Usability of novel major TraumaApp for digital data collection.

BACKGROUND: Delivery of major trauma care is complex and often fast paced. Clear and comprehensive documentation is paramount to support effective communication during complex clinical care episodes, and to allow collection of data for audit, research and continuous improvement. Clinical events are typically recorded on paper-based records that are developed for individual centres or systems. As one of the priorities laid out by the Scottish Trauma Network project was to develop an electronic data collection system, the TraumaApp was created as a data collection tool for major trauma that could be adopted worldwide. METHODS: The study was performed as a service evaluation based at the Queen Elizabeth University Hospital Emergency Department. Fifty staff members were recruited in pairs and listened to five paired major trauma standby and handover recordings. Participants were randomised to input data to the TraumaApp and one into the existing paper proforma. The time taken to input data add into was measured, along with time for clarifications and any errors made. Those using the app completed a System Usability Score. RESULTS: No statistically significant difference was demonstrated between times taken for data entry for the digital and paper documentation, apart from the Case 5 Handover (p < 0.05). Case 1 showed a significantly higher time for clarifications and number of errors with digital data collection (p = 0.01 and p = 1.79E-05 respectively). There were no other differences between data for the app and the proforma. The mean System Usability score for this cohort was 75 out of 100, with a standard deviation of 17 (rounded to nearest integer). CONCLUSION: Digital real-time recording of clinical events using a tool such as the TraumaApp is comparable to completion of paper proforma. The System Usability Score for the TraumaApp was above the internationally validated standard of acceptable usability. There was no evidence of improvement in use over time or familiarity, most likely due to the brevity of the assessments and the refined user interface. This would benefit from further research, exploring data completeness and a potential mixed methods approach to explore training requirements for use of the TraumaApp.

Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.

BACKGROUND: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. METHODS: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. RESULTS: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. CONCLUSIONS: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.

Exploring the impact of traumatic injury on mortality: An analysis of the certified cause of death within one year of serious injury in the Scottish population.

BACKGROUND: Few studies effectively quantify the long-term incidence of death following injury. The absence of detailed mortality and underlying cause of death data results in limited understanding and a potential underestimation of the consequences at a population level. This study takes a nationwide approach to identify the one-year mortality following injury in Scotland, evaluating survivorship in relation to pre-existing comorbidities and incidental causes of death. STUDY DESIGN: This retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score ≥ 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three groups: trauma death, trauma-contributed death, and non-trauma death. Kaplan-Meier curves were used for survival analysis to evaluate mortality, and cox proportional hazards regression analysed risk factors linked to death. RESULTS: 4056 patients were analysed with a median age 63 years (58-88) and male predominance (55.2 %). Falls accounted for 73.1 % of injuries followed by motor vehicle accidents (16.3 %) and blunt force (4.9 %). Extremity was the most commonly injured region overall followed by chest and head. However, head injury prevailed in those who died. The registry demonstrated a one-year mortality of 19.3 % with 55 % deaths occurring post-discharge. Of all deaths reported, 35.3 % were trauma deaths, and 47.7 % were trauma-contributed deaths. These groups accounted for over 70 % of mortality within 30 days of hospital admission and continued to represent the majority of deaths up to 6 months post-injury. Patients who died after 6 months were mainly the result of non-traumatic causes, frequently circulatory, neoplastic, and respiratory diseases (37.7 %, 12.3 %, 9.1 %, respectively). Independent risk factors for one-year mortality included a GCS ≤ 8, modified Charlson Comorbidity score >5, Injury Severity Score >25, serious head injury, age and sex. CONCLUSION: With a one-year mortality of 19.3 %, and post-discharge deaths higher than previously appreciated, patients can face an extended period of survival uncertainty. As mortality due to index trauma lasted up to 6 months post-admission, short-term outcomes fail to represent trauma burden and so cogent survival predictions should be avoided in clinical and patient settings.

Epidemiology of major trauma in older adults within Scotland: A national perspective from the Scottish Trauma Audit Group (STAG).

