bluuebunny/crossref_metadata_2025_split huggingface dataset:
1404 NELA Risk Mortality Scores from Admission to Theatre in Emergency Gastrointestinal Perforation – A Retrospective Cohort Study
Authors: Misbert E , Hughes M , Burke J , Schofield C , Young A 
Published: October 2021

Abstract

Background
Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The aim of this study was to assess delay, from symptom onset to theatre in patients with gastrointestinal perforation and its effect on perioperative risk.

Method
A single-centre retrospective study was performed in the Leeds Trust Hospitals, UK investigating the NELA database for patients requiring emergency laparotomy for perforated gastrointestinal viscus who presented to the acute surgical unit or emergency department between 1st February 2018 and 31st January 2020.

Results
101 patients met the inclusion criteria (47% F and 53% M), mean age 59 [21-91]. 37% of patients’ NELA scores worsened from admission to pre-op (median change of + 5.9% IQR 1.3-11.5]), 14% stayed the same and 49% improved (median change of -4.4%[IQR 0.4-9.1]) 3% had their NELA score documented at the time of consent. 18% did not wait for a CT report or went straight to theatre. Mean time from admission to scan report was 9.3 hours (0.9-22.0). Median time from symptom onset to presentation (2 days [IQR 1-13]) was greater in patients with an Index of Multiple Deprivation Decile of 1-5, (n = 64, median 2 days [IQR 1-6]) compared to those in deciles 6-10, (n = 37, median 1 day[IQR 1-3]), p = 0.097.

Conclusions
NELA mortality risk score changes from presentation to surgery in patients with acute gastrointestinal perforation requiring emergency laparotomy. There is suggestion that delay in symptom onset to presentation may correlate with Index of Multiple Deprivation Decile.
1553 Non-Operative Management of Acute Appendicitis at A Major Trauma Centre – A Retrospective Case Series
Authors: Chong S J K , Kaur M , Palmer C , Jaunoo S 
Published: October 2021

Abstract

Aim
The recent CODA trial concluded that appendicitis patients with confirmed faecolith are at higher risk of appendicectomy and complications than those without faecolith. A retrospective case series of patients undergoing non-operative management of appendicitis at a major trauma centre was conducted to determine the success of non-operative management, defined as lack of operative management within 30 and 90 days of diagnosis, and the impact of presence of faecolith on outcomes.

Method
All patients who received a working diagnosis of appendicitis over a 16-week period between March and June 2020 were identified and their electronic records interrogated for: preliminary and final diagnoses; imaging modality and result; operative or non-operative initial treatment strategy; final treatment strategy; and histopathology results where applicable. Patients who received an initial operative treatment strategy were excluded. Patients for whom appendicitis was not confirmed on either imaging or histopathology were excluded.

Results
24 patients received an initial non-operative treatment strategy and were eligible for inclusion. 15 patients (62.5%) underwent successful non-operative management. The remaining 9 patients (37.5%) required operative management within 30 days. Presence of faecolith was confirmed in 9 patients (37.5%). 3 patients (33%) with presence of faecolith required operative management, while 3 patients (25%) without presence of faecolith required operative management. 1 patient with confirmed faecolith developed a large intra-abdominal abscess while undergoing a non-operative treatment strategy and subsequently required right hemicolectomy.

Conclusions
The majority of our eligible appendicitis patients were successfully managed non-operatively. Presence of faecolith in acute appendicitis is associated with increased risk of requiring operative management.
1575 Predictive Ability of Neutrophil-To-Lymphocyte Ratio in Acute Appendicitis
Authors: Nawaz G , Qayum M , Hajibandeh S , Hajibandeh S 
Published: October 2021

Abstract

Aim
Neutrophil-to-lymphocyte ratio (NLR) predicts both diagnosis and severity of appendicitis. We aimed to evaluate accuracy of NLR to predict acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis.

