Acute haemorrhage rate in 28,000 Out-of-Hours CT heads

Objectives: The aim of this paper is to assess the acute haemorrhage rate in patients who had CT head investigation out-of-hours with and without trauma and compare the rates of haemorrhage between warfarin and DOACs, at a busy teritary teaching hospital. Methods: All CT heads performed between January 2008 and December 2019 were identified from the radiology information system (RIS) at Sheffield Teaching Hospitals (STH), with the requesting information being available from January 2015. The clinical information was assessed for the mention of trauma or anticoagulation and the reports were categorised into acute and non-acute findings. Results: Between 2008 and 2019 the number of scans increased by 63%, with scans performed out of hours increasing by 278%. Between 2015 and 2019, the incidence of acute ICH was similar over the 5 year period, averaging at 6.9% and ranging from 6.1 to 7.6%. The rate of detection of acute haemorrhage following trauma was greater in those not anticoagulated (6.8%), compared with patients on anticoagulants such as warfarin (5.2%) or DOACs (2.8%). Conclusions: Over 12 years, there has been a significant increase in the number of CT heads performed at STH. The rate of ICH has remained steady over the last 5 years indicating a justified increase in imaging demand. However the incidence of ICH in patients prescribed DOACs is lower than the general population and those on warfarin. Advances in knowledge: : This finding in a large centre should prompt discussion of the risk of bleeding with DOACs in relation to CT head imaging guidelines.

Postpartum haemorrhage and synthetic oxytocin dilutions in labour

This study investigated postpartum haemorrhage and historic oxytocin usage, because haemorrhage rates are rising. During the evolution of practice from intravenous bovine post-pituitary extract to synthetic oxytocin, experimental interventions had produced improved outcomes in certain cases and the postpartum haemorrhage rate was low. In this study, current synthetic oxytocin regimes from across the UK were compared with the 1977 (unchanged) licensed instructions for infusion. As a result of the pain-inducing properties of synthetic oxytocin, epidural analgesia prior to infusion is now standard for unlicensed regimes, adding complexity to intrapartum care and greater risks of complex births, as the fetus may be adversely affected by epidural drugs and acidosis. Unlicensed synthetic oxytocin dilutions and increments, the desensitising of oxytocin receptors, and unmeasured error factors in infusion pumps affect labour progress and outcomes. Today's rates of postpartum haemorrhage are associated with these changes to obstetric practice. Failure to inform women of intended unlicensed practices with synthetic oxytocin, or obtain consent for such, or offer licensed practice as standard constitutes neglect of the legal obligations outlined for doctors and midwives by professional Codes of Practice, intended to protect patients from predictable dangers.

709 A Prospective Analysis of Post-Tonsillectomy Haemorrhage and Hospital Reamission Rates in A Tertiary Pediatric Centre

Introduction Tonsillectomies are one of the most commonly performed procedures., with one particular leading tertiary paediatric centre performing 1,067 tonsillectomies within the last year. Post-tonsillectomy haemorrhage is a considerable complication leading to further primary care costs, readmission, and surgical intervention. Previous national audits have suggested that post-tonsillectomy haemorrhage rates are between 3.0-3.5%1 and readmission rates are approximately 8.8%2. Aim Assess post-tonsillectomy haemorrhage and readmission rates at a leading tertiary paediatric centre. Method A prospective phone survey was completed for every patient receiving a tonsillectomy 6 weeks post-operatively, using a 2-month inclusion period. Results Of the 51 patients included, 51 responded to phone survey. The total post-tonsillectomy haemorrhage rate was 23.5%. Of the 51 respondents, 10 (19.6%) were readmitted through A&E, all of which had extracapsular tonsillectomies. 1 (10%) of those readmitted had further surgical intervention whilst the remaining 9 (90%) were treated conservatively. A further 4 (7.8%) attended their GP, with 3 (75%) of those requiring antibiotics. Conclusions This data shows that both the post-tonsillectomy haemorrhage and readmission rates at the tertiary paediatric centre were higher than the national average. We suggest that previous national data audits describing bleeding rates lack the granularity to reveal true post-operative complication rates. Our prospective cohort has demonstrated that there may be a large proportion of patients with morbidity that never reach the attention of the ENT surgeon and additionally that subgroups in particular may benefit from interventions designed to minimise patients’ post-operative risks, including specific perioperative management and advice.