BACKGROUND: Major trauma in older adults (MTOA) poses distinctive health and social care challenges, further underlined by the unique socioeconomic and geographical environment of Scotland. This study provides epidemiological trends of MTOA, to provide insight into areas where further evaluation and research are required. MATERIALS AND METHODS: Pseudonymised aggregated demographic, injury and outcome data from 2011 to 2020 were obtained from the Scottish Trauma Audit Group (STAG) Database, covering 28 hospitals across Scotland. Only individuals age ≥ 70 with an Injury Severity Score (ISS) > 15 were included. RESULTS: There was an average of 216 annual cases of MTOA, with a 259 % rise in incidence from 2011 to 2020. This was predominantly driven by a rise in low velocity trauma (fall <2 m height; 287 % increase). The proportion of all major trauma attributable to those aged ≥70 rose from 18.5 % in 2011 to 34.6 % in 2020. Death censored median (IQR) acute hospital length of stay was 18 days (9-30). Overall, 30-day survival was 65.3 %, with no improvement seen between 2011 and 2020 (p = 0.50). Independent predictors of improved 30-day survival included Ages 70-79 & 80-89 [compared to reference ≥ 90] (OR 3.12; 95 %CI 2.24,4.31; p < 0.001 and OR 1.66; 95 %CI 1.21,2.29; p = 0.002 respectively), and Extremity injury (OR 1.89; 95 %CI 1.48,2.41; p < 0.001). Head injury (OR 0.72; 95 %CI 0.54,0.96; p = 0.027) and increasing ISS score (OR 0.88, 95 %CI 0.86,0.89; p < 0.001) were associated with lower likelihood of 30-day survival. A further model also including the admission ward (from eSTAG data November 2017 onwards) demonstrated an association with reduced 30-day survival with admission to General Surgery (OR 0.42; 95 %CI 0.19,0.93; p = 0.033), Intensive Care (OR 0.25; 95 %CI 0.10,0.60; p = 0.002) and Medical Specialities (OR 0.33; 95 %CI 0.15,0.73; p = 0.007) compared to the reference (Major Trauma). Exponential Smoothing predictions revealed a further potential 184 % rise in incidence of MTOA from 2021 to 2030 (3657 per 100,000 population at risk to 10,392 per 100,000 population at risk). CONCLUSION: MTOA is likely to be a rising health care burden, requiring larger quantities of health and social care resource. Urgent preventative strategies are required to reduce low velocity trauma (standing height falls), as well as the high mortality and morbidity of MTOA.

A simplified computational model of possible hydrodynamic interactions between respiratory and swimming-related water flows in labriform-swimming fishes.

Hydrodynamic interactions in bony fishes between respiratory fluid flows leaving the opercular openings and simultaneous flows generated by movements of downstream pectoral fins are both poorly understood and likely to be complex. Labriform-swimming fishes that swim primarily by moving only their pectoral fins are good subjects for these studies. We performed a computational fluid dynamics investigation of a simplified 2D model of these interactions based on previously published experimental observations of both respiratory and pectoral fin movements under both resting and slow, steady swimming conditions in two similar labriform swimmers: the bluegill sunfish (L. macrochirus) and the largemouth bass (M. salmoides). We carried out a parametric study investigating the effects that swimming speed, strength of opercular flow and phase difference between the pectoral fin motion and the opercular opening and closing have on the thrust and sideslip forces generated by the pectoral fins during both the abduction and adduction portions of the fin movement cycle. We analyzed pressure distributions on the fin surface to determine physical differences in flows with and without opercular jets. The modeling indicates that complex flow structures emerge from the coupling between the opercular jets and vortex shedding from pectoral fins. The jets from the opercular openings appear to exert significant influence on the forces generated by the fins; they are potentially significant in the maneuverability of at least some labriform swimmers. The numerical simulations and the analysis establish a framework for the study of these interactions in various labriform swimmers in a variety of flow regimes. Similar situations in groups of fishes using other swimming modes should also be investigated.