Method
Patients of any age and gender presenting with clinical history of acute appendicitis over a 4 month period were included. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of NLR were evaluated considering the cut-off values of 4.7 for acute appendicitis and 8.8 for complicated appendicitis.

Results
A total of 54 patients were included. Thirty-eight patients had acute appendicitis of whom 21 (55.2%) had complicated appendicitis. NLR was associated with sensitivity of 89.4%, specificity of 81.2%, PPV 91.8%, NPV of 76.5%, and accuracy of 87.0% for acute appendicitis. Moreover, it was associated with sensitivity of 61.4%, specificity of 78.9%, PPV 76.5%, NPV of 65.2%, and accuracy of 70.0% for complicated appendicitis.

Conclusions
NLR has acceptable sensitivity, specificity, PPV, NPV and accuracy to predict uncomplicated and complicated appendicitis with relatively better ability to predict the former. NLR can be utilised for prioritising cases for surgery, for monitoring conservatively treated patients and for patients who do not routinely undergo CT scan (pregnant or paediatric patients).
457 The Effect of Biochemical Adversity of Primary Hyperparathyroidism on Preoperative Imaging (SPECT-CT and US Parathyroids)
Authors: Durand C , Anderson H , Simpson D , Gull S , Oprean R , Lim K , Lee F , Kakos C , Cvasciuc T 
Published: October 2021

Abstract

Aim
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, with an estimated incidence of 1/500 women and 1/2000 men older than 40 years. Several factors influence the positivity of preoperative scans including serum calcium, PTH and vitamin D levels, and gland size. The aim of our study is to examine the effect of biochemical adversity of primary hyperparathyroidism on preoperative imaging (SPECT-CT and US parathyroids).

Method
Retrospective study of 176 parathyroidectomies (2017-2020) in a tertiary referral centre with biochemistry, SPECT-CT, US parathyroids and histology outcomes being recorded. Failed parathyroidectomies were excluded.

Results
Patients were divided into 4 groups based on the preoperative calcium levels (normocalcemia &lt;2.6, 3.4%; mild 2.60-2.79, 51.1%; moderate 2.80-2.99, 31.2%; severe &gt;3.0 mmol/l, 14.2% of patients). Age (p-0.0297), preoperative vitamin D (p-0.03) and PTH levels (p-0.0001) were different while SPECT-CT positivity (p-0.29) weight of gland (p-0.015) and US positivity (p-0.09) were similar within the subgroups. Looking at the whole group, patients with positive SPECT-CT have a larger weight (p &lt; 0.0001) while preoperative PTH levels was higher for the positive SPECT-CT patients (p-0.0289). No relation was identified between calcium levels and SPECT-CT positivity (p-0.18). No significance between preoperative vitamin D and positivity of US and SPECT-CT within the study group were noted.

Conclusions
Serum PTH levels and weight of the gland are directly correlated with positivity of preoperative imaging. Preoperative calcium and vitamin D levels correlates indirectly with the severity of the disease but did not influence the preoperative imaging positivity.
1108 Comparing the Accuracy of Ultrasonography and Nuclear Imaging Scan in Preoperative Localisation of Parathyroid Lesions in Patients with Primary Hyperparathyroidism
Authors: Jayawardena P , Peris R , Rafie A 
Published: October 2021

Abstract

Aim
Parathyroidectomy remains the only method to cure Primary Hyperparathyroidism. Preoperative localisation of the lesion is vital for successful surgical management. The preferred initial preoperative imaging is an ultrasound scan (USS) of the neck. NICE recommends a second preoperative imaging modality to guide the surgical management. This study was conducted to compare the effectiveness of USS of the neck and SPECT scan in the preoperative localisation of parathyroid lesions in a single Teaching Hospital.

Method
A retrospective study performed included a cohort of patients between 2018 and 2020. 31 patients that underwent elective focussed parathyroidectomy were followed up. Data on preoperative investigations including USS of the neck and SPECT and final histological diagnosis of the specimen was captured using the hospital’s electronic medical records Quadramed.

