Adverse Events Relating to Prolonged Hard Collar Immobilisation: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar. METHODS: Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies. RESULTS: The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication. CONCLUSIONS: There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.

Proposal for establishment of the UK Cranial Reconstruction Registry (UKCRR).

BACKGROUND: The increasing utilisation of decompressive craniectomy for traumatic brain injury and stroke has led to an increase in the number of cranioplasties undertaken. Cranioplasty is also undertaken following excision of tumours originating from or invading the skull vault, removal of bone flaps due to post-operative infection, and decompressive craniectomy for the management of rarer causes of brain oedema and/or refractory intracranial hypertension. The existing literature which mainly consists of single-centre, retrospective studies, shows a significant variation in practice patterns and a wide range of morbidity. There also exists a need to measure the outcome as perceived by the patients themselves with patient reported outcome measures (PROMs; functional outcome, quality of life, satisfaction with cosmesis). In the UK, the concept of long-term surveillance of neurosurgical implants is well established with the UK shunt registry. Based on this background, we propose to establish the UK Cranial Reconstruction Registry (UKCRR). AIM: The overarching aim of the UKCRR is to collect high-quality data about cranioplasties undertaken across the UK and Ireland in order to improve outcomes for patients. METHODS: Any patient undergoing reconstruction of the skull vault with autologous bone, titanium, or synthetic material in participating units will be eligible for inclusion. Data will be submitted directly by participating units to the Outcome Registry Intervention and Operation Network secure platform. A Steering Committee will be responsible for overseeing the strategic direction and running of the UKCRR. OUTCOME MEASURES: These will include re-operation due to a cranioplasty-related issue, surgical site infection, re-admission due to a cranioplasty-related issue, unplanned post-operative escalation of care, adverse events, length of stay in admitting unit, destination at discharge from admitting unit, mortality at discharge from admitting unit, neurological status and PROMs during routine follow-up. CONCLUSION: The UKCRR will be an important pillar in the ongoing efforts to optimise the outcomes of patients undergoing cranioplasty.

Patients' and staff's experiences of multidisciplinary follow-up for high-grade glioma after radical radiotherapy.

Meeting the complex needs of patients with high-grade glioma requires multidisciplinary input. How best to provide care after initial treatment ends is contentious. This study explored the experiences of patients and staff at one UK centre where regular multidisciplinary clinics and brain scanning is provided. In-depth interviews conducted with 10 patients and six staff were transcribed and analysed qualitatively. Patients reported: supportive, individualised care with familiar staff; good communication; that regular scanning was reassuring. Staff believed that team follow-up facilitated immediate decision-making and referral, and reduced visits. They felt that patients value seeing their scans. Patients and staff described positive and negative experiences of multidisciplinary follow-up. There is need to investigate the impact of different approaches to ongoing care.

Acute cerebral tissue oxygenation changes following experimental subarachnoid hemorrhage.

Primary brain ischemia following subarachnoid hemorrhage is a major cause of morbidity and mortality. This study aims to determine whether changes in cerebral tissue oxygenation are related to cerebral blood flow changes in the acute phase following experimental subarachnoid hemorrhage. The endovascular puncture model was used to study subarachnoid hemorrhage in male Wistar rats with a tissue oxygenation probe and a laser Doppler probe placed contralateral to the side of hemorrhage. Following the subarachnoid hemorrhage intracranial pressure rose to 53.0 +/- 9.8 mmHg (mean +/- SEM). This was associated with a fall in cerebral blood flow to 43.9% +/- 7.1% of its baseline value and a fall in tissue oxygenation to 42.8% +/- 7.7% of baseline. The time course of the fall and recovery in tissue oxygenation was closely correlated to that of the cerebral blood flow (r = 0.66, p = 0.02). The fall in cerebral blood flow was associated with a 42.1% +/- 6.47% fall in the concentration of moving blood cells and a rise of 181.2% +/- 27.2% in velocity indicating acute microcirculatory vasoconstriction. Interstitial tissue oxygenation changes mirrored changes in cerebral blood flow indicating that a change in oxygen delivery was occurring.