A Comparison of Isogenic Homozygous Clone and Wildtype Zebrafish (Danio rerio): Survival and Developmental Responses to Low pH Conditions.

The value of bioassays as analytical methods for assessing the potency of particular stressors on live animal models depends on the precision of their results, which are greatly influenced by the choice of test subjects. The genetic makeup of experimental subjects varies, and, as such, so will their responses to the test environment. Genetic diversity of test populations may contribute to statistical variability; therefore, the use of genetically similar subjects may enhance the utility of bioassays. This study addresses the efficacy of using isogenic homozygous zebrafish (Danio rerio) as subjects for bioassays. Stress responses (acidic conditions) were compared during early development for gynogenetically produced isogenic homozygous line of zebrafish (C32) and wildtype (WT) zebrafish. Experiments evaluated early life stage milestones after exposure to low pH in water of a different electrolyte composition. Because the isogenic homozygous clonal (IHC) fish possessed far less genetic variability than the WT fish tested, it was predicted that the IHC fish would exhibit less variability in their response to stress. Although we found no significant differences in the variability between the responses of the IHC and WT fish, pH and water hardness level had a differential effect on the two groups. Simple strain differences may be the probable cause of the response differences to environmental stress. Factors that may affect stress response, such as heterogeneity, co-adapted gene complexes, and domestication, are discussed. Our findings and review of recent zebrafish literature stress the need for researchers to carefully consider breeding histories and trait characteristics for each potential test subject to maximize the sensitivity of the assay.

Aracaniform Swimming: A Proposed New Category of Swimming Mode in Bony Fishes (Teleostei: Tetraodontiformes: Aracanidae).

The deepwater boxfishes of the family Aracanidae are the phylogenetic sister group of the shallow-water, generally more tropical boxfishes of the family Ostraciidae. Both families are among the most derived groups of teleosts. All members of both families have armored bodies, the forward 70% of which are enclosed in rigid bony boxes (carapaces). There is substantial intragroup variation in both groups in body shapes, sizes, and ornamentation of the carapaces. Swimming-related morphology, swimming mode, biomechanics, kinematics, and hydrodynamics have been studied in detail in multiple species of the ostraciids. Ostraciids are all relatively high-performance median and paired fin swimmers. They are highly maneuverable. They swim rectilinearly with substantial dynamic stability and efficiency. Aracanids have not been previously studied in these respects. This article describes swimming-related aspects of morphology, swimming modes, biomechanics, and kinematics in two south Australian species (striped cowfish and ornate cowfish) that are possibly representative of the entire group. These species differ morphologically in many respects, both from each other and from ostraciids. There are differences in numbers, sizes, and placements of keels on carapaces. The most important differences from ostraciids are openings in the posterior edges of the carapaces behind the dorsal and anal fins. The bases of those fins in ostraciids are enclosed in bone. The openings in aracanids free the fins and tail to move. As a result, aracanids are body and caudal fin swimmers. Their overall swimming performances are less stable, efficient, and effective. We propose establishing a new category of swimming mode for bony fishes called "aracaniform swimming."

Functional consequences of structural differences in stingray sensory systems. Part I: mechanosensory lateral line canals.

Short range hydrodynamic and electrosensory signals are important during final stages of prey capture in elasmobranchs (sharks, skates and rays), and may be particularly useful for dorso-ventrally flattened batoids with mouths hidden from their eyes. In stingrays, both the lateral line canal and electrosensory systems are highly modified and complex with significant differences on ventral surfaces that relate to feeding ecology. This study tests functional hypotheses based on quantified differences in sensory system morphology of three stingray species, Urobatis halleri, Myliobatis californica and Pteroplatytrygon violacea. Part I investigates the mechanosensory lateral line canal system whereas part II focuses on the electrosensory system. Stingray lateral line canals include both pored and non-pored sections and differ in branching complexity and distribution. A greater proportion of pored canals and high pore numbers were predicted to correspond to increased response to water flow. Behavioral experiments were performed to compare responses of stingrays to weak water jets mimicking signals produced by potential prey at velocities of 10-20 cm s(-1). Bat rays, M. californica, have the most complex and broadly distributed pored canal network and demonstrated both the highest response rate and greater response intensity to water jet signals. Results suggest that U. halleri and P. violacea may rely on additional sensory input, including tactile and visual cues, respectively, to initiate stronger feeding responses. These results suggest that stingray lateral line canal morphology can indicate detection capabilities through responsiveness to weak water jets.