Results
Both USS and SPECT scan correctly identified the nature and location of the lesion in only 35.4% patients. USS alone correctly identified the nature and location of the lesion in 50.0% patients whereas SPECT was 46.7%. USS incorrectly identified the nature or the location of the lesion in 33.3% patients whereas SPECT was 40.0%. Interestingly, the USS did not identify any abnormal pathology in 5 patients and SPECT in 4 patients, although all 9 showed pathological histology findings.

Conclusions
Data collected shows that either scan alone would not be sufficient to confirm the absence of parathyroid pathology. A second scan decreases the likelihood of missing any abnormal pathology. However, in patients with a high clinical suspicion abnormality cannot be ruled out despite having two negative scan results.
168 Emergency Medicine Clinicians’ Confidence in Managing Epistaxis Is Improved by A Simple Intervention: A Closed-Loop Quality Improvement Study
Authors: Banhidy N , Jamshaid S 
Published: October 2021

Abstract

Aim
Epistaxis is a common, potentially life-threatening presentation in the Emergency Department (ED) with an incidence of 108/100 000 population per year. 85% of all patients presenting with epistaxis are managed by ED clinicians without specialist input or admission. Guidelines exist from ENT UK on epistaxis management, however awareness of these guidelines, nuances in techniques and levels of confidence by ED clinicians is not known. This quality improvement study aims to assess the confidence of ED clinicians in managing epistaxis, and investigate whether this could be improved through educational intervention.

Method
A single-centre, prospective, baseline audit was conducted following local approval. An initial questionnaire assessed knowledge of appropriate Hippocratic first aid method for epistaxis, alongside individual confidence in providing epistaxis prevention advice. The educational intervention included a 30 minute interactive tutorial on epistaxis during the local department teaching for ED clinicians. The audit loop was then closed by repeating the questionnaire.

Results
Pre- (n = 20) and post- (n = 8) intervention questions were completed by ED clinicians. Knowledge scores of appropriate epistaxis first aid provision increased from 53% pre-intervention to 88% post-intervention. Reported confidence in providing epistaxis prevention advice also increased from a mean score of 2.7 pre-intervention to 4.1 post-intervention on a 5-point Likert scale.

Conclusions
ED clinicians generally lack knowledge on appropriate first aid techniques on managing epistaxis and confidence in providing epistaxis prevention advice. Both of these parameters may be improved by simple educational interventions which may be implemented nationally.
515 Patient Satisfaction on Drainless Outpatient Parotidectomy
Authors: Maniam P , Flach S , Hey S Y , Owusu-Ayim M , Manickavasagam J 
Published: October 2021

Abstract

Background
Parotidectomy is commonly performed as an inpatient procedure due to drain insertion. However recent evidence suggests that drainless outpatient parotidectomy is a safe option with comparable postoperative complication and hospital readmission rates to inpatient parotidectomies.

Aim
Patient satisfaction on outpatient parotidectomy is unclear and this study aims to report patients’ perspective and satisfaction on drainless outpatient parotidectomy.

Method
Anonymous ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D) questionnaire survey was completed by patients who underwent drainless same day parotidectomy at Ninewells Hospital, Dundee from June 2018 to October 2020. Patient satisfaction on different aspects of their outpatient parotidectomy journey (e.g., pre-admission, admission on ward, in-theatre experience, nursing care, pain control and overall satisfaction) were scored using a five-point Likert scale.

Results
A total of 31 drainless outpatient parotidectomies were performed and 28 patients completed the patient satisfaction survey. The majority of patients were highly satisfied (i.e., scored 5/5) with their preadmission visit (79.5%), admission on the ward (84.5%), operating room experience (96.4%), nursing care (83.9%), medical care (87.5%), information received (75.0%), autonomy (79.8%) and discharge and after care (61.9%). Despite preferring drainless parotidectomy, 16/28 (57.1%) patients either stayed for less than 23 hours or preferred to stay overnight stay in the hospital for non-surgical reasons.

