done. Her post-operative period was complicated with wound infection that managed successfully with Vacuum-assisted closure (VAC) dressing. She recovered well without gastrointestinal sequelae in 4 years follow up.

Conclusions
A high level of suspicion must be maintained for heritable systemic connective tissue diseases in any young patient with unusual spontaneous perforation. As these patients can develop life-threatening conditions, immediate intervention is required in addition to prepare for anticipated complications.
EP.FRI.743 Mortality Risk prediction in Emergency Laparotomy (ORIEL) Study Outcomes at Wythenshawe Hospital
Authors: Pittam Bradley , Carey Charles , Mobarak Shahd , Varley Rebecca , Kingston Jennifer , Agwunobi Anselm 
Published: October 2021

Abstract

Aim
Emergency laparotomy is a high-risk procedure with significant morbidity and mortality. ORIEL is a multi-centre national study aiming to compare the 30-day mortality predictions generated by NELA, P-POSSUM, ACS-NSQIP and SORT risk calculators with observed 30-day mortality rates in patients undergoing emergency laparotomies. We present the data collected from Wythenshawe hospital.

Method
Data were collected retrospectively on adult patients undergoing an emergency laparotomy between 01/12/2017 to 30/11/2019 at Wythenshawe hospital from the online NELA database. The median pre-operative mortality risks were calculated using the four risk calculators for all patients. Mortality and morbidity were compared with data reported in the Sixth NELA report.

Results
The median predicted pre-operative mortality (IQR) for all patients studied using NELA, P-POSSUM, ACS-NSQIP and SORT were: 4.3 (13.0), 5.2 (14.2), 3.4 (8.2) and 2.9 (9.3) respectively. Among patients who were alive 30 days post-operatively, the median predicted mortalities (IQR) were: 3.8 (8.5), 4.8 (11.0), 2.6 (6.9) and 2.8 (7.1) respectively, and among those who died were: 30.8 (18.9), 30.3 (63.4), 16.9 (13.9) and 20.3 (16.2). Compared to the national average, mortality rates at Wythenshawe were lower (9% v 9.3%), the median length of stay in hospital was lower (12 days v 15.4 days) and the percentage of high-risk patients admitted to critical care was higher (93% v 85%).

Conclusions
Similar values were generated with all the scoring systems among all patients. Wythenshawe hospital reports lower mortality rates and shorter stays in hospital despite operating on higher risk patients (ASA grades 3-5).
EP.FRI.745 Information Sustainability: SCR+: A bespoke module to optimise information flows around the Somerset Cancer Register to enhance the multidisciplinary cancer team process
Authors: Rahman Fatima , Hales Alan , Beegan Ryan , Cable David , Rew David 
Published: October 2021

Abstract

Background
Many surgeons work within multidisciplinary cancer teams. The Somerset Cancer Register (SCR) is a national reporting system for service performance which is in use in more than 100 NHS Trusts. However, the core system has not yet been optimised for MDT users or for the surfacing of clinical data for research and other uses.

Methods
SCR replaced our legacy cancer reporting system in 2014. Working with the SCR developers, we integrated our cellular pathology and imaging records with the SCR MDT outputs. We subsequently developed SCR+ to optimise workflows for MDT coordinators and information presentation to clinical users.

Results
Our HTML-enabled SCR+ software application displays all cancer patients by pathological type and year of presentation on dynamic histograms, for ease of visualisation and interaction. Every selected case is displayed in list order for each and every MDT meeting, with a fast hyperlink to our integral Lifelines EPR interface, to electronic pathology records back to 1990, and to our Breast Cancer Data System for relevant patients.

Conclusions
The SCR+ module transforms the access and visualisation of cancer workload across our Trust for all authorised MDT users, with appropriate data security. The agile programming methodology allowed us to build a sustainable cancer data system with further development potential. The product substantially enhances user experience, data recall and productivity over legacy systems. Close cooperation between clinically proficient IT teams and clinicians as the end consumers of digital health data systems yields significant operational benefits at pace and with very modest costs.
EP.FRI.753 Investigating the use of a novel pre-hospital triage tool for acute abdominal surgical emergencies – a two-phase single centre cohort study
Authors: Misbert Emily , Hughes Michael , Burke Joshua , Schofield Claire , Young Alistair 
Published: October 2021

Abstract

Aims
Despite recent improvements, delay to theatre in emergency laparotomy(EL) continues to be associated with increased mortality in the UK. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting.

Methods
A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.

Results
Phase 1: 45 patients were coded through NELA and confirmed through operation note as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80%(n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED resus of which 69 were initially treated by the ambulance service. 30%(n = 21) of these patients had an initial NEWS2 of 3 or above. The sensitivity of a NEWS2 score of &gt;/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95%(95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98%(95%CI, 87-99).