Functional consequences of structural differences in stingray sensory systems. Part II: electrosensory system.

Elasmobranch fishes (sharks, skates and rays) possess highly sensitive electrosensory systems, which enable them to detect weak electric fields such as those produced by potential prey organisms. Different species have unique electrosensory pore numbers, densities and distributions. Functional differences in detection capabilities resulting from these structural differences are largely unknown. Stingrays and other batoid fishes have eyes positioned on the opposite side of the body from the mouth. Furthermore, they often feed on buried prey, which can be located non-visually using the electrosensory system. In the present study we test functional predictions based on structural differences in three stingray species (Urobatis halleri, Pteroplatytrygon violacea and Myliobatis californica) with differing electrosensory system morphology. We compare detection capabilities based upon behavioral responses to dipole electric signals (5.3-9.6 microA). Species with greater ventral pore numbers and densities were predicted to demonstrate enhanced electrosensory capabilities. Electric field intensities at orientation were similar among these species, although they differed in response type and orientation pathway. Minimum voltage gradients eliciting feeding responses were well below 1 nVcm(-1) for all species regardless of pore number and density.

Long-term outcomes of major trauma without head injury in the West of Scotland: pilot case-control study.

The aim of this study was to identify the outcomes of survivors of blunt major trauma (without head injury) 2 years or more following injury. The study uses a case-control design, is set in the West of Scotland and includes trauma patients treated in Greater Glasgow NHS Board hospitals. Participants consisted of patients who had sustained major trauma (injury severity score >15) with little or no head injury at least 2 years before assessment, identified from the Scottish Trauma Audit Group database, and age and sex-matched controls nominated by the index case's general practitioner. Nineteen cases and seven controls completed the study from 223 potential cases and 39 potential controls. Participants and non-participants had comparable injury severity score, probability of survival (Ps) and length of stay. American Medical Association impairment scores show survivors were more impaired than controls (25.9 vs 7.4%, P=0.043). No differences were observed in Functional Independence Measure (FIM) or Community Integration Questionnaire (CIQ) scores, although a type II error is possible. Short-form 36 (SF36) Physical Component Summary (PCS) scores of survivors showed no difference compared with controls although survivors' PCS scores were below UK and US means (P=0.008). SF36 Mental Component Summary (MCS) scores of survivors were below those of controls (45.07 vs 56.65, P=0.004) and normal values of the UK population (P=0.036). No differences in work status were noted, but small sample sizes were used. Non-head-injured survivors of major trauma in the West of Scotland have poorer health status (SF36), physically and mentally, than the UK population. They have greater impairment, but have an employment status comparable to that of the controls. The lack of differences in FIM and CIQ scores between survivors and controls may be due to small sample sizes.

Impact of trauma system structure on injury outcomes: a systematic review protocol.

BACKGROUND: Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of trauma care varies significantly across trauma systems and we know little about which components of trauma systems contribute to their effectiveness. The objective of the study described in this protocol is to systematically review evidence of the impact of trauma system components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization. METHODS: We will perform a systematic review of studies evaluating the association between at least one trauma system component (e.g. accreditation by a central agency, interfacility transfer agreements) and at least one injury outcome (e.g. mortality, disability, resource use). We will search MEDLINE, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, thesis holdings, key injury organisation websites and conference proceedings for eligible studies. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles. Methodological quality will be evaluated using elements of the ROBINS-I tool and the Cochrane risk of bias tool for non-randomized and randomized studies, respectively. Strength of evidence will be evaluated using the GRADE tool. DISCUSSION: We expect to advance knowledge on the components of trauma systems that contribute to their effectiveness. This may lead to recommendations on trauma system structure that will help policy-makers make informed decisions as to where resources should be focused. The review may also lead to specific recommendations for future research efforts. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 28-06-2016. PROSPERO 2016:CRD42016041336 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016041336 .