Conclusions
Outpatient parotidectomy is well received by patients and the majority of patients preferred drainless parotidectomy over inpatient parotidectomy with drains.
695 Photo-otoscopy Audit: A Review of Change in Departmental Practice Due to COVID-19
Authors: Chan K Y , Thornton H , Gordon C , Ishii H , Clark M 
Published: October 2021

Abstract

Background
Photo-otoscopy is a new service set up during the COVID-19 pandemic, with the view to minimise unnecessary appointments, protect vulnerable patients, and optimise efficiency of ENT-outpatient appointments. The objectives are to assess rate of diagnostic photos and investigate how to improve this service.

Method
First cycle was performed between June and July and second cycle between October and December 2020. All patients attending Audiology who had a photo taken were included. Photos were analysed based on a number of variables to identify the proportion of diagnostic and non-diagnostic photos. First cycle highlighted a few changes to practice that were then instigated for second cycle.

Results
324 patients and 232 patients were included in first and second cycle respectively. 17 operators/audiologists were involved. There is slight improvement in percentage of diagnostic photos in second cycle compared to first (30.6% to 31.9% in right ear and 23.5% to 35.8% in left ear). Percentages of non-diagnostic photos with blurriness as sole reason have increased compared to first cycle. Percentages of non-diagnostic photos with all 3 variables present have reduced significantly. Mean percentage of acceptable photos per operator have also improved. 8 out of 10 ENT consultants/registrars found the service useful.

Conclusions
Rate of diagnostic photos remained low (&lt;40%) despite implementation of changes to practice from first cycle. 38% of non-diagnostic photos were wax-related. There is significant variation in rate of diagnostic photos due to its operator-dependent nature. Given the expansion of telemedicine, there is definitely scope for future development for photo-otoscopy.
709 A Prospective Analysis of Post-Tonsillectomy Haemorrhage and Hospital Reamission Rates in A Tertiary Pediatric Centre
Authors: Thompson N , Street I 
Published: October 2021

Abstract

Introduction
Tonsillectomies are one of the most commonly performed procedures., with one particular leading tertiary paediatric centre performing 1,067 tonsillectomies within the last year. Post-tonsillectomy haemorrhage is a considerable complication leading to further primary care costs, readmission, and surgical intervention. Previous national audits have suggested that post-tonsillectomy haemorrhage rates are between 3.0-3.5%1 and readmission rates are approximately 8.8%2.

Aim
Assess post-tonsillectomy haemorrhage and readmission rates at a leading tertiary paediatric centre.

Method
A prospective phone survey was completed for every patient receiving a tonsillectomy 6 weeks post-operatively, using a 2-month inclusion period.

Results
Of the 51 patients included, 51 responded to phone survey. The total post-tonsillectomy haemorrhage rate was 23.5%. Of the 51 respondents, 10 (19.6%) were readmitted through A&E, all of which had extracapsular tonsillectomies. 1 (10%) of those readmitted had further surgical intervention whilst the remaining 9 (90%) were treated conservatively. A further 4 (7.8%) attended their GP, with 3 (75%) of those requiring antibiotics.

Conclusions
This data shows that both the post-tonsillectomy haemorrhage and readmission rates at the tertiary paediatric centre were higher than the national average. We suggest that previous national data audits describing bleeding rates lack the granularity to reveal true post-operative complication rates. Our prospective cohort has demonstrated that there may be a large proportion of patients with morbidity that never reach the attention of the ENT surgeon and additionally that subgroups in particular may benefit from interventions designed to minimise patients’ post-operative risks, including specific perioperative management and advice.
909 ENT Telephone Clinic During COVID-19 Pandemic
Authors: Sargsyan N , Karunaratne D , Masani A , Yousif M 
Published: October 2021

Abstract

Introduction
In response to the COVID-19 pandemic, ENT services in NHS hospitals have fundamentally changed the way they function. Focus is narrowed on emergency care and cancer care, with cancellation of most elective procedures. In response to this, 2 week wait (2ww) ENT telephone clinics were set up.
This project reviewed the effectiveness of ENT telephone clinic appointments in managing 2ww referrals and to determine whether the introduction of 2ww telephone clinics improves patient waiting times and appropriates of referrals.