Conclusion
A NEWS2 score of &gt;/3 predicts the need for emergency surgical intervention including laparotomy for gastroinestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.
EP.FRI.821 Operative Treatment of Abscesses – Optimising A Timely Route to Theatre
Authors: Ikram Hamza , Taylor Roland , Dosis Alexios , Robinson Jonathan 
Published: October 2021

Abstract

Aim
1st audit cycle to assess whether patients presenting to the acute surgical service had their abscesses incised and drained in a prompt and timely manner. To develop a pathway for improving efficiency

Methods
All general surgical patients admitted to the surgical admissions unit between 1st September and 31st October 2020 by reviewing clinical and operative notes. Only those patients that had abscesses drained under general anaesthesia. Other specialties abscesses were excluded. Guidelines from the American Society of Colon and Rectal surgeons for draining abscesses acutely were used. Data was collected on various parameters.

Results
A total of 62 patients had abscesses drained. The mean age of patients was 32 years. The average waiting time between decision to operate and surgery was 14 hours and 54 minutes. 19% of the patients were sent home after decision was made to operate and brought back in the morning.

Conclusion
This 1st audit cycle concludes long waiting times and unnecessary overnight stay. A re-audit will be carried out using the same parameters in March 2021. Implementing a dedicated general surgical abscess pathway for patients without significant co-morbidities will improve efficiency and patient satisfaction.
References
1. Kumar C, Page R, Smith I, Stocker M, Tickner C, Williams S, et al. Day case and short stay surgery: 2. Anaesthesia. 2011;66(5):417–34.
2. Balakumar R, Samuel N, Jackson A, Butterworth J, Shiwani MH. Day-surgery approach for incision and drainage of an abscess. Surg Pract. 2016;20(4):157–60.
EP.FRI.828 Accidental Placement of Nasogastric Tube into the brain
Authors: Harvitkar Rafique , Ansari Khursheed , Peri Harish 
Published: October 2021

Abstract
The nasogastric tube (NGT) plays a very vital role in the early resuscitation of head injury patients for various reasons. Though considered a simple procedure, it can be associated with multiple dreadful complications. Our patient was a 44-year-old male, referred from a peripheral health center for further management of severe head and faciomaxillary injuries following a motor vehicular accident. On arrival at the hospital, the endotracheal tube and NGT were in situ. A computed tomography scan of the brain revealed the NGT piercing through the cribriform plate of ethmoid and coiling into the cranial cavity with pneumocephalus. The NGT was retrieved under C-arm guidance and his injuries were managed respectively. The patient was discharged after prolong hospitalization with an acceptable outcome. With this case report, we want to remind emergency health care providers to avoid this catastrophic complication of NGT insertion in a faciomaxillary trauma patient by doing it transorally. We report a novel method of safely removing NGT which has not been reported in the past.
EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital
Authors: Nair Nandu , Kalatzis Vasileios , Gudipati Madhavi , Gaunt Anne , Machineni Vishnu 
Published: October 2021

Abstract

Aims
During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail.

Methods
Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records.

Results
Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered. 22 cases had 87% data entry and 22 cases had &lt;50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete. This led us to engage in a quality improvement project with following measures -

Conclusions
We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.
EP.FRI.949 “When it works, it works brilliantly…. on the days that it doesn’t work, it tends to just all kind of crumble” – a qualitative study of patient and staff experience of ambulatory care on the surgical assessment unit
Authors: Massey Lisa , Day Jo , Bethune Rob , Lang Iain 
Published: October 2021

Abstract

Aims
To explore patients’ experiences of being managed in an ambulatory manner and to explore medical staff’s experiences and attitudes of emergency ambulatory care.

Methods
Twenty patients and 12 members of staff (nurses, HCAs, junior doctors and consultants) underwent in-depth telephone (patients) and face-to-face (staff) interviews about their experience of emergency ambulatory care. The transcribed interviews underwent thematic analysis.

Results
Patients’ opinion on ambulatory care is influenced by factors including whether they felt that they were “ill enough” to need to stay in, a fear of staying overnight in hospital and how much they valued their individual home environment. Many thought that this sort of care had been introduced to “save the bed”.
Staff were passionate about the service as a good option for many patients who would otherwise have hospital admissions. However, some thought it had been brought in to manage patients who could be managed in primary care. Some factors thought by doctors to influence their decision-making include their perception of the risk involved, previous negative experiences and external pressures such as theatre availability and bed status. There are varied views on whether the service should be more or less protocol-led. Many believe that it is “easier” for them to admit people than manage them in an ambulatory manner.