Spectral Doppler characterization of endoleaks following endoluminal abdominal aortic aneurysm repair.

BACKGROUND: Colour Doppler ultrasound of endoluminal abdominal aortic aneurysm repair is becoming an established imaging technique in identifying endoleak. Management and treatment of endoleak is determined in part by the exact nature of the endoleak, namely its type and whether it has single or multiple vessel inflow and outflow. To date, spectral Doppler waveform analysis has provided some information about the propensity for spontaneous seal of isolated type II endoleaks, rather than assisting in their classification. METHODS: We present a collection of three case reports outlining the directionality/phasicity of the Doppler waveform profile associated with endoleaks whose type and subtype (uni- /or multi-conduital) were angiographically determined. RESULTS: In all three cases uniconduital type II endoleak demonstrated a to-and-fro waveform on Doppler ultrasound imaging. CONCLUSIONS: To-and-fro Doppler waveforms may be associated with uniconduital type II endoleaks. If upon investigation of further cases this is found to be the case, this waveform classification may facilitate determination of the subtype (uni- or multi-conduital) of endoleak, thus identifying those cases which may be more amenable to percutaneous repair.

Can systems biology help to separate evolutionary analogies (convergent homoplasies) from homologies?

Convergent evolutionary analogies (homoplasies) of many kinds occur in diverse phylogenetic clades/lineages on both the animal and plant branches of the Tree of Life. Living organisms whose last common ancestors lived millions to hundreds of millions of years ago have later converged morphologically, behaviorally or at other levels of functionality (from molecular genetics through biochemistry, physiology and other organismic processes) as a result of long term strong natural selection that has constrained and channeled evolutionary processes. This happens most often when organisms belonging to different clades occupy ecological niches, habitats or environments sharing major characteristics that select for a relatively narrow range of organismic properties. Systems biology, broadly defined, provides theoretical and methodological approaches that are beginning to make it possible to answer a perennial evolutionary biological question relating to convergent homoplasies: Are at least some of the apparent analogies actually unrecognized homologies? This review provides an overview of the current state of knowledge of important aspects of this topic area. It also provides a resource describing many homoplasies that may be fruitful subjects for systems biological research.

The greatest step in vertebrate history: a paleobiological review of the fish-tetrapod transition.

Recent discoveries of previously unknown fossil forms have dramatically transformed understanding of many aspects of the fish-tetrapod transition. Newer paleobiological approaches have also contributed to changed views of which animals were involved and when, where, and how the transition occurred. This review summarizes major advances made and reevaluates alternative interpretations of important parts of the evidence. We begin with general issues and concepts, including limitations of the Paleozoic fossil record. We summarize important features of paleoclimates, paleoenvironments, paleobiogeography, and taphonomy. We then review the history of Devonian tetrapods and their closest stem group ancestors within the sarcopterygian fishes. It is now widely accepted that the first tetrapods arose from advanced tetrapodomorph stock (the elpistostegalids) in the Late Devonian, probably in Euramerica. However, truly terrestrial forms did not emerge until much later, in geographically far-flung regions, in the Lower Carboniferous. The complete transition occurred over about 25 million years; definitive emergences onto land took place during the most recent 5 million years. The sequence of character acquisition during the transition can be seen as a five-step process involving: (1) higher osteichthyan (tetrapodomorph) diversification in the Middle Devonian (beginning about 380 million years ago [mya]), (2) the emergence of "prototetrapods" (e.g., Elginerpeton) in the Frasnian stage (about 372 mya), (3) the appearance of aquatic tetrapods (e.g., Acanthostega) sometime in the early to mid-Famennian (about 360 mya), (4) the appearance of "eutetrapods" (e.g., Tulerpeton) at the very end of the Devonian period (about 358 mya), and (5) the first truly terrestrial tetrapods (e.g., Pederpes) in the Lower Carboniferous (about 340 mya). We discuss each of these steps with respect to inferred functional utility of acquired character sets. Dissociated heterochrony is seen as the most likely process for the evolutionarily rapid morphological transformations required. Developmental biological processes, including paedomorphosis, played important roles. We conclude with a discussion of phylogenetic interpretations of the evidence.

Boron phenylalanine and related impurities: HPLC analysis, stability profile and degradation pathways.

Boron phenylalanine is one of the lead drug candidates in the field of Boron Neutron Capture Therapy. Its inherent low toxicity allows large doses to be administered, but this makes it important to identify, rationalise and quantify impurities. Here we report a chromatographic assay method, the conditions under which the parent compound is unstable, and the suggested degradation mechanisms.

Desymmetrization of cyclic meso-epoxides with silicon tetrachloride catalyzed by PINDOX, a chiral bipyridine mono-N-oxide.

PINDOX 8 has been identified as a chiral organocatalyst for the enantioselective ring-opening of cyclic meso-epoxides with SiCl(4) to produce chlorohydrins in up to 90% ee. The catalyst is most effective with saturated cyclic substrates containing more than seven carbon units.

Cyanoacrylate embolization of endoleaks after abdominal aortic aneurysm repair.

INTRODUCTION: Type II endoleaks occur in up to a fifth of endoluminal repairs for abdominal aortic aneurysms and are commonly treated when aortic sac expansion can be demonstrated. Technical failure is common when catheter-guided particulates or coil embolic agents are used. Presented here is a feasibility study using catheter-directed N-butyl-2-cyanoacrylate (Histoacryl, Braun, Tuttlingen, Germany) embolotherapy. METHOD: A retrospective review of the case notes of patients undergoing embolization procedures for type II endoleaks with expanding sacs was performed from this centre's cohort of endoluminal aortic repair patients under surveillance. Data on patients with type II endoleaks who were treated with either or both cyanoacrylate and coil embolization were extracted. The outcomes were then compared. RESULTS: In total, five cases were identified, and four of these cases had both coil and glue embolization. Technical success was defined as endoleak closure proven on follow-up computed tomographic imaging. Technical success was achieved in all four patients treated with intra-sac cyanoacrylate. One case treated initially with coil embolization was successful. All patients had a computed tomographic scan at 3 months. One minor complication occurred that resolved without treatment. DISCUSSION: Type II endoleaks after EVAR with expanding sacs require treatment. Percutaneous catheter-directed cyanoacrylate embolization offers an alternative to coil or particulate embolization and, in this series, was found to be more likely to result in endoleak closure.

Abdominal aortic aneurysm surveillance: application of the UK Small Aneurysm Trial to a New Zealand tertiary hospital.

AIMS: We present 5-year results of an abdominal aortic aneurysm surveillance programme at Christchurch Hospital, based on the UK Small Aneurysm Trial. METHOD: Patients with infrarenal abdominal aortic aneurysms between 30 and 55 mm were placed in an ultrasound-based surveillance programme with an intention to treat when their aneurysms reached the Vascular Service determined threshold, when the AAA became symptomatic, or when rapid AAA growth was demonstrated. Patients were divided into three groups: Group 1, those currently under or those who had completed surveillance (n=198); Group 2, those excluded from surveillance and therefore treatment due to unsuitability for open surgical or endoluminal exclusion who had not completed surveillance (n=18); and Group 3, those who declined surgery on completion of surveillance (n=5). We looked at the number of aneurysm-related deaths in these groups and examined any issues that arose during or upon completion of surveillance. RESULTS: There were five aneurysm-related deaths in Group 1. There was one aneurysm-related death in Group 2, and one in Group 3. CONCLUSION: The data highlights problems related to setting threshold diameters for abdominal aortic aneurysms in women, and to the interval between completion of surveillance and undergoing endoluminal or open surgical repair.