Method
Retrospective review of ENT telephone clinic 2ww referral outcomes at Eastbourne District General Hospital and the effectiveness of managing these patients.

Results
A total of 58 ENT Telephone Clinic 2ww referrals from the GP were reviewed. After a telephone consultation 63% of patients were referred to 2ww imaging, from which 70% were discharged following imaging. 83% of patient offered face to face appointment following imaging, required further investigation or treatment, again reducing delay in diagnosis.

Conclusions
Telephone clinic is an effective way of managing 2ww referral patients. In the ongoing pandemic, telephone clinics will be used to manage cancer pathways. This study shows that a large number of patients are discharged after imaging following a telephone clinic. Further study is required to determine whether low scoring patients on symptom-based risk calculators for cancer referrals could be directly referred to imaging to avoid delay in diagnosis, reduce anxiety as well as allow appropriate resource allocation.
1121 Single Use Nasal Endoscopes – A Review of The Cost and Organisational Implications Based on Department Size
Authors: Wallace J , Evans V , Sanu A , Howard A , Berry S 
Published: October 2021

Abstract

Aim
Single use nasal endoscopes have become increasingly popular since the COVID-19 pandemic. By avoiding the risk of cross contamination and reducing exposure by eliminating the need for re-processing, the disposable scopes have clear safety benefits. Despite ENT UK guidelines recommending that disposable nasal endoscopes be available in every department for use in emergencies, they have often been considered prohibitively expensive. The aim of this study was to analyse the costs associated with traditional nasal endoscopes and compare them to the single use scopes.

Method
A micro costing exercise was undertaken in three ENT departments: 2 university hospitals, and 1 district general hospital. The outcomes were compared and discussed with relation to the logistics of the departments, as well as organizational considerations.

Results
Cost per procedure varied according to the reprocessing methods used in the different departments. The cost of the disposable nasal endoscopes appears high, however there are many hidden costs associated with the traditional scopes, which can be difficult to quantify accurately.

Conclusions
Although disposable endoscopes appear costly, reprocessing and frequent repairs required for re-usable scopes account for the comparable cost per procedure. The high risk of COVID-19 transmission from examining the upper aerodigestive tract means that the safety benefits bear more weight in the current climate. However, concerns regarding environmental impact, image quality and storage of examinations also need to be considered.
1184 Operation Note – Are We Documenting Accessibility to The Larynx
Authors: Motter D , Williams H 
Published: October 2021

Abstract

Introduction
Diagnostic laryngeal procedures are often done under general anaesthesia to aid in assessment and management of laryngeal lesions. Obtaining tissue samples for histology is an extremely important tool used to aid in further surgical planning. Documentation of accessibility to the larynx is paramount to patient care and future surgical planning. We aimed to highlight operative notes for those undergoing diagnostic procedures and assess whether sufficient detail is documented. The Royal College of Surgeons recommends that all operative notes must be comprehensive and “all problems/complications” must be documented for good practice.

Method
We carried out a 3-month retrospective data collection on patients who have undergone diagnostic laryngeal procedures at the Royal Glamorgan Hospital. We included microlaryngoscopies, panendoscopies and laser-specific procedures. We accessed the theatre booking system and retrieved the operation notes.

Results
During the 3-month period, 33 procedures were undertaken. 52% of the operative notes did not document level of accessibility. 48% of the operative notes included the level of accessibility, highlighting keywords such as “good access”, “difficult access” and “difficult access but possible for laser therapy”.

Conclusions
Documentation of intra-operative findings can aid further surgical management and help prepare the surgeon and theatre staff. It is especially important in patients who have vocal cord lesions that might benefit from laser therapy. We recommend documenting the intubation grade (Malampati Score) and accessibility to the larynx.