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1. The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres.

Author

Paediatric Surgery Trainee Research Network, Harwood, R., Bethell, G., Eastwood, M. P., Hotonu, S., Allin, B., Boam, T., Rees, C. M., Hall, N. J., Rhodes, H., Ampirska, T., Arthur, F., Billington, J., Bough, G., Burdall, O., Burnand, K., Chhabra, S., Driver, C., Ducey, J., and Engall, N.

Subjects
INTENSIVE care units, BLUNT trauma, LIVER, TRAUMA centers, BED rest, PATIENTS, HOSPITAL admission & discharge, QUESTIONNAIRES, FALSE aneurysms, SPLEEN, HEMODYNAMICS, ADOLESCENCE
Abstract

Purpose: To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance. Methods: UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres. Results: All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic. Conclusions: UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak. [ABSTRACT FROM AUTHOR]

Published
2023
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3. Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Author

Lee, MJ, Drake, TM, Sayers, AE, Walsh, CJ, Davies, MM, Fearnhead, NS, Abercrombie, J, Acheson, A, Alderson, D, Anderson, I, Bach, S, Davies, M, Hamady, Z, Hind, D, Hollyman, M, Hare, S, Lee, E, Northover, J, Lewis, C, Marriott, P, Maynard, N, Murray, D, Tierney, G, Verjee, A, Wild, J, Abbott, S, Abdulaal, Y, Afshar, S, Ah‐Chuen, J, Ahmed, T, Akhtar, M, Akram, F, Aldred, E, Ali, A, Aly, M, Amajuoyi, A, Amin, V, Anderson, D, Anderson, O, Andreou, A, Ansari, A, Appleton, S, Ardley, R, Arshad, F, Ashour, O, Asour, A, Athem, A, Athersmith, M, Ayoub, F, Azeem, H, Azhar, B, Badenoch, T, Baillie, C, Bandyopadhyay, D, Barker, J, Barker, S, Barkham, B, Baron, R, Barrie, J, Barry‐Yarrow, E, Bashir, G, Battersby, N, Bazoua, G, Behar, N, Bellam, S, Berger, C, Bhandari, S, Bhasin, S, Biggs, S, Bisset, C, Blake, L, Blencowe, N, Boam, T, Boddy, A, Boereboom, C, Bogdan, M, Bogle, R, Bohra, P, Boland, M, Bolkan, H, Borg, C, Boulton, R, Bouras, G, Boyer, M, Boyle, J, Branagan, G, Brewer, H, Briggs, C, Broadhurst, J, Brown, E, Brown, J, Brown, L, Brown, O, Burns, K, Butcher, K, Butler, M, Byrne, B, Campbell, L, Capper, C, Cartmell, M, Cash, T, Chan, S, Chandratreya, N, Chapman, J, Chapman, S, Charalabopoulos, A, Cheek, C, Chok, S, Choong, W, Chow, M, Chowdhury, J, Coe, P, Conaghan, P, Conn, G, Cook, N, Cook, T, Cooper, S, Cornish, J, Cotton, D, Cox, C, Coyne, P, Crook, R, Crozier, J, Cuffolo, G, Cunha, P, Curtis, N, Cutting, J, Da Costa, K, Silva, L, Das, B, Davenport, M, Davies, J, Davies, T, Day, A, Dayal, S, Dean, S, Demetriou, G, Dengu, F, Dennis, R, Dent, H, Dent, P, Deputy, M, Devoto, L, Di Benedetto, G, Dindyal, S, Donnelly, E, Doody, P, Douka, E, Downham, C, Dowson, H, Edent, H, Edgerton, K, Ekpete, N, El Farran, M, Elamin, O, Eljaafari, M, Elsaid, N, El‐Sharif, M, Evans, J, Evans, M, Ewe, R, Ewing, A, Exarchou, K, Fallaize, R, Faoury, M, Farag, S, Farinella, E, Faulkner, G, Ferguson, H, Fisher, O, Fletcher, J, Forouzanfar, A, Foster, A, Fox, R, Francis, N, Fretwell, V, Fung, D, Gammeri, E, Garnham, J, Geraghty, A, Gilbert, A, Gill, C, Gill, M, Gillespie, M, Giordano, P, Glasbey, J, Goh, M, Golder, A, Green, N, Gregoir, T, Grey, T, Groundwater, E, Grove, T, Growcott, S, Gunasekaran, S, Habib, H, Haddow, J, Halahakoon, V, Halkias, C, Hall, C, Hampson, A, Hancock, L, Hanna, T, Hannay, J, Harikrishnan, A, Harries, R, Harris, G, Hartley, J, Harvey, K, Hawkin, P, Hawkins, J, Healy, R, Heard, R, Heartshorne, R, Heller, S, Hendra, L, Herrod, P, Heywood, N, Hicks, G, Hobson, B, Holtham, S, Hope, C, Hopley, P, Hossain, T, Hossaini, S, Howse, F, Hubbard, T, Humphreys, A, Ikram, H, Ioannis, M, Iqbal, M, Iqbal, N, Jain, R, Jatania, J, Jenkinson, P, Jokhan, S, Jones, A, Jones, C, Jones, L, Joshi, H, Joshi, K, Joy, M, Jull, P, Kakaniaris, G, Kallam, R, Kane, E, Kang, P, Kanitkar, R, Kauser, S, Kazmi, F, Kedrzycki, M, Kelly, S, Kendall, J, Khan, M, Khan, T, King, G, Kisiel, A, Kitsis, C, Kolawole, I, Korambayil, S, Kosasih, S, Kosti, A, Kotb, A, Kouris, S, Kshatriya, K, Kumar, S, Lafaurie, G, Lal, R, Lau, A, Lazim, T, Lazzaro, A, Lee, K, Lefroy, R, Leinhardt, D, Lennon, H, Leong, K, Levy, B, Lim, E, Lim, J, Lindley, S, Liu, D, Lloyd, P, Locker, D, Lockwood, S, Lowe, C, Lund, J, Lunevicius, R, Lunt, A, Lutfi, S, Luther, A, Luwemba, S, Mahankali‐Rao, P, Mahroof, S, Mai, D, Majid, S, Malik, A, Malik, K, Mann, K, Mansour, S, Manu, N, Mapara, R, Martin, C, Martin, J, Martin, R, Mason, C, Massey, L, Mathias, J, Mathur, P, Maude, K, McArthur, D, McCain, S, McCluney, S, McFall, M, McIlroy, B, McKay, S, McKinley, N, McNair, A, McWhirter, D, Mekhail, P, Mellor, K, Merchant, J, Merker, L, Messenger, D, Miles, A, Mir, S, Mishra, A, Mistry, P, Miu, V, Moat, M, Mockford, K, Mohamed, E, Mohamed, I, Mondragon‐Pritchard, M, Moore, N, Moretti, L, Morris, H, Morrison, T, Morrison‐Jones, V, Moss, J, Moug, S, Mountford, D, Moynihan, R, Muhammad, K, Muldoon‐Smith, D, Mulholland, J, Mullan, M, Murgitroyd, E, Murugaiyan, K, Myers, A, Mykoniatis, I, Nana, G, Nash, T, Nassar, A, Newton, R, Ng, C, Ng, P, Nguyen, K, Nicholas, F, Noor, M, Nowers, J, Nugent, C, Nunn, A, Nunn, R, Obeid, N, O'Callaghan, J, O'Hara, R, Oke, O, Olivier, J, O'Neill, A, O'Neill, S, Osei‐Bordom, D, Osgood, L, Panagiotopoulos, S, Panchasara, B, Parks, R, Patel, H, Patel, P, Patel, R, Patel, S, Pawelec, K, Payne, C, Pearson, K, Perin, G, Peristerakis, I, Petronio, B, Phelan, L, Phillips, J, Pisaneschi, C, Pitt, J, Plunkett‐Reed, K, Ponchietti, L, Pouzi, A, Pouzi, M, Powell, A, Powell‐Chandler, A, Pranesh, N, Proctor, V, Pywell, S, Qureshi, A, Qureshi, N, Rahman, M, Rai, Z, Ramcharan, S, Rangarajan, K, Rashid, M, Reader, H, Rehman, A, Rehman, S, Rengifo, C, Richards, E, Richardson, N, Robinson, A, Robinson, D, Rossi, B, Rutherford, F, Sadien, I, Saghir, T, Sahnan, K, Salahia, G, Sarveswaran, J, Saunders, M, Scott, B, Scott, K, Seager, A, Seal, S, Sezen, E, Shaban, F, Shah, P, Shahmohammadi, M, Shamsiddinova, A, Shankar, S, Sharpe, A, Shatkar, V, Sheel, A, Shields, T, Shinkwin, M, Shurmer, J, Siddika, A, Siddiqui, S, Simson, R, Sinclair, P, Singh, B, Singh, S, Sivaraj, J, Skaife, P, Skelly, B, Skinner, A, Slim, N, Smart, C, Smart, N, Smith, F, Smith, I, Smith, R, Spence, G, Sreedhar, A, Steinke, J, Stevenson, L, Stewart‐Parker, E, Stott, M, Stubbs, B, Stylianides, N, Subramonia, S, Swinkin, M, Swinscoe, M, Symons, N, Tahir, W, Taj, T, Takacs, K, Tam, J, Tan, K, Tani, S, Tanner, N, Tao, D, Taylor, M, Thava, B, Thippeswamy, K, Thomas, C, Thompson, E, Thompson, R, Thompson‐Reil, C, Thorn, C, Tongo, F, Toth, G, Turnbull, A, Turnbull, J, Valero, C, Boxel, G, Varcada, M, Venn, M, Ventham, N, Venza, M, Vimalachandran, D, Virlos, I, Wade, T, Wafi, A, Waite, K, Walker, M, Walker, N, Walker, T, Walsh, U, Wardle, S, Warner, R, Watfah, J, Watson, N, Watt, J, Watts, J, Wayman, J, Weegenaar, C, West, H, West, M, Whitehurst, L, Whyler, M, Wiggans, M, Wijeyekoon, S, Williams, G, Williams, R, Williamson, A, Williamson, J, Wilson, J, Winter, A, Wolpert, L, Wong, J, Yeap, E, Yeong, T, Zaman, S, Zappa, B, and Zosimas, D