Winter – the Increment of Spontaneous ICH

Background: Spontaneous intracranial haemorrhage (ICH) is defined as intraparenchymal bleeding in the absence of trauma or surgery. Spontaneous ICH is most disabling and deadly type of stroke. Meteorologic factors and seasons on the incidence of spontaneous ICH with ambiguous results. Objectives: To determine whether different seasons had any relationship with the rate of primary intracerebral hemorrhage. Methods: Total of 209 patients were diagnosed as spontaneous ICH and they have been first time reported & admitted in Combined Military Hospital (CMH) Dhaka, between Jan 2017 and December 2018. Males were 146(69.85%), females were 63(30.15%) and were aged between 18 and 95 years old. Diagnosis was based on history, clinical examination and non-contrast Computed Tomography(CT) scan of brain. Results: 209 admitted patients in CMH Dhaka from Jan 2017- Dec 2018 are included in our study who full-fill the criteria. Intracerebral haemorrhage rate among age group less than 55years old being 55(26.31%) and 55 years and above 154(73.69%).There were a significant relationship between different seasons and intracerebral haemorrhage. Intracerebral haemorrhage incidence in winter season 61(29.18%) and late autumn 19(9.09%), out of 209 patients. Among them hypertensive patients were 137(65.55%) and non-hypertensive patient 72(34.45%), 170 (81.33%) were nondiabetic & 39(18.66%) diabetic of total 209 patients.Out of 61 patients in winter; 54 (88.52%) hypertensive patients had large sized haemorrhage. Conclusion: The highest rate of intracerebral haemorrhage during December-January. There is a seasonal variation in patient’s age, incidence among hypertensive patients, size of hemorrhage and more in number in winter season. Bang. J Neurosurgery 2020; 9(2): 130-134

Known and unknown cerebral arteriovenous malformations in pregnancies: haemorrhage risk and influence on obstetric management

Objective The objective of this study was to evaluate the haemorrhage risk of known and unknown cerebral arteriovenous malformations and their obstetric management. Methods A retrospective review was performed and analysed 67 consecutive cases of arteriovenous malformation with pregnancy history. Results Sixty-seven cases of arteriovenous malformation with pregnancy histories were identified. In 14 cases (20.9%) of arteriovenous malformation diagnosed before pregnancy, 11 cases were treated (10 embolisation and one surgery), there was no haemorrhage in 14 pregnancies, 14 healthy babies were delivered by caesarean section in 12 pregnancies (85.7%) and vaginal delivery in two pregnancies (14.3%). In 53 cases (89.1%) of arteriovenous malformation diagnosed during/after pregnancy, there was one (1.6%) case of subarachnoid haemorrhage at 38 weeks’ gestation in 64 pregnancies, 64 healthy babies were delivered by caesarean section in 11 pregnancies (17.2%) and vaginal delivery in 53 pregnancies (82.8%). This resulted in 1.6% (95% confidence interval 0–4.6%) haemorrhage rate per pregnancy in unknown arteriovenous malformations. Known arteriovenous malformation gravida was prone to caesarean section; however, vaginal delivery did not increase the haemorrhage risk in unknown arteriovenous malformation gravidas (1.8% vs. 0%, P = 1.000). Conclusion Prior treatment for ruptured arteriovenous malformation could prevent its haemorrhage during pregnancy and the haemorrhage risk of unruptured arteriovenous malformation in pregnancies is low. Although known arteriovenous malformation gravida is prone to caesarean section, vaginal delivery seems not to increase the haemorrhage risk in unknown arteriovenous malformation gravidas.

(Ton)silly seasons? Do atmospheric conditions actually affect post-tonsillectomy secondary haemorrhage rates?

Background:Tonsillectomy is a common procedure, with potentially life-threatening complications. Previous investigations into post-tonsillectomy secondary haemorrhage rates suggest an influence of climactic and atmospheric conditions on haemorrhage rate, particularly temperature and water vapour pressure. With a single emergency department and a large variance in atmospheric conditions, Darwin, Australia, is ideal for investigating the effects of local climate on rates of post-operative haemorrhage.Methods:A five-year retrospective review was conducted of all tonsillectomy procedures performed between 2008 and 2013. Effects of atmospheric variables were examined using Pearson's correlation coefficient and analysis of variance.Results:A total of 941 patients underwent tonsillectomy in the study period. The bleeding rate was 7.7 per cent. No variation was found between wet and dry season tonsillectomies (p= 0.4). Temperature (p= 0.74), water vapour pressure (p= 0.94) and humidity (p= 0.66) had no effect on bleeding.Conclusion:The findings revealed no correlation between humidity, season, water vapour pressure and haemorrhage rates. Further research should use multi-site data to investigate the effect of air conditioning, humidification and climactic conditions between different regions in Australia.

Intra-Arterial Therapy as a Rescue Strategy after Clinically Failed Intravenous Thrombolysis May Increase the Likelihood of a Good Outcome in Patients with Severe Ischaemic Stroke

The purpose of this study was to evaluate the efficacy and safety of intra-arterial therapy as a rescue strategy after clinically failed intravenous thrombolysis (IVT) in acute ischaemic stroke patients. We conducted a retrospective analysis of consecutive acute ischaemic stroke patients treated with rescue therapy. The results from this study group were compared with those obtained from a control group consisting of 260 consecutive patients treated with IVT alone. The study group consisted of 52 patients with a mean age of 63 years and a median NIHSS score at admission of 17. Recanalization was achieved in 92% with a symptomatic haemorrhage rate of 9.6%. Rescue patients admitted with a severe stroke (NIHSS score >12) had a significantly better outcome at 90 days compared to patients with the same score but treated with IVT alone. No difference was seen for patients with a lower score at admission. This study indicates that rescue therapy may increase the proportion of patients with independent outcome if presenting with a severe stroke (NIHSS score >12) without increasing the rate of symptomatic haemorrhage.

Is there any role of post operative antibiotics in reducing secondary haemorrhage after tonsillectomy

Objective: To compare with and without the antibiotic therapy in reducing post-tonsillectomy secondary haemorrhage.Method: A prospective study was conducted at Shaheed Shamsuddin Ahmed Hospital, Sylhet from April 2010 to April 2012. 170 patients who underwent tonsillectomy divided into two groups randomly each consisting of 85 patients. In group A (intervention group) - antibiotic was given post-operatively, while in group B (control group) - no antibiotic was given. Postoperative follow-up was done till the tonsillar fossa healed.Results: Among 170 patients 61.18% were female and 38.82% were male, mean age was 21.58 years. One patient from antibiotic group had secondary haemorrhage (1.18%), while no haemorrhage was observed in non- antibiotic group. Secondary haemorrhage rate was 0.59% in total study population.Conclusion: The study showed that antibiotic did not have any significant role in reducing the post-tonsillectomy secondary haemorrhage DOI: http://dx.doi.org/10.3329/bjo.v18i2.12009 Bangladesh J Otorhinolaryngol 2012; 18(2): 166-170

Paediatric day-case tonsillectomy: a three-year prospective audit spiral in a district hospital

Background:Paediatric tonsillectomy is a common ENT operation. The use of day-case surgery is increasing, in order to improve efficiency in healthcare.Methods:A prospective audit spiral was carried out from January 2006 to December 2008 for all children undergoing day-case tonsillectomy at Huddersfield Royal Infirmary.Results:There was a haemorrhage rate of 2.6 per cent over three years. The most common complication was nausea and vomiting, seen in 5.3 per cent of patients.Conclusions:For a well selected group of children, day-case tonsillectomy in a district hospital setting is a safe and efficient alternative to an in-patient stay. A dedicated day-case team, good anaesthetic technique, adequate post-operative analgesia and on-site paediatric in-patient facilities are essential.