Conclusions
There is definitely scope to expand ambulatory care but patients may not engage with this if they feel ill enough to stay in. Decision-making in staff is influenced by a number of factors on an individual level.
EP.FRI.1023 Clinical Portal: a clinician-led IT solution to the ‘surgical list’
Authors: Bleakley Cait , Wright Chloe , Salem Rola , Bowling Kirk 
Published: October 2021

Abstract

Aim
Burnout amongst junior doctors is an emotive topic, with time pressures during busy on-call shifts negatively impacting efficiency and morale. Historically, within busy surgical firms the most junior team members commonly worked beyond scheduled hours. It has been highlighted within our trust that our IT systems significantly contributed to this. Thus leading to the creation of a clinician-led IT solution, enabling direct access to accurate information at a single point. This study aims to measure the impact of the systems introduction on efficiency and shift experience of our junior doctors.

Methods
'Clinical Portal’ was introduced in August 2019. This IT system enables all patient information to be collated in one place, with the added benefit of simplifying the creation of patient lists. Number and duration of Exception Reports (ER) by on-call surgical juniors were measured for two months pre and post intervention. A qualitative survey was also distributed to this cohort to measure satisfaction and experience during on-call shifts within this period.

Results
Following introduction of 'Clinical Portal', the total length of time included in ERs reduced. Surgical juniors expressed an improvement in their on-call experience, most notably dedicating less time to collating patient information and ward list formation. The overall experience improved despite time required to become proficient at using the new system.

Conclusions
Streamlining of IT systems used during on-call shifts demonstrates improved efficiency amongst juniors reflected in a reduction of ERs. A direct consequence of these implemented changes is significant improvement in morale amongst our juniors.
EP.FRI.1036 Provision of 7 Day Radiology Service: Are we compliant against standards
Authors: Ikram Saad , Demetriou George , Shariff Umar , Helmy Salah 
Published: October 2021

Abstract

Aim
The audit aimed to retrospectively look into reporting times for investigations for acute surgical inpatients and determine if we were able to meet standards as set in NHS 7 day service provision standards which aims to provide 7day radiological service for hospital inpatients from commission to reporting.

Method
A prospective audit is undertaken to collect waiting times for investigations for all acute admissions requiring radiological investigations over one month. Investigations were categorized into ‘critical’, ‘urgent’ and ‘non-urgent’ according to guidelines set by Royal College of Surgeons. The results were tabulated in Excel and analyzed to determine level of compliance.

Results
Collected data shows that off the total 119 investigations performed, 34% were USG, 63% were CT scans and 2.5% were MRI. Standards were met for a total of 67% of the investigations. Only 20% of critical, 67% of urgent and 76% of non-urgent scans were done within the standard time while by modality, CT scans had the highest rate of compliance. 60% of investigations requested over weekends met standards with highest compliance for USG and for non-urgent scans. Average reporting time was approximately 50 minutes.

Conclusion
The audit outcome highlighted that 1 out of 3 investigations did not meet standards. Within its limitations of no numerical parameters to guide urgency, the audit was able give an idea of the radiology service offered by the hospital and highlighted clear areas for improvements which can be suggested to improve compliance such as documenting ‘operative catergory’ of requested investigations on request forms.
EP.FRI.1040 Management of Acute Colonic Diverticulitis According to The WSES (World Society of Emergency Surgery) Classification in a Tertiary Centre
Authors: Hickey Lorraine , Goldsmith Paul 
Published: October 2021

Abstract

Aims
Debate remains regarding management of complicated diverticulitis. The WSES acute diverticulitis working group published in 2015 a CT-guided classification of left colon acute diverticulitis, divided into uncomplicated (Stage 0) and complicated (Stage 1a-4). Using this classification, we reviewed our management of CT-proven acute colonic diverticulitis.

Methods
A single-centre retrospective review of management of CT-proven acute colonic diverticulitis over 12 months based on the WSES classification.

Results
24 males and 31 females presented (median age=56, IQR 45-68). Median white cell count=12 (IQR 10-16) and median C-reactive protein=88 (IQR 41-157).
Based on CT, 25 (45.5%) patients =stage 0, 14 (25.5%) =stage 1a, 6 (11%) =stage 1b, 4 (7%) =stage 2a, 6 (11%) =stage 2b, and none staged 3/4.
15% (8/55) patients had an operation, remainder were conservatively managed. 2 patients had laparoscopic washout/drainage (stages 1b and 2b). 6 patients had Hartmanns (x1 stage 1a, x1 stage 1b, x4 stage 2b).
Median length of stay=5 days (IQR 4-8). There was 1 related reattendance declining readmission (stage 1a managed conservatively) and 2 readmissions (1 stage 0 managed conservatively, other initially stage 1a managed conservatively but on readmission staged 2b proceeding to Hartmanns). 30-day mortality included 3 deaths (stages 1b/2a/2b all managed conservatively).

Conclusions
Hartmanns resection is advocated as treatment of choice for complicated acute diverticulitis, particularly for Stage 2b or above.