scholarly journals 890 Predictive Factors for Mortality Following Trauma & Orthopaedic Surgery in The Covid-19 Pandemic. The Manchester Equation

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Waugh ◽  
N Jain ◽  
A Bhutta ◽  
T Havenhand ◽  
M Qureshi ◽  
...  
Keyword(s):  
Decision Making ◽  
Mortality Rate ◽  
Predictive Factors ◽  
Mortality Risk ◽  
Scoring System ◽  
Orthopaedic Surgery ◽  
Clinical Decision Making ◽  
Surgical Intervention ◽  
Clinical Decision ◽  
Surgical Mortality

Abstract Introduction Covid-19 caused many service changes including limitations on operations due to potential increased mortality risk to patients. We report our findings from Trauma & Orthopaedic (T&O) surgical mortality through this period and the effectiveness of using a scoring system (The Manchester Equation) to predict likelihood of mortality. Method We reviewed all T&O admissions that underwent surgical intervention during the height of the pandemic. We recorded numerous factors for each patient including mortality and Covid status. From this we created a scoring system which is the product of Covid status, Anaesthetic type, Medical co-morbidities and other medical factors and ASA Score. We then analysed the findings to determine whether the score could be predictive of mortality rate. Results Of 123 patients undergoing surgery 6 deaths were observed (mean score of 51.3) compared to 117 patients surviving (mean score 31.9), p = 0.001. A score of less than 32 carried a 0% chance of death whereas a score of 32 or more resulted in a 14.6% mortality rate (p = 0.01). Conclusion The Manchester Equation can be used to help predict the mortality rate of T&O surgery in the presence of Covid-19 and may be useful for clinical decision making and consent purposes.

scholarly journals INNV-34. PATTERNS OF FAILURE AND DEVELOPMENT OF A NOVEL PROGNOSTIC SCORING SYSTEM IN ELDERLY PATIENTS WITH GLIOBLASTOMA – FOLLOW UP ON 10 YEAR ANALYSIS OF THE BC CANCER AGENCY POPULATION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi137-vi137
Author(s):  
Jonathan Zeng ◽  
Kimberly DeVries ◽  
Andra Krauze
Keyword(s):  
Decision Making ◽  
Scoring System ◽  
Clinical Decision Making ◽  
Radiographic Progression ◽  
Clinical Decision ◽  
Patient Stratification ◽  
Patterns Of Failure ◽  
Resection Status ◽  
Cancer Agency

Abstract PURPOSE Glioblastomas (GBM) are the most common primary brain tumour recurring in most patients despite maximal management. Patient selection for appropriate treatment modality remains challenging resulting in heterogeneity in management. We examined the patterns of failure and developed a scoring system for patient stratification to optimise clinical decision making. METHODS 822 adults (BC Cancer Agency registry) diagnosed 2005–2015 age ≥60 with histologically confirmed GBM ICD-O-3 codes (9440/3, 9441/3, 9442/3) were reviewed. Univariate and Kaplan-Meier analysis were performed. Performance status (PS), age and resection status were assigned a score, cummulative maximal (favorable) score of 10 and minimum (unfavorable) score of 3. Patterns of failure were further analysed in the subset of patients with radiographic follow-up. RESULTS PS score of 3(KPS >80, ECOG 0/1), 2 (KPS 60–70, ECOG 2), 1 (KPS < 60, ECOG 3/4) (median OS 11, 6, 3 months respectively), age score and resection status were prognostic for OS with PS resulting in the most significant curve separation (p< 0.0001). Biopsy as compared to STR/GTR resulted in poorer OS in patients over 70 (age score 1/2) but had less impact in patients younger than 70 (age scores 3/4). The median OS for cumulative scores of 9/10 (123 patients), 7/8 (286 patients), 5/6 (313 patients), and 3/4 (55 patients) were 14, 8, 4 and 2 months respectively (p< 0.0001) allowing for stratification into 4 prognostic groups. 133 patients had >3 MRIs following diagnosis allowing for clinical and radiographic analysis of progression. Clinical/radiographic progression occurred within 3 months (29%/45%), 6 months (50%/66%), 9 months (70%/81%). Progression type (radiographic, clinical, both was not associated with OS. CONCLUSION Our novel prognostic scoring system is effective in achieving patient stratification and may guide clinical decision making. Early radiographic progression appears to precede clinical deterioration and may represent true progression in the elderly.

scholarly journals A new severity scoring system designed for the management of adult spinal tuberculosis—a retrospective case series study

2020 ◽  
Author(s):  
Qi Wang ◽  
Xiaobo Luo ◽  
Chi Wang ◽  
Wenhao Hu ◽  
Litao Li ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Scoring System ◽  
Clinical Decision Making ◽  
Spinal Tuberculosis ◽  
Case Series ◽  
Reliability And Validity ◽  
Clinical Decision ◽  
Severity Scoring ◽  
Case Series Study

Abstract Background: Surgeons have been successfully handle with spinal tuberculosis via conservative or surgical treatment. However, There are quite few classifications or scoring systems concerning spinal tuberculosis to guide the surgeons to manage the complicated pattern of spinal tuberculosis. The purpose of this study is to design a practical, yet comprehensive, severity scoring system for spinal tuberculosis that helps in clinical decision-making in terms of the need for operative versus non-operative management.Methods: A group of 129 spinal tuberculosis cases (70 male and 59 female patients) successfully treated and followed up for at least 2 years were retrospectively reviewed. Clinical spine experts from our institutions were gathered to confirm the information they considered pivotal in the communication of spinal tuberculosis and the clinical decision-making process. Typical spinal tuberculosis patterns were reviewed and reconsidered in view of these essential characteristics. An initial validation process to determine the reliability and validity of this system was also undertaken. Results: A new severity scoring system was designed based on three essential characteristics: 1) the stability of spinal infectious segments determined by imaging appearance, 2) the cause of spinal cord compression and the severity of neurologic deficit, and 3) the efficacy of the anti-tuberculosis drug therapy. A severity score was calculated from these characteristics, which divided patients into surgical and nonsurgical treatment groups. Conclusions: The severity scoring system comprehensively considers features cited in the literature including prediction of spinal stability and kyphosis deformity progression, identification of neurologic compromise and characteristics of mechanical compression of spinal cord. This classification system is intended to facilitate clinical decision-making in the management of adult spinal tuberculosis (from C3 to L5 segments) . The severity scoring system may help to improve the communication among spine surgeons. Further studies are needed to determine the reliability and validity of this system.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 221S-230S ◽  
Author(s):  
Michael G. Fehlings ◽  
Allan R. Martin ◽  
Lindsay A. Tetreault ◽  
Bizhan Aarabi ◽  
Paul Anderson ◽  
...  
Keyword(s):  
Decision Making ◽  
Outcome Prediction ◽  
Clinical Decision Making ◽  
Surgical Intervention ◽  
Clinical Decision ◽  
Clinical Expertise ◽  
Resonance Imaging ◽  
Cord Injury

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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