Subjects
Adult, Male, medicine.medical_specialty, National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators, Incisional hernia, lcsh:Surgery, 030230 surgery, Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, NASBO Collaborators, medicine, Humans, Hernia, Hospital Mortality, General, Emergency Treatment, Aged, Proportional Hazards Models, Aged, 80 and over, Groin, business.industry, Mortality rate, Hazard ratio, West Midlands Research Collaborative, General Medicine, Odds ratio, Original Articles, lcsh:RD1-811, Middle Aged, medicine.disease, Quality Improvement, United Kingdom, Surgery, Hernia, Abdominal, Bowel obstruction, medicine.anatomical_structure, Logistic Models, 030220 oncology & carcinogenesis, Original Article, Female, business, NASBO Steering Group, Intestinal Obstruction
Abstract

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group., This study shows that small bowel obstruction due to abdominal wall hernia is common, typically involves a co‐morbid group of patients and has poor outcomes, including high mortality rates. High mortality from this problem

Published
2020

5. National prospective cohort study of the burden of acute small bowel obstruction

Author

Lee, M. J., Sayers, A. E., Drake, T. M., Marriott, P. J., Anderson, I. D., Bach, S. P., Bradburn, M., Hind, D., Verjee, A., Fearnhead, N. S., Abercrombie, John, Acheson, Austin, Alderson, Derek, Anderson, Iain, Davies, Michael, Hamady, Zaed, Hollyman, Marianne, Hare, Sarah, Lee, Ellen, Northover, John, Lewis, Christopher, McFall, Malcolm, Murugananthan, Aravinth, Murray, David, Singh, Pritam, Tierney, Gillian, Walsh, Ciaran, Wild, Jonathan, Wilson, Timothy, Abbott, S, Abdulaal, Y, Afshar, S, Ah‐Chuen, J, Ahmed, T, Akhtar, M, Akram, F, Aldred, E, Ali, A, Aly, M, Amajuoyi, A, Amin, V, Anderson, D, Anderson, O, Andreou, A, Ansari, A, Appleton, S, Ardley, R, Arshad, F, Ashour, O, Asour, A, Athem, A, Athersmith, M, Ayoub, F, Azeem, H, Azhar, B, Badenoch, T, Baillie, C, Bandyopadhyay, D, Barker, J, Barker, S, Barkham, B, Baron, R, Barrie, J, Barry‐Yarrow, E, Bashir, G, Battersby, N, Bazoua, G, Behar, N, Bellam, S, Berger, C, Bhandari, S, Bhasin, S, Biggs, S, Bisset, C, Blake, L, Blencowe, N, Boam, T, Boddy, A, Boereboom, C, Bogdan, M, Bogle, R, Bohra, P, Boland, M, Bolkan, H, Borg, C, Boulton, R, Bouras, G, Boyer, M, Boyle, J, Branagan, G, Brewer, H, Briggs, C, Broadhurst, J, Brown, E, Brown, J, Brown, L, Brown, O, Burns, K, Butcher, K, Butler, M, Byrne, B, Campbell, L, Capper, C, Cartmell, M, Cash, T, Chan, S, Chandratreya, N, Chapman, J, Chapman, S, Charalabopoulos, A, Cheek, C, Chok, S, Choong, W, Chow, M, Chowdhury, J, Coe, P, Conaghan, P, Conn, G, Cook, N, Cook, T, Cooper, S, Cornish, J, Cotton, D, Cox, C, Coyne, P, Crook, R, Crozier, J, Cuffolo, G, Cunha, P, Curtis, N, Cutting, J, Da Costa, K, Silva, L, Das, B, Davenport, M, Davies, J, Davies, T, Day, A, Dayal, S, Dean, S, Demetriou, G, Dengu, F, Dennis, R, Dent, H, Dent, P, Deputy, M, Devoto, L, Di Benedetto, G, Dindyal, S, Donnelly, E, Doody, P, Douka, E, Downham, C, Dowson, H, Edent, H, Edgerton, K, Ekpete, N, El Farran, M, Elamin, O, Eljaafari, M, Elsaid, N, El‐Sharif, M, Evans, J, Evans, M, Ewe, R, Ewing, A, Exarchou, K, Fallaize, R, Faoury, M, Farag, S, Farinella, E, Faulkner, G, Ferguson, H, Fisher, O, Fletcher, J, Forouzanfar, A, Foster, A, Fox, R, Francis, N, Fretwell, V, Fung, D, Gammeri, E, Garnham, J, Geraghty, A, Gilbert, A, Gill, C, Gill, M, Gillespie, M, Giordano, P, Glasbey, J, Goh, M, Golder, A, Green, N, Gregoir, T, Grey, T, Groundwater, E, Grove, T, Growcott, S, Gunasekaran, S, Habib, H, Haddow, J, Halahakoon, V, Halkias, C, Hall, C, Hampson, A, Hancock, L, Hanna, T, Hannay, J, Harikrishnan, A, Harries, R, Harris, G, Hartley, J, Harvey, K, Hawkin, P, Hawkins, J, Healy, R, Heard, R, Heartshorne, R, Heller, S, Hendra, L, Herrod, P, Heywood, N, Hicks, G, Hobson, B, Holtham, S, Hope, C, Hopley, P, Hossain, T, Hossaini, S, Howse, F, Hubbard, T, Humphreys, A, Ikram, H, Ioannis, M, Iqbal, M, Iqbal, N, Jain, R, Jatania, J, Jenkinson, P, Jokhan, S, Jones, A, Jones, C, Jones, L, Joshi, H, Joshi, K, Joy, M, Jull, P, Kakaniaris, G, Kallam, R, Kane, E, Kang, P, Kanitkar, R, Kauser, S, Kazmi, F, Kedrzycki, M, Kelly, S, Kendall, J, Khan, M, Khan, T, King, G, Kisiel, A, Kitsis, C, Kolawole, I, Korambayil, S, Kosasih, S, Kosti, A, Kotb, A, Kouris, S, Kshatriya, K, Kumar, S, Lafaurie, G, Lal, R, Lau, A, Lazim, T, Lazzaro, A, Lee, K, Lefroy, R, Leinhardt, D, Lennon, H, Leong, K, Levy, B, Lim, E, Lim, J, Lindley, S, Liu, D, Lloyd, P, Locker, D, Lockwood, S, Lowe, C, Lund, J, Lunevicius, R, Lunt, A, Lutfi, S, Luther, A, Luwemba, S, Mahankali‐Rao, P, Mahroof, S, Mai, D, Majid, S, Malik, A, Malik, K, Mann, K, Mansour, S, Manu, N, Mapara, R, Martin, C, Martin, J, Martin, R, Mason, C, Massey, L, Mathias, J, Mathur, P, Maude, K, McArthur, D, McCain, S, McCluney, S, McIlroy, B, McKay, S, McKinley, N, McNair, A, McWhirter, D, Mekhail, P, Mellor, K, Merchant, J, Merker, L, Messenger, D, Miles, A, Mir, S, Mishra, A, Mistry, P, Miu, V, Moat, M, Mockford, K, Mohamed, E, Mohamed, I, Mondragon‐Pritchard, M, Moore, N, Moretti, L, Morris, H, Morrison, T, Morrison‐Jones, V, Moss, J, Moug, S, Mountford, D, Moynihan, R, Muhammad, K, Muldoon‐Smith, D, Mulholland, J, Mullan, M, Murgitroyd, E, Murugaiyan, K, Myers, A, Mykoniatis, I, Nana, G, Nash, T, Nassar, A, Newton, R, Ng, C, Ng, P, Nguyen, K, Nicholas, F, Noor, M, Nowers, J, Nugent, C, Nunn, A, Nunn, R, Obeid, N, O'Callaghan, J, O'Hara, R, Oke, O, Olivier, J, O'Neill, A, O'Neill, S, Osei‐Bordom, D, Osgood, L, Panagiotopoulos, S, Panchasara, B, Parks, R, Patel, H, Patel, P, Patel, R, Patel, S, Pawelec, K, Payne, C, Pearson, K, Perin, G, Peristerakis, I, Petronio, B, Phelan, L, Phillips, J, Pisaneschi, C, Pitt, J, Plunkett‐Reed, K, Ponchietti, L, Pouzi, A, Pouzi, M, Powell, A, Powell‐Chandler, A, Pranesh, N, Proctor, V, Pywell, S, Qureshi, A, Qureshi, N, Rahman, M, Rai, Z, Ramcharan, S, Rangarajan, K, Rashid, M, Reader, H, Rehman, A, Rehman, S, Rengifo, C, Richards, E, Richardson, N, Robinson, A, Robinson, D, Rossi, B, Rutherford, F, Sadien, I, Saghir, T, Sahnan, K, Salahia, G, Sarveswaran, J, Saunders, M, Scott, B, Scott, K, Seager, A, Seal, S, Sezen, E, Shaban, F, Shah, P, Shahmohammadi, M, Shamsiddinova, A, Shankar, S, Sharpe, A, Shatkar, V, Sheel, A, Shields, T, Shinkwin, M, Shurmer, J, Siddika, A, Siddiqui, S, Simson, R, Sinclair, P, Singh, B, Singh, S, Sivaraj, J, Skaife, P, Skelly, B, Skinner, A, Slim, N, Smart, C, Smart, N, Smith, F, Smith, I, Smith, R, Spence, G, Sreedhar, A, Steinke, J, Stevenson, L, Stewart‐Parker, E, Stott, M, Stubbs, B, Stylianides, N, Subramonia, S, Swinkin, M, Swinscoe, M, Symons, N, Tahir, W, Taj, T, Takacs, K, Tam, J, Tan, K, Tani, S, Tanner, N, Tao, D, Taylor, M, Thava, B, Thippeswamy, K, Thomas, C, Thompson, E, Thompson, R, Thompson‐Reil, C, Thorn, C, Tongo, F, Toth, G, Turnbull, A, Turnbull, J, Valero, C, Boxel, G, Varcada, M, Venn, M, Ventham, N, Venza, M, Vimalachandran, D, Virlos, I, Wade, T, Wafi, A, Waite, K, Walker, M, Walker, N, Walker, T, Walsh, U, Wardle, S, Warner, R, Watfah, J, Watson, N, Watt, J, Watts, J, Wayman, J, Weegenaar, C, West, H, West, M, Whitehurst, L, Whyler, M, Wiggans, M, Wijeyekoon, S, Williams, G, Williams, R, Williamson, A, Williamson, J, Wilson, J, Winter, A, Wolpert, L, Wong, J, Yeap, E, Yeong, T, Zaman, S, Zappa, B, Zosimas, D, Moug S Mondragon‐Pritchard, M, Rehan, S, and van Boxel, G

Abstract

Background: \ud Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK.\ud \ud Methods: \ud This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected.\ud \ud Results: \ud Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication.\ud \ud Conclusion: \ud Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.

Published
2019

6. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Author

Drake, Thomas M., primary, Lee, Matthew J., additional, Sayers, Adele E., additional, Abercrombie, John, additional, Acheson, Austin, additional, Alderson, Derek, additional, Anderson, Iain, additional, Bradburn, Mike, additional, Davies, Michael, additional, Hamady, Zaed, additional, Hind, Daniel, additional, Hollyman, Marianne, additional, Hare, Sarah, additional, Lee, Ellen, additional, Northover, John, additional, Lewis, Christopher, additional, Marriott, Paul J., additional, Maynard, Nick, additional, McFall, Malcolm, additional, Muragananthan, Aravinth, additional, Murray, David, additional, Singh, Pritam, additional, Tierney, Gillian, additional, Verjee, Azmina, additional, Walsh, Ciaran, additional, Wild, Jonathan RL., additional, Wilson, Timothy, additional, Abbott, S., additional, Abdulaal, Y., additional, Afshar, S., additional, Akhtar, M., additional, Anderson, D., additional, Appleton, S., additional, Bandyopadhyay, D., additional, Bashir, G., additional, Behar, N., additional, Bhandari, S., additional, Branagan, G., additional, Boulton, R., additional, Borg, C., additional, Bouras, G., additional, Boyle, J., additional, Brewer, H., additional, Brown, L., additional, Briggs, C., additional, Cartmell, M., additional, Chan, S., additional, Chandratreya, N., additional, Conaghan, P., additional, Cornish, J., additional, Cotton, D., additional, Coyne, P., additional, Crozier, J., additional, Cook, T., additional, Cunha, P., additional, Curtis, N., additional, Day, A., additional, Dayal, S., additional, Dennis, R., additional, Dent, P., additional, Dowson, H., additional, Fallaize, R., additional, Farag, S., additional, El Farran, M., additional, Faulkner, G., additional, Giordano, P., additional, Grey, T., additional, Halahakoon, V., additional, Hannay, J., additional, Harikrishnan, A., additional, Holtham, S., additional, Hawkin, P., additional, Hall, C., additional, Hancock, L., additional, Hartley, J., additional, Howse, F., additional, Kallam, R., additional, Kakaniaris, G., additional, Kelly, S., additional, Lockwood, S., additional, Leinhardt, D., additional, Levy, B., additional, Lal, R., additional, Lazim, T., additional, Lund, J., additional, Lunevicius, R., additional, Mathur, P., additional, Maude, K., additional, McArthur, D., additional, McIlroy, B., additional, Miles, A., additional, Moug, S., additional, Mondragon-Pritchard, M., additional, Messenger, D., additional, Mullan, M., additional, Myers, A., additional, Muhammad, K., additional, Mason, C., additional, Sarveswaran, J., additional, Shatkar, V., additional, Singh, B., additional, Skelly, B., additional, Subramonia, S., additional, Swinscoe, M., additional, Thava, B., additional, Thorn, C., additional, Panagiotopoulos, S., additional, Patel, P., additional, Phillips, J., additional, Peristerakis, I., additional, Qureshi, A., additional, Saunders, M., additional, Shah, P., additional, Sheel, A., additional, Siddiqui, S., additional, Skaife, P., additional, Smart, 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A., additional, Powell-Chandler, A., additional, Pranesh, N., additional, Proctor, V., additional, Qureshi, N., additional, Rahman, M., additional, Rai, Z., additional, Ramcharan, S., additional, Rangarajan, K., additional, Rashid, M., additional, Reader, H., additional, Rehman, A., additional, Rehan, S., additional, Rengifo, C., additional, Richardson, N., additional, Robinson, A., additional, Robinson, D., additional, Rossi, B., additional, Rutherford, F., additional, Sadien, I., additional, Saghir, T., additional, Sahnan, K., additional, Salahia, G., additional, Scott, B., additional, Scott, K., additional, Seager, A., additional, Seal, S., additional, Sezen, E., additional, Shaban, F., additional, Shahmohammadi, M., additional, Shamsiddinova, A., additional, Shankar, S., additional, Sharpe, A., additional, Shields, T., additional, Shinkwin, M., additional, Shurmer, J., additional, Siddika, A., additional, Simson, R., additional, Singh, S., additional, Sivaraj, J., additional, 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additional, Yeong, T., additional, and Fearnhead, Nicola S., additional

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2019
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12. Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study

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Dmitri Nepogodiev, Richard JW Wilkin, Catherine J Bradshaw, Clare Skerritt, Alasdair Ball, Waaka Moni-Nwinia, Ruth Blanco-Colino, Priyesh Chauhan, Thomas M Drake, Matteo Frasson, Oliver Gee, James C Glasbey, Jacob H Matthews, Gabriella L Morley, David N Naumann, Francesco Pata, Antonio S Soares, Aneel Bhangu, SH Abbas, AM Abdelgadir, A Abdelrahman, M Abdelrahman, A Abdelwahed, Y Abou El Ella, M Abulafi, A Acharya, ME Adam, RE Adams, SO Adegbola, A Adimonye, M Adnan, S Afshar, A Ahad, J Ahel, DP Ahern, A Ahmad Asmadi, B Ahmed, G Ahmed, OS Ahmed, S Ahmed, K Akbari, O Akinsola, W Al-Khyatt, B Al-Sarireh, M Al-Sheikh, M Alani, R Alexander, T Alhammali, M Ali, A Aljorfi, M Allen, J Allington, A Alshafei, R Amarasinghe, A Amayo, V Amin, Thuva Amuthalingam, L Anandan, O Anderson, SM Andreani, B Andrews, A Ang, B Aravind, JE Archer, MA Aremu, S Arunachalam, N Aruparayil, DL Ashmore, O Ashour, N Ashraf, N Assaf, H Avalapati, OO Awokoya, J Ayube-Brown, T Badenoch, R Bagga, A Baginski, S Bailey, STR Bailey, C Baird, B Baker, EJ Balai, A Balasubramaniam, SK Bandyopadhyay, A Banks, H Bansal, W Barnieh, A Barrie, CA Barter, J Bastianpillai, WD Beasley, CR Bell, J Bell, D Beral, BJM Berry, KE Bevan, V Bevan, Shiv Bhanderi, A Bhargava, D Bilku, A Birindelli, OD Blackford, JEM Blackwell, L Blake, Natalie S Blencowe, TD Boam, C Boereboom, M Bogdan, P Bohra, JC Bolger, W Bolton, S Bond, CM Borg, K Borghol, PR Boshier, N Bouhadiba, J Bowen, H Bowerman, CR Bowman, H Boyd-Carson, CJ Bradshaw, G Branagan, P Brennan, M Brett, HK Brewer, H Brewer, C Bronder, A Brown, AG Brown, CE Brown, M Brown, R Brown, S Buckley-Jones, A Budzanowski, W Bukhari, C Bull, JK Bullivant, KM Burns, D Burnside, A Busuttil, BE Byrne, CK Byrnes, M Caldwell, R Callan, FC Cameron, U Campbell, UM Campbell, W Campbell, CA Carden, CFW Carder, K Carney, H Cartwright, P Cay, A Chalk, B Chambers, A Champsi, D Chan, TCW Chan, SB Chandler, J Chapman, A Charalabopoulos, B Chasty, M Chatzikonstantinou, WL Cheah, CS Chean, S Cheng, SA Cheng, M Cheruvu, MY Chin, IA Chishti, S Choi, SM Chok, B Chong, JH Choong, M Chowdhary, F Chowdhury, CH Choy, L Christian, P Christopoulos, K Chui, M Cipparrone, GL Clark, SA Clarke, SJ Cleeve, KD Clement, B Clements, C Clements, JD Clements, JM Clements, JS Clements, JA Clements, R Clingan, L Cloney, ECS Clough, PO Coe, O Collier-Wakefield, DW Colliver, DA Colvin, TM Connelly, MJ Connor, V Cook, F Cooke, F Cooper, AE Cotton, DG Couch, L Cousins, D Coyle, W Creasy, RL Cresner, A Crone, K Cross, J Crozier, P Cunha, NJ Curtis, N D'Souza, H Dagash, S Dalmia, I Daniels, D Danquah-Boateng, FA Dar, K Dart, A Das, R Daureeawoo, S Davidson, JR Davidson, PL Davies, S Davis, V Daya Shetty, A De-Manzoni-Garberini, JA De-Marchi, EA Dean, S Dean, C Delimpalta, S Denley, G Dennison, AA Devine, S Dharamavaram, AA Dhari, F Di Franco, S Di Saverio, C Dobson, JA Docherty, C Doherty, G Donaldson, NO Donohoe, O Donohoe, E Douka, T Doulias, M Downey, C Doyle, N Drye, DT Du, JG Dudek, PG Dunning, ARS Dyal, NJ Eardley, L Earnshaw, S Easdon, SE Edwards, RJ Egan, S El-Masry, O El-Tayar, CR Elbourne, S Elgaddal, M Elseedawy, M Elshaer, OH Elsharnoby, WMA Elzeneini, KM Emslie, NFT Engall, B Ertansel, HD Esmail, C Ettles, J Evans, JD Evans, A Everden, M Fadel, SE Fahmy, CJ Fairfield, BF Fanibi, Valeria Farina, SM Farrell, EZ Farrow, JA Fasuyi, G Faulkner, D Fawkner-Corbett, F Fawzi, M Fehervari, N Ferguson, JG Finch, H Finlayson, T Flack, W Foers, NM Foley, K Ford, A Forgie, A Foster, JD Foster, AMW Fox, N Francis, D Franklin, H Froud, HL Fuller, E Gaines, J Galea, E Gammeri, J Garnham, J Garvin, Z Gates, R Gentry, I Ghaffari, S Ghatorae, AL Gidwani, TG Gilbert, TM Gilbert, S Gill, M Gillespie, J Gillick, A Giorga, K Gopalakrishnan, S Gopalswamy, S Gopinath, R Gormely, G Govind, C Grant, J Graveston, J Gray, RT Gray, D Griffith, JP Griffith, Ewen A Griffiths, SN Griffiths, EJ Griggs, S Grosvenor, T Grove, M Gulamhussein, J Guliani, A Gummaraju, S Gunning, SV Gurjar, S Guru-Naidu, S Gurung, H Habib, L Hackney, James B Haddow, S Hajibandeh, C Halkias, NJ Hall, RN Hamelmann, M Haneef, MS Haneef, Z Hanif, C Hanley, AJ Hann, T Hanna, E Hardy, A Harlinska, F Harper, RL Harries, A Harris, Grant Harris, MP Harris, R Hasan, A Hassane, JR Hatt, Z Haveliwala, W Hawkins, Z Hayat, C Hayes, KRM Hebbar, L Henderson, LT Henderson, PJJ Herrod, P Hever, LM Hickey, G Hicks, JM Hodgson, M Hoff, A Hollingsworth, A Hook, ST Hornby, E Horsfield, EE Howie, L Huang, NJ Hudson-Peacock, DL Hughes, KA Hureibi, A Hussain, N Hussain, SA Hussaini, A Hussein, B Hutchinson, YMS Ibrahim, S Ikram, T Ilozue, E Iosif, MR Iqbal, S Irukulla, R Irwin, N Islam, P Ivey, CR Jackson, A Jackson, SMH Jah, A Jain, S Jain, Sarus Jain, GM Jama, NB Jamieson, S Janardanan, B Jasinski, D Jenner, E Jerome, B Johnson, A Johnstone, S Jokhan, A Jones, CE Jones, CS Jones, E Jones, L Jones, U Kabir, S Kabwama, M Kamal, IW Kamande, V Kanakala, M Kannegieser-Bailey, S Kaptanis, MJ Karim, RS Karwal, G Kaur, R Keegan, A Kelay, ND Kennedy, DA Kent, A Khair, K Khan, S Khan, A Khasria, H Kho, J Kilkenny, R King, J Kinross, EN Kirkham, B Knight, R Kochupapy, C Koh, O Kouli, A Krishnamoorthy, S Krivan, K Kumar, S Kumar, VWS Kung, R Kuo, G Lafaurie, CW Lai, N Lal, S Lawday, S Layman, GR Layton, A Lazzaro, L Lecky-Thompson, KA Lee, KJ Lee, M Lee, SL Lee, PA Leighton, RP Leitch, HC Lennox-Warburton, EL Leung, CH Li, JM Lim, C Limb, G Ljungqvist, G Lloyd, S Lodhia, PC Logan, M Long, P Long, RH Long, A Longshaw, C Louw, JN Lund, C Ly, MJ Lynch Wong, JKY Ma, A Macdonald, EGE Macinnes, T Magro, R Mahapatra, B Mahendran, F Mahmood, A Mahmoud, D Mahon, D Mai, A Maina, CP Major, R Makhija, Y Malam, A Malik, K Malik, SN Malik, VM Manda, KM Manektella, C Mann, P Manoharan, R Manson, S Mansoor, MM Mansour, S Mansour, F Maqboul, D Maragouthakis, G Marangoni, S Mardhiah, H Maripi, P Marriott, L Marsh, G Marshall, A Martin, LM Martin, E Martinou, R Mashar, John Mason, M Masood, G Mathew, K Maude, E Mazumdar, A Mc-Dermott, D Mcarthur, RS Mccain, S McCain, C Mccann, P Mccaughey, SJ Mccluney, J Mccullough, D Mcdonnell, NA Mcdowall, JE McEntee, K McGlynn, D Mcgrath, O Mcgucken, S Mcilwaine, AC Mcilwrath, SC Mckay, MA McKelvie, M Mckenna, J Mckeon, KL Mckevitt, NC Mckinley, D McLaughlin, SV McMahon, D Mcmorran, L McNally, M Mcquaid, DM Mcwhirter, K Mealy, A Mears, D Menzies, H Merai, RJ Mersh, M Miguras, D Milgrom, K Miller, J Milward, S Mirza, AT Misky, D Mistry, MJ Mitchard, RM Mitru, IM Mohamed, Imran Mohamed, TM Mohamed, WO Mohamed, N Mohd, C Moore, J Moradzadeh, TEM Morrison, V Morrison-Jones, Dion G Morton, BS Mothe, Fh Motiwala, D Motter, NG Mowbray, Z Mughal, J Mulsow, N Mundkur, A Muntean, C Murphy, R Murphy, MP Murray, M Muzaffar, A Myatt, A Nadeem, D Nagarajan, S Nagendram, A Nair, MK Nair, MS Nair, KN Naismith, K Nambiar, GR Nana, Z Nash, P Nastro, S Nazarian, G Neagle, A Neale, PM Neary, RC Newton, M Ng, S Ng, O Niaz, S Nickson, D Nicol, E Nimako, MS Noor Mohamed, M Nyeko-Lacek, BR O'Connor, E O'Neill, N O'Neill, D O'Sullivan, J O'Brien, M Oakey, N Obeid, A Odeh, S Ogboru, C Ogbuokiri, B Okekunle, E Okorocha, O Olagbaiye, JB Olivier, R Ooi, P Orawiec, M Orizu, N Orme, R Ormiston, C Paget, A Pal, LK Palani-Velu, Y Pan, N Panda, V Pandey, R Pandya, D Pandya, KR Paramasevon, C Pardy, MJ Parkola, Sandro Pasquali, AS Patel, BY Patel, C Patel, H Patel, N Patel, RT Patel, S Patel, Y Patel, MM Patel, SD Patil, CJ Payne, RE Payne, JCH Pearce, L Pearce, A Pedder, CB Peirce, GB Peiris, A Peleki, Gianluca Pellino, V Pento, D Peprah, HS Perera, MI Perera, L Phelan, D Photiou, R Pierre, JP Pilkington, Thomas D Pinkney, B Pisavadia, A Poacher, M Podda, H Pollard, D Popova, M Poudevigne, A Prideaux, UP Pullabatla Venkata, A Quddus, S Quill, M Rabie, MR Rabie, RW Radwan, JF Rae, A Rahim, LS Rahmani, S Rajagopal, R Rajaram, N Rajaretnam, Y Rajjoub, H Rallage, S Ramcharan, S Ranathunga, M Rao, VSR Rao, A Raofi, M Rashid, A Rate, R Ravindran, M Raymond, SS Raza, A Reddy, EP Redman, AE Redmond, S Rekhraj, S Renshaw, D Rex, M Rezacova, S Rezvani, B Ribeiro, JE Rich, TD Richardson, S Rigby, B Rigney, S Rinkoff, HD Robb, C Robertson, D Robinson, A Robinson, V Rodger, R Rolph, S Roomi, NPG Roth, K Rothnie, C Roy, S Rupani, DG Rutherford, R Sacks, N Saghir, A Saha, SJ Sahay, K Sahnan, Y Salama, S Salim, M Samuel, S Sana, L Sandu, P Sarmah, J Sarveswaran, SMF Saunders, A Savill, F Savioli, JR Schuster Bruce, JF Sebastian, TC Seddon, N Seneviratne, M Seth, T Setshwaelo, E Sezen, P Sgardelis, A Sgrò, C Shah, J Shah, K Shah, SM Shah, Z Shakoor, MS Shalaby, V Shanmuganathan, K Shanmugarajah, A Sharma, P Sharma, OL Sharp, JA Shepherd, MA Sherif, S Shet, G Shingler, MH Shiwani, D Shreshta, T Sian, MN Siddiqui, ZA Siddiqui, KL Siggens, N Sihra, I Silva, A Simioni, LFC Simmonds, DJ Simpson, A Singh, S Singh, T Singhal, P Sivaloganathan, K Sloan, N Smallcombe, CJ Smart, Neil J Smart, R Smith, H Smoker, L Solinas, JEH Souter, EL Springate, GF Stephens, R Stevenson, DJ Stewart, I Stoica, E Strachan, BM Stubbs, W Stupalkowska, A Suliman, A Sultana, H Sunter, S Suriyakumar, NRA Symons, K Szentpali, A Szucs, V Tabain, LE Tague, K Tailor, CY Tan, S Tan, AM Tang, M Tarazi, YH Tay, S Tayeh, M Taylor, NS Taylor, D Taze, E Teasdale, N Thakral, B Thava, N Thavanesan, AJ Thaventhiran, K Theodoropoulou, AT Thomas, L Thomas, DB Thompson, R Thompson, SN Thoukididou, SG Tiboni, LA Tiedt, N Ting, BJ Tinsley, JM Tognarelli, J Torkington, A Torrance, DC Townsend, PJ Tozer, M Trail, F Trew, V Tudyka, L Tullie, A Turnbull, EJ Turner, CS Twum-Barima, Robert Tyler, S Vakis, A La Valle, GI Van Boxel, J Vance-Daniel, M Varcada, N Varma, EM Vaughan, VR Velchuru, R Velho, AK Venkatasubramaniam, ML Venn, V Vijay, Z Vinnicombe, P Vitish-Sharma, S Wagener, K Waite, KJ Walters, U Walters, BG Wardle, SD Wardle, J Warusavitarne, J Watfah, N Watson, J Wauchope, LW Weatherburn, CR Weegenaar, S Welsh, S Wheatstone, HE Whewell, P Whitehouse, E Whiteman, L Whittaker, K Wijesundera, D Wilkinson, GL Williams, M Williams, R Williams, S Williams, EJ Wilson, MSJ Wilson, DC Winter, G Winter, J Wolff, A Wong, CLL Wong, SY Wong, CS Wood, C Woodrow, A Woodward, B Woodward, E Wright, HL Wright, F Wu, S Yalamarthi, P Yang, E Yardimci, T Yasin, SK Yen, S Yoganathan, S Yoong, H Youssef, LPS Yow, A Zaborowski, AZ Zadi, ZA Zarka, MA Zarog, AY Zhang, Nepogodiev, D., Wilkin, R. 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W., Kanakala, V., Kannegieser-Bailey, M., Kaptanis, S., Karim, M. J., Karwal, R. S., Kaur, G., Keegan, R., Kelay, A., Kennedy, N. D., Kent, D. A., Khair, A., Khan, K., Khan, S., Khasria, A., Kho, H., Kilkenny, J., King, R., Kinross, J., Kirkham, E. N., Knight, B., Kochupapy, R., Koh, C., Kouli, O., Krishnamoorthy, A., Krivan, S., Kumar, K., Kumar, S., Kung, V. W. S., Kuo, R., Lafaurie, G., Lai, C. W., Lal, N., Lawday, S., Layman, S., Layton, G. R., Lazzaro, A., Lecky-Thompson, L., Lee, K. A., Lee, K. J., Lee, M., Lee, S. L., Leighton, P. A., Leitch, R. P., Lennox-Warburton, H. C., Leung, E. L., Li, C. H., Lim, J. M., Limb, C., Ljungqvist, G., Lloyd, G., Lodhia, S., Logan, P. C., Long, M., Long, P., Long, R. H., Longshaw, A., Louw, C., Lund, J. N., Ly, C., Lynch Wong, M. J., Ma, J. K. Y., Macdonald, A., Macinnes, E. G. E., Magro, T., Mahapatra, R., Mahendran, B., Mahmood, F., Mahmoud, A., Mahon, D., Mai, D., Maina, A., Major, C. 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M., Mohamed, I. M., Mohamed, I., Mohamed, T. M., Mohamed, W. O., Mohd, N., Moore, C., Moradzadeh, J., Morrison, T. E. M., Morrison-Jones, V., Morton, D. G., Mothe, B. S., Motiwala, F., Motter, D., Mowbray, N. G., Mughal, Z., Mulsow, J., Mundkur, N., Muntean, A., Murphy, C., Murphy, R., Murray, M. P., Muzaffar, M., Myatt, A., Nadeem, A., Nagarajan, D., Nagendram, S., Nair, A., Nair, M. K., Nair, M. S., Naismith, K. N., Nambiar, K., Nana, G. R., Nash, Z., Nastro, P., Nazarian, S., Neagle, G., Neale, A., Neary, P. M., Newton, R. C., Ng, M., Ng, S., Niaz, O., Nickson, S., Nicol, D., Nimako, E., Noor Mohamed, M. S., Nyeko-Lacek, M., O'Connor, B. R., O'Neill, E., O'Neill, N., O'Sullivan, D., O'Brien, J., Oakey, M., Obeid, N., Odeh, A., Ogboru, S., Ogbuokiri, C., Okekunle, B., Okorocha, E., Olagbaiye, O., Olivier, J. B., Ooi, R., Orawiec, P., Orizu, M., Orme, N., Ormiston, R., Paget, C., Pal, A., Palani-Velu, L. K., Pan, Y., Panda, N., Pandey, V., Pandya, R., Pandya, D., Paramasevon, K. R., Pardy, C., Parkola, M. J., Pasquali, S., Patel, A. S., Patel, B. Y., Patel, C., Patel, H., Patel, N., Patel, R. T., Patel, S., Patel, Y., Patel, M. M., Patil, S. D., Payne, C. J., Payne, R. E., Pearce, J. C. H., Pearce, L., Pedder, A., Peirce, C. B., Peiris, G. B., Peleki, A., Pellino, G., Pento, V., Peprah, D., Perera, H. S., Perera, M. I., Phelan, L., Photiou, D., Pierre, R., Pilkington, J. P., Pinkney, T. D., Pisavadia, B., Poacher, A., Podda, M., Pollard, H., Popova, D., Poudevigne, M., Prideaux, A., Pullabatla Venkata, U. P., Quddus, A., Quill, S., Rabie, M., Rabie, M. R., Radwan, R. W., Rae, J. F., Rahim, A., Rahmani, L. S., Rajagopal, S., Rajaram, R., Rajaretnam, N., Rajjoub, Y., Rallage, H., Ramcharan, S., Ranathunga, S., Rao, M., Rao, V. S. R., Raofi, A., Rashid, M., Rate, A., Ravindran, R., Raymond, M., Raza, S. S., Reddy, A., Redman, E. P., Redmond, A. E., Rekhraj, S., Renshaw, S., Rex, D., Rezacova, M., Rezvani, S., Ribeiro, B., Rich, J. E., Richardson, T. D., Rigby, S., Rigney, B., Rinkoff, S., Robb, H. D., Robertson, C., Robinson, D., Robinson, A., Rodger, V., Rolph, R., Roomi, S., Roth, N. P. G., Rothnie, K., Roy, C., Rupani, S., Rutherford, D. G., Sacks, R., Saghir, N., Saha, A., Sahay, S. J., Sahnan, K., Salama, Y., Salim, S., Samuel, M., Sana, S., Sandu, L., Sarmah, P., Sarveswaran, J., Saunders, S. M. F., Savill, A., Savioli, F., Schuster Bruce, J. R., Sebastian, J. F., Seddon, T. C., Seneviratne, N., Seth, M., Setshwaelo, T., Sezen, E., Sgardelis, P., Sgro, A., Shah, C., Shah, J., Shah, K., Shah, S. M., Shakoor, Z., Shalaby, M. S., Shanmuganathan, V., Shanmugarajah, K., Sharma, A., Sharma, P., Sharp, O. L., Shepherd, J. A., Sherif, M. A., Shet, S., Shingler, G., Shiwani, M. H., Shreshta, D., Sian, T., Siddiqui, M. N., Siddiqui, Z. A., Siggens, K. L., Sihra, N., Silva, I., Simioni, A., Simmonds, L. F. C., Simpson, D. J., Singh, A., Singh, S., Singhal, T., Sivaloganathan, P., Sloan, K., Smallcombe, N., Smart, C. J., Smart, N. J., Smith, R., Smoker, H., Solinas, L., Souter, J. E. H., Springate, E. L., Stephens, G. F., Stevenson, R., Stewart, D. J., Stoica, I., Strachan, E., Stubbs, B. M., Stupalkowska, W., Suliman, A., Sultana, A., Sunter, H., Suriyakumar, S., Symons, N. R. A., Szentpali, K., Szucs, A., Tabain, V., Tague, L. E., Tailor, K., Tan, C. Y., Tan, S., Tang, A. M., Tarazi, M., Tay, Y. H., Tayeh, S., Taylor, M., Taylor, N. S., Taze, D., Teasdale, E., Thakral, N., Thava, B., Thavanesan, N., Thaventhiran, A. J., Theodoropoulou, K., Thomas, A. T., Thomas, L., Thompson, D. B., Thompson, R., Thoukididou, S. N., Tiboni, S. G., Tiedt, L. A., Ting, N., Tinsley, B. J., Tognarelli, J. M., Torkington, J., Torrance, A., Townsend, D. C., Tozer, P. J., Trail, M., Trew, F., Tudyka, V., Tullie, L., Turnbull, A., Turner, E. J., Twum-Barima, C. S., Tyler, R., Vakis, S., Valle, A. L., Van Boxel, G. I., Vance-Daniel, J., Varcada, M., Varma, N., Vaughan, E. M., Velchuru, V. R., Velho, R., Venkatasubramaniam, A. K., Venn, M. L., Vijay, V., Vinnicombe, Z., Vitish-Sharma, P., Wagener, S., Waite, K., Walters, K. J., Walters, U., Wardle, B. G., Wardle, S. D., Warusavitarne, J., Watfah, J., Watson, N., Wauchope, J., Weatherburn, L. W., Weegenaar, C. R., Welsh, S., Wheatstone, S., Whewell, H. E., Whitehouse, P., Whiteman, E., Whittaker, L., Wijesundera, K., Wilkinson, D., Williams, G. L., Williams, M., Williams, R., Williams, S., Wilson, E. J., Wilson, M. S. J., Winter, D. C., Winter, G., Wolff, J., Wong, A., Wong, C. L. L., Wong, S. Y., Wood, C. S., Woodrow, C., Woodward, A., Woodward, B., Wright, E., Wright, H. L., Wu, F., Yalamarthi, S., Yang, P., Yardimci, E., Yasin, T., Yen, S. K., Yoganathan, S., Yoong, S., Youssef, H., Yow, L. P. S., Zaborowski, A., Zadi, A. Z., Zarka, Z. A., Zarog, M. A., and Zhang, A. Y.

Subjects
Male, Pediatrics, medicine.medical_specialty, Validation study, Adolescent, Ultrasound scan, Pain, Risk prediction models, Risk Assessment, Sensitivity and Specificity, Cohort Studies, Ilium, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, 030225 pediatrics, Developmental and Educational Psychology, medicine, Appendectomy, Humans, Prospective Studies, 030212 general & internal medicine, Surgical emergency, Child, Ultrasonography, business.industry, Area under the curve, Appendicitis, medicine.disease, United Kingdom, Child, Preschool, Acute Disease, Pediatrics, Perinatology and Child Health, Female, Right iliac fossa pain, business, Ireland, Cohort study
Abstract

BACKGROUND: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS:15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING: None.

Published
2021
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13. Do Children With Osteosarcoma Benefit From Pulmonary Metastasectomy?: A Systematic Review of Published Studies and "Real World" Outcomes.

Author

Boam T, Rogoyski BG, Jawaid W, and Losty PD

Subjects
Humans, Child, Bone Neoplasms secondary, Bone Neoplasms surgery, Bone Neoplasms mortality, Pneumonectomy methods, Survival Rate, Treatment Outcome, Osteosarcoma surgery, Osteosarcoma mortality, Osteosarcoma secondary, Lung Neoplasms secondary, Lung Neoplasms surgery, Lung Neoplasms mortality, Metastasectomy methods
Abstract

Objective: To critically examine the evidence-base for survival benefit of pulmonary metastasectomy (PM) for osteosarcoma (OS) in the pediatric population., Background: PM for OS is recommended as the standard of care in both pediatric and adult treatment protocols. Recent results from the "Pulmonary Metastasectomy in Colorectal Cancer" trial demonstrate no survival benefit from PM in colorectal cancer in adults., Methods: A systematic review was undertaken according to "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" guidelines. Medline, Embase, and 2 clinical trial registers were searched for all studies detailing pediatric patients with OS (<18 years) undergoing PM with a comparison cohort group that did not receive PM., Results: Eleven studies met inclusion criteria dating from 1984 to 2017. All studies were retrospective and none directly compared PM versus no PM in pediatric patients as its main objective(s). Three-year survival rates ranged from 0% to 54% for PM and 0% to 16% for no PM. No patients receiving PM were usually those with unresectable disease and/or considered to have a poor prognosis. All studies were at high risk of bias and there was marked heterogeneity in the patient selection., Conclusions: There is a weak evidence base (level IV) for a survival benefit of PM for OS in pediatric patients likely due to selection bias of "favorable cases." The included studies many of which detailed outdated treatment protocols were not designed in their reporting to specifically address the questions directly. A randomized controlled trial-while ethically challenging in a pediatric population-incorporating modern OS chemotherapy protocols is needed to crucially address any "survival benefit.", Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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14. A Regional Analysis of Potentially Preventable Injuries Sustained From Burning Garbage and Yard Waste.

Author

Hill DM, Rath AJ, Boam T, Fletchall S, Sabbatini S, Geib T, Krebs M, Funk D, Greer C, Mincey M, Wayne M, Dadireddy K, Liu X, and Velamuri SR

Subjects
Humans, Retrospective Studies, Body Surface Area, Length of Stay, Burns epidemiology, Burns etiology, Burns prevention & control, Substance-Related Disorders
Abstract

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This 5-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1 and Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a 3-fold higher length of stay (10 vs 3 days; P = .023). Patients with lower pre-injury functionality had almost four times higher mortality (23.7% vs 6.3%; P = .085). There were 9 (6.7%) deaths with an average (±SD) of 74.3 ± 13.1 years of age, median of 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median of $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste-burning injuries., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2023
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15. Surgical drainage procedures for paediatric chronic pancreatitis: a scoping review.

Author

Boam T, Gabriel M, Rogoyski BG, Ram AD, and Awan A

Subjects
Humans, Child, Prospective Studies, Drainage methods, Pancreaticojejunostomy methods, Pancreas surgery, Pancreatitis, Chronic surgery, Pancreatic Pseudocyst etiology
Abstract

Paediatric chronic pancreatitis (CP) is a relatively rare entity, but it can be accompanied by debilitating complications such as pseudocysts, chronic pain and pancreatic duct obstruction. Surgical drainage procedures, such as pancreaticojejunostomy or cystogastrostomy/jejunostomy to address these complications may be required; however, there is a paucity of evidence as to the efficacy and long-term outcomes of these operations in the paediatric population. A scoping review of contemporary (post-2000) studies detailing surgical pancreatic drainage procedures performed in children (< 18 years) was undertaken. After screening, 24 case series detailing a total of 248 patients met the inclusion criteria. Longitudinal pancreaticojejunostomy and cystogastrostomy were the most common surgical procedures performed in children with CP and pseudocysts, respectively. Overall generally favourable outcomes were reported, but all studies were considered to have a high risk of bias. Operative management for paediatric CP is infrequently required; therefore, large prospective studies or trials focusing on this population are infeasible, limiting the best available evidence on the topic to case series, level IV. Recommendations to improve the quality of surgical care in the paediatric CP population could include centralisation and the formation of registries to allow accurate long-term follow-up., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2022
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17. Cryogels: recent applications in 3D-bioprinting, injectable cryogels, drug delivery, and wound healing.

Author

Jones LO, Williams L, Boam T, Kalmet M, Oguike C, and Hatton FL

Abstract

Cryogels are macroporous polymeric structures formed from the cryogelation of monomers/polymers in a solvent below freezing temperature. Due to their inherent interconnected macroporosity, ease of preparation, and biocompatibility, they are increasingly being investigated for use in biomedical applications such as 3D-bioprinting, drug delivery, wound healing, and as injectable therapeutics. This review highlights the fundamentals of macroporous cryogel preparation, cryogel properties that can be useful in the highlighted biomedical applications, followed by a comprehensive review of recent studies in these areas. Research evaluated includes the use of cryogels to combat various types of cancer, for implantation without surgical incision, and use as highly effective wound dressings. Furthermore, conclusions and outlooks are discussed for the use of these promising and durable macroporous cryogels., (Copyright © 2021, Jones et al.)

Published
2021
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18. Gastroschisis or exomphalos? An unusual abdominal defect.

Author

Sivaraj J, Boam T, and Gozzini S

Subjects
Abdomen diagnostic imaging, Abdominal Muscles, Female, Humans, Pregnancy, Prenatal Diagnosis, Gastroschisis diagnostic imaging, Gastroschisis surgery, Hernia, Umbilical diagnostic imaging, Hernia, Umbilical surgery
Abstract

A baby with an antenatal diagnosis of exomphalos was born at term. The abnormality had a highly unusual appearance, a right-sided paraumbilical defect, similar to gastroschisis, but with a sac typical of exomphalos containing both abdominal contents and over 1 L of serosanguinous fluid. The sac was drained and suspended from the top of the incubator in silo fashion. Definitive closure was achieved at day 3 of life, and the patient had a non-eventful recovery. Despite exomphalos and gastroschisis normally being discrete entities, ambiguity in the presentation this case necessitated a composite management approach., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2021
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19. Outcomes following emergency fixation of torted and non-torted testes.

Author

Boam T, Kiely D, Peeraully R, Jancauskaite M, and Fraser N

Subjects
Child, Humans, Male, Orchiectomy, Pain, Retrospective Studies, Treatment Outcome, Spermatic Cord Torsion surgery, Testis surgery
Abstract

Introduction: Scrotal exploration is a frequently performed emergency procedure in children. It is a subject of debate as to whether and how a non-torted testis should be fixed, with a wide variation in practice across the UK. This study aims to ascertain whether the method of testicular fixation (if any) impacts on patient outcomes., Methods: A review of all emergency scrotal explorations performed in children under the age of 18 between 2008 and 2018 in a tertiary Paediatric Surgery unit was undertaken. Patients were categorised by initial fixation method, chi squared analysis was used to compare complication and reoperation rates., Results: 522 boys were taken to theatre, 424 had a unilateral procedure and 98 had bilateral; after 35 orchidectomies, 585 testes were left in situ. The most frequent diagnosis at operