Assad U Khan1, Louise Dulhanty1, Andy Vail2, Pippa Tyrrell3, James Galea4, Hiren C Patel5. 1. Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. 2. Centre for Biostatistics, Institute of Population Health, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. 3. Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. 4. Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK; Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. 5. Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK; Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. Electronic address: hiren.patel@srft.nhs.uk.
Abstract
BACKGROUND: The management of neurosurgical disorders has become increasingly specialised. The care of patients with subarachnoid haemorrhage (SAH) has generally been part of core neurosurgical practice, provided by general neurosurgeons whatever their specialist interest. The aim of this present study therefore is to ascertain if, and to what extent care provided by a dedicated neurovascular team (compared to care provided by a general neurosurgical team) change patient disposition in SAH. METHODS: This is a retrospective analysis of SAH patients, identified from a departmental database of a single neurosurgical centre. In 2008, the service was reorganised such that a neurovascular team cared for all SAH patients. We compared clinical outcome in people admitted prior to this service reorganisation (Period A, 2004-2007) with patients admitted afterwards (Period B, 2009-2011). Survival and recovery were assessed according to the Glasgow Outcome Scale (GOS). Multi-factorial logistic regression analysis was performed to determine the injury and age adjusted incidence of complications, odds of survival at discharge, discharge home, mortality, good recovery (GOS 5) and favourable outcome, by dichotomising GOS (GOS 4-5 vs. GOS 1-3) at 3 months. RESULTS: 1114 patients were included in the study. The mean age of patients presenting in Period A (n = 543) was younger [50 years (SD 13.5)] than those in Period B (n = 571) [53 years (SD 13)]. Patients admitted in Period B were more likely to present as poor grade (World Federation of Neurological surgeons (WFNS) grades 4 and 5) compared to Period A (26.5% vs. 21.3%). No statistical differences between the groups in the incidence of pre-operative re-bleeding (3% vs. 5%) or rates of delayed cerebral ischaemia (16.1% vs. 16.1%) were observed. After adjustment for age, sex and injury severity, the odds of patient time to discharge, discharge home and good recovery (GOS 5) were 27% (p < 0.001), 45% (p = 0.001) and 93% (p < 0.001) higher respectively in Period B than Period A. CONCLUSIONS: The data presented here demonstrates that management of SAH by a dedicated neurovascular team improves the potential for patient recovery.
BACKGROUND: The management of neurosurgical disorders has become increasingly specialised. The care of patients with subarachnoid haemorrhage (SAH) has generally been part of core neurosurgical practice, provided by general neurosurgeons whatever their specialist interest. The aim of this present study therefore is to ascertain if, and to what extent care provided by a dedicated neurovascular team (compared to care provided by a general neurosurgical team) change patient disposition in SAH. METHODS: This is a retrospective analysis of SAHpatients, identified from a departmental database of a single neurosurgical centre. In 2008, the service was reorganised such that a neurovascular team cared for all SAHpatients. We compared clinical outcome in people admitted prior to this service reorganisation (Period A, 2004-2007) with patients admitted afterwards (Period B, 2009-2011). Survival and recovery were assessed according to the Glasgow Outcome Scale (GOS). Multi-factorial logistic regression analysis was performed to determine the injury and age adjusted incidence of complications, odds of survival at discharge, discharge home, mortality, good recovery (GOS 5) and favourable outcome, by dichotomising GOS (GOS 4-5 vs. GOS 1-3) at 3 months. RESULTS: 1114 patients were included in the study. The mean age of patients presenting in Period A (n = 543) was younger [50 years (SD 13.5)] than those in Period B (n = 571) [53 years (SD 13)]. Patients admitted in Period B were more likely to present as poor grade (World Federation of Neurological surgeons (WFNS) grades 4 and 5) compared to Period A (26.5% vs. 21.3%). No statistical differences between the groups in the incidence of pre-operative re-bleeding (3% vs. 5%) or rates of delayed cerebral ischaemia (16.1% vs. 16.1%) were observed. After adjustment for age, sex and injury severity, the odds of patient time to discharge, discharge home and good recovery (GOS 5) were 27% (p < 0.001), 45% (p = 0.001) and 93% (p < 0.001) higher respectively in Period B than Period A. CONCLUSIONS: The data presented here demonstrates that management of SAH by a dedicated neurovascular team improves the potential for patient recovery.
Authors: Peter Y M Woo; Joanna W K Ho; Natalie M W Ko; Ronald P T Li; Leo Jian; Alberto C H Chu; Marco C L Kwan; Yung Chan; Alain K S Wong; Hoi-Tung Wong; Kwong-Yau Chan; John C K Kwok Journal: BMC Neurol Date: 2020-11-03 Impact factor: 2.474
Authors: Chinh Quoc Luong; Hung Manh Ngo; Hai Bui Hoang; Dung Thi Pham; Tuan Anh Nguyen; Tuan Anh Tran; Duong Ngoc Nguyen; Son Ngoc Do; My Ha Nguyen; Hung Dinh Vu; Hien Thi Thu Vuong; Ton Duy Mai; Anh Quang Nguyen; Kien Hoang Le; Phuong Viet Dao; Thong Huu Tran; Luu Dang Vu; Linh Quoc Nguyen; Trang Quynh Pham; He Van Dong; Hao The Nguyen; Chi Van Nguyen; Anh Dat Nguyen Journal: PLoS One Date: 2021-08-13 Impact factor: 3.240