9 results on '"Moran, C."'
Search Results
2. II. Major trauma networks in England.
- Author
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McCullough, A. L., Haycock, J. C., Forward, D. P., and Moran, C. G.
- Subjects
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WOUNDS & injuries , *MORTALITY , *DISABILITIES , *TRAFFIC accidents , *TRAUMA severity indices , *RESUSCITATION , *NATIONAL health services , *PATIENTS - Published
- 2014
- Full Text
- View/download PDF
3. Time to definitive care within major trauma networks in England.
- Author
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Haslam NR, Bouamra O, Lawrence T, Moran CG, and Lockey DJ
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Emergency Medical Services statistics & numerical data, Emergency Medical Services trends, England epidemiology, Female, Humans, Infant, Infant, Newborn, Injury Severity Score, Logistic Models, Male, Middle Aged, Patient Transfer statistics & numerical data, Time-to-Treatment trends, Trauma Centers statistics & numerical data, Young Adult, Emergency Medical Services organization & administration, Time-to-Treatment statistics & numerical data, Trauma Centers organization & administration, Wounds and Injuries mortality, Wounds and Injuries surgery
- Abstract
Background: Significant mortality improvements have been reported following the implementation of English trauma networks. Timely transfer of seriously injured patients to definitive care is a key indicator of trauma network performance. This study evaluated timelines from emergency service (EMS) activation to definitive care between 2013 and 2016., Methods: An observational study was conducted on data collected from the UK national clinical audit of major trauma care of patients with an Injury Severity Score above 15. Outcomes included time from EMS activation to: arrival at a trauma unit (TU) or major trauma centre (MTC); to CT; to urgent surgery; and to death., Results: Secondary transfer was associated with increased time to urgent surgery (median 7·23 (i.q.r. 5·48-9·28) h versus 4·37 (3·00-6·57) h for direct transfer to MTC; P < 0·001) and an increased crude mortality rate (19·6 (95 per cent c.i. 16·9 to 22·3) versus 15·7 (14·7 to 16·7) per cent respectively). CT and urgent surgery were performed more quickly in MTCs than in TUs (2·00 (i.q.r. 1·55-2·73) versus 3·15 (2·17-4·63) h and 4·37 (3·00-6·57) versus 5·37 (3·50-7·65) h respectively; P < 0·001). Transfer time and time to CT increased between 2013 and 2016 (P < 0·001). Transfer time, time to CT, and time to urgent surgery varied significantly between regional networks (P < 0·001)., Conclusion: Secondary transfer was associated with significantly delayed imaging, delayed surgery, and increased mortality. Key interventions were performed more quickly in MTCs than in TUs., (© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.)
- Published
- 2020
- Full Text
- View/download PDF
4. Predictors and outcomes of treatment in hip hemiarthroplasty dislocation.
- Author
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Salem KM, Shannak OA, Scammell BE, and Moran CG
- Subjects
- Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip instrumentation, Arthroplasty, Replacement, Hip methods, Arthroplasty, Replacement, Hip mortality, England epidemiology, Female, Hemiarthroplasty instrumentation, Hemiarthroplasty mortality, Hip Dislocation mortality, Hip Dislocation surgery, Hip Prosthesis, Humans, Intraoperative Period, Kaplan-Meier Estimate, Male, Postoperative Complications epidemiology, Prospective Studies, Risk Factors, Treatment Outcome, Arthroplasty, Replacement, Hip adverse effects, Femoral Neck Fractures surgery, Hemiarthroplasty adverse effects, Hip Dislocation etiology
- Abstract
Introduction: Dislocation following hip hemiarthroplasty (HHA), its incidence, predictors, treatment outcomes and mortality were investigated in a single centre series., Methods: The prospectively collected data on neck of femur fracture admissions compiled over 11 years were reviewed. Place of residence, place of fall, past medical history, intraoperative factors (grade of surgeon, delay in surgery, type of implant and operative time), postoperative complications and mortality were compared between patients who suffered a dislocation and those who did not. In the dislocation group, the mean number of dislocations, reduction method, type and fate of implant, and mortality were investigated., Results: Prospective data on 8,631 admissions were collected; 41% of these were managed with a HHA. The dislocation rate was 0.76%. A delay in surgery of >24 hours was associated with a fourfold increase in the dislocation risk. The majority (81%) of dislocations occurred in the first six weeks and closed manipulation was the definitive treatment in only 23% of the cases. The mortality rate was not increased following HHA dislocation., Conclusions: The delay in surgery was the most important predictor of HHA dislocation. Closed reduction was associated with a high failure rate. While an initial attempt at closed reduction for a first dislocation is recommended, for redislocators, we recommend early exploration/revision as an alternative to repeat manipulations.
- Published
- 2014
- Full Text
- View/download PDF
5. Nottingham Hip Fracture Score: longitudinal and multi-assessment.
- Author
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Moppett IK, Parker M, Griffiths R, Bowers T, White SM, and Moran CG
- Subjects
- Aged, Aged, 80 and over, Algorithms, Cohort Studies, Comorbidity, Databases, Factual, England epidemiology, Female, Hip Fractures epidemiology, Hip Fractures mortality, Hospital Mortality, Humans, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Reproducibility of Results, Treatment Outcome, Hip Fractures diagnosis
- Abstract
Background: The Nottingham Hip Fracture Score (NHFS) was developed and validated in a single centre in 2007 as a predictor of 30 day mortality. It has subsequently been shown to predict longer term and functional outcomes. We wished to assess the ability of NHFS to predict outcomes in other centres and to investigate the change in outcome after hip fracture over time., Methods: The NHFS was calculated for all patients with data from three UK hip fracture units: Peterborough (1992-2009), Brighton (2008-9), and Nottingham (2000-9) including 4804, 585, and 1901 patients, respectively. The logistic regression was used to recalibrate the NHFS to 30 day mortality across the three units using a random selection of 50% of the data set. Calibration was assessed using the Hosmer-Lemeshow goodness of fit., Results: The median (inter-quartile range) NHFS values were Peterborough [4.0 (1-6)], Brighton [5.0 (3-7)], and Nottingham [5.0 (3-7)]. There was no correlation between 30 day mortality and time (R(2)=0.05, P=0.115). The proportion of patients with NHFS ≥ 4 showed a weak correlation with time (R(2)=0.2, P=0.003). The original NHFS equation overestimates mortality in the higher-risk groups. A modified equation shows good calibration for all three centres {30 day mortality (%)=100/1+e([(5.012 × (NHFS × 0.481)])}. The hospital was not a predictor of 30 day mortality., Conclusions: The NHFS, with an updated equation, is a robust predictor of 30 day mortality after hip fracture repair in geographically distinct UK centres.
- Published
- 2012
- Full Text
- View/download PDF
6. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery.
- Author
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Maxwell MJ, Moran CG, and Moppett IK
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- Age Factors, Aged, Aged, 80 and over, England epidemiology, Epidemiologic Methods, Female, Femoral Neck Fractures mortality, Humans, Male, Postoperative Complications mortality, Prognosis, Psychiatric Status Rating Scales, Residence Characteristics, Sex Factors, Femoral Neck Fractures surgery, Trauma Severity Indices
- Abstract
Background: Hip fractures are common in the elderly and have a high 30 day postoperative mortality. The ability to recognize patients at high risk of poor outcomes before operation would be an important clinical advance. This study has determined key prognostic factors predicting 30 day mortality in a hip fracture population, and incorporated them into a scoring system to be used on admission., Methods: A cohort study was conducted at the Queen's Medical Centre, Nottingham, over a period of 7 yr. Complete data were collected from 4967 patients and analysed. Forward univariate logistic regression was used to select the independent predictor variables of 30 day mortality, and then multivariate logistic regression was applied to the data to construct and validate the scoring system., Results: The variables found to be independent predictors of mortality at 30 days were: age (66-85 yr, > or =86 yr), sex (male), number of co-morbidities (> or =2), mini-mental test score (< or =6 out of 10), admission haemoglobin concentration (< or =10 g dl(-1)), living in an institution, and presence of malignant disease. These variables were subsequently incorporated into a risk score, the Nottingham Hip Fracture Score. The number of deaths observed at 30 days, and the number of deaths predicted by the scoring system, indicated good concordance (chi(2) test, P=0.79). The area (SE) under the receiver operating characteristic curve was 0.719 (0.018), which demonstrated a reasonable predictive value for the score., Conclusions: We have developed and validated a scoring system that reliably predicts the probability of mortality at 30 days for patients after hip fracture.
- Published
- 2008
- Full Text
- View/download PDF
7. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.
- Author
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Roche JJ, Wenn RT, Sahota O, and Moran CG
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- Age Distribution, Aged, Aged, 80 and over, Comorbidity, England epidemiology, Epidemiologic Methods, Female, Hip Fractures surgery, Humans, Length of Stay, Male, Middle Aged, Hip Fractures mortality, Postoperative Complications mortality
- Abstract
Objectives: To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality., Design: Prospective observational cohort study., Setting: University teaching hospital., Participants: 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery., Interventions: Routine care for hip fractures., Main Outcome Measures: Postoperative complications and mortality at 30 days and one year., Results: Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3)., Conclusions: In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.
- Published
- 2005
- Full Text
- View/download PDF
8. POSSUM scoring for patients with fractured neck of femur.
- Author
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Ramanathan TS, Moppett IK, Wenn R, and Moran CG
- Subjects
- Adult, Aged, England epidemiology, Femoral Neck Fractures diagnosis, Femoral Neck Fractures mortality, Humans, Medical Audit methods, Middle Aged, Preoperative Care methods, Prognosis, Risk Assessment methods, Sensitivity and Specificity, Triage methods, Femoral Neck Fractures surgery, Trauma Severity Indices
- Abstract
Background: POSSUM scoring is validated as an audit tool in general and orthopaedic surgery. It is also used for preoperative triage to assess perioperative risk. However its ability to predict mortality in specific surgical subgroups, such as patients with fractured neck of the femur, has not been studied. This study assessed the predictive capability of POSSUM for 30-day mortality after surgery for fractured neck of femur., Methods: A cohort study was conducted in Queen's Medical Centre, Nottingham over a period of nearly 2 yr. Complete data from 1164 patients were analysed to compare the mortality predicted by POSSUM and the observed mortality. POSSUM risk of death was calculated using the original POSSUM equation, with modifications to the operative score appropriate for orthopaedic surgery., Results: POSSUM predicted 181 (15.6%) deaths and the observed mortality was 119 (10.2%). The area under the receiver operating characteristic curve was 0.62, indicating poor performance by the POSSUM equation., Conclusion: POSSUM overpredicts mortality in hip fracture patients. It should be used with caution whether as an audit tool or for preoperative triage.
- Published
- 2005
- Full Text
- View/download PDF
9. Vipers and viper bites in the West Country.
- Author
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Moran CJ
- Subjects
- Adolescent, Adult, Blood Transfusion, Child, Child, Preschool, Edema etiology, England, Female, Hemorrhage etiology, Humans, Male, Middle Aged, Snake Bites complications, Snake Bites epidemiology, Snake Bites mortality, Snake Bites therapy
- Published
- 1970
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