Head and neck cancer: A 6-year retrospective analysis and review of three common triaging systems.

OBJECTIVES: In the United Kingdom, head and neck cancer (HNC) cases continue to rise and are the fourth commonest cancers in men. Additionally, in the last decade, the incidence rise in women is twice their male counterpart, signifying the need for robust and dynamic triaging systems to maintain high pick-up rates across both genders. This study investigates local risk factors associated with HNC and reviews the most commonly used guidelines and risk calculator tool for two-week-wait (2ww) HNC clinics. DESIGN: Six-year retrospective case-control analysis of 2ww HNC clinics within a district general hospital in Kent studying symptoms and risk factors. RESULTS: Two hundred cancer patients (128M:72F) were identified and compared against 200 randomised non-cancer patients (78M:122F). Increasing age, male gender, smoking, previous cancer and neck lumps were statistically relevant risk factors for HNC (p < .001). HNC mortality at 1 and 5 years was 21% and 26%, respectively. Adjusting guidelines to improve local services obtained the following area under curve (AUC) scores: NICE guidelines 67.3, Pan-London 58.0 and HNC risk calculator version 2 (HaNC-RC V.2) 76.5. Our adjusted HaNC-RC V.2 improved sensitivity by 10% to 92%, and theoretically reduces local general practice referrals by 61% when utilising triaging staff. CONCLUSION: Our data portray the primary risk factors as increasing age, male gender and smoking for this demographic. The presence of a neck lump was the most significant symptom within our cohort. This study demonstrates a critical balance when adjusting sensitivity and specificity of guidelines and proposes that departments adjust diagnostic tools for their local demographic to improve referral numbers and patient outcomes.

Coblation® intracapsular tonsillectomy in children with recurrent tonsillitis: Initial experience.

OBJECTIVES: The use of Coblation® intracapsular tonsillectomy for the treatment of sleep disordered breathing (SDB)/obstructive sleep apnoea (OSA) has an increasing evidence base. However, the results for tonsillitis as the predominant indication for surgery are not as clear. We present our initial results from 80 paediatric cases undergoing Coblation® intracapsular tonsillectomy for infective indications. METHODS: Prospective case series within the secondary care environment, January 2016-July 2018, all with completed follow-up. We utilised the validated T14 tonsil symptom questionnaire pre- and postoperatively and also collected data regarding postoperative complications. RESULTS: 80 consecutive patients (age range 2-16 years and mean 7.2 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy) predominantly for infective reasons although some also had concomitant adenoidectomy for snoring/sleep disordered breathing were included. Mean follow-up was at 13 months postoperatively. 38 children had tonsillitis (with or without snoring) and 42 children had SDB in combination with tonsillitis. The mean over-all total T14 score was 32.7 preoperatively and 2.7 postoperatively (p < 0.0001). The mean infective score was 22.1 preoperatively and 1.5 postoperatively (p < 0.0001). The mean SDB score was 10.6 preoperatively and 1.5 postoperatively (p < 0.0001). There were no cases of haemorrhage, re-admission or regrowth noted. CONCLUSION: Coblation® intracapsular tonsillectomy is a safe and effective technique for treating children with recurrent tonsillitis. Future studies should incorporate longer term follow-up.

Is the target of 1 day length of stay per 1% total body surface area burned actually being achieved? A review of paediatric thermal injuries in South East Scotland.

OBJECTIVES: Length of stay is a standard variable used to evaluate outcomes in burn care. Is the target of 1 day length of stay per 1% total body surface area burned actually being achieved? METHODS: A retrospective analysis of 328 paediatric thermal injuries admitted to the South East Scotland Regional Burn Unit between January 2003 and March 2007 to assess whether the target is met and if not, which factors are contributing to a prolonged hospitalisation. RESULTS: 57% achieved the target and 43% failed the target. Factors associated with a lengthened hospital stay were burn depth, burn location, presence of infection/sepsis and the need for theatre visits for either dressing change or surgical intervention. CONCLUSIONS: Many factors can contribute to patients' length of hospital stay. It is valuable to identify areas of practice which can be altered to minimise the impact of these factors. For example, consider the use of laser Doppler imaging to help assess burn depth more accurately; this leading to potentially more accurate requirements for surgery or not, early excision of deep burns, improved infection control and use of dressings may all contribute to reduce the length of inpatient stay with a view to improving patient outcome.

Temporal artery biopsy size does not matter.

This study aimed to clarify whether positive temporal artery biopsies had a greater sample length than negative biopsies in temporal arteritis. It has been suggested that biopsy length should be at least 1 cm to improve diagnostic accuracy. A retrospective review of 149 patients who had 151 temporal artery biopsies was conducted. Twenty biopsies were positive (13.3%), 124 negative (82.1%) and seven samples were insufficient (4.6%). There was no clinically significant difference in the mean biopsy size between positive (0.7 cm) and negative samples (0.65 cm) (t-test: p = .43 NS). Ninety-four patients fulfilled all three ACR criteria prior to biopsy (62.3%) and four patients (2.6%) changed ACR score from 2 to 3 after biopsy. Treatment should not be delayed in anticipation of the biopsy or withheld in the case of a negative biopsy if the patient's symptoms improve.