Factors predicting the transition from acute to persistent pain in people with 'sciatica': the FORECAST longitudinal prognostic factor cohort study protocol.

INTRODUCTION: Sciatica is a common condition and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared with low back pain alone. Although many patients recover, a third develop persistent sciatica symptoms. It remains unclear, why some patients develop persistent sciatica as none of the traditionally considered clinical parameters (eg, symptom severity, routine MRI) are consistent prognostic factors.The FORECAST study (factors predicting the transition from acute to persistent pain in people with 'sciatica') will take a different approach by exploring mechanism-based subgroups in patients with sciatica and investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica. METHODS AND ANALYSIS: We will perform a prospective longitudinal cohort study including 180 people with acute/subacute sciatica. N=168 healthy participants will provide normative data. A detailed set of variables will be assessed within 3 months after sciatica onset. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will determine outcome with the Sciatica Bothersomeness Index and a Numerical Pain Rating Scale for leg pain severity at 3 and 12 months.We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small data sets will be used to identify the most powerful predictors and model selection/accuracy.The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and may identify prognostic factors of pain persistence. ETHICS AND DISSEMINATION: The FORECAST study has received ethical approval (South Central Oxford C, 18/SC/0263). The dissemination strategy will be guided by our patient and public engagement activities and will include peer-reviewed publications, conference presentations, social media and podcasts. TRIAL REGISTRATION NUMBER: ISRCTN18170726; Pre-results.

Ambulatory Pathway for the Management of Superficial Abscesses: Criteria for Safe Provision of Care.

Background Superficial abscesses are common surgical emergencies and unless complicated, are considered a low-priority emergency often leading to delayed primary treatment. Patients who are clinically stable benefit more from an ambulatory-care approach to their treatment. Aim of study This is a retrospective study to investigate the current practice of treatment of superficial abscesses at West Suffolk Hospital, United Kingdom, and evaluate the potential impact of implementing care via the ambulatory pathway to improve patients' experience, optimise the use of hospital resources and identify areas for service improvement. Patients and methods A total of 76 patients who required inpatient care for drainage of their superficial abscess under general anaesthesia over six months were a part of the study. Admission, procedure, and hospital stay characteristics were evaluated as well as our proposed superficial abscess ambulatory-care pathway (SAAP) criteria. Results The mean age was 39 ± 18 years. Perianal and pilonidal abscesses accounted for 53% of the procedures. Only 24% of the patients had a C-reactive protein (CRP) >100 at admission. The average waiting time before intervention was 19 hours (± 16.25) with patients spending two days on average in the hospital for a procedure that lasted an average of 31 minutes. Overall, 39.5% of the patients received drainage of their abscess on the same day of presentation to the hospital with only five discharges on the same day of admission. Of the total patients, 52.6% met our SAAP criteria for ambulatory care and could have avoided inpatient care and benefitted from same-day discharges. Conclusion Ambulatory care of a superficial abscess is a safe, feasible approach. We recommend establishing an ambulatory care pathway for the management of superficial abscess cases with our SAAP criteria serving as a useful objective guide for effective and safe triage of patients with reduced hospital stay and more efficient utilisation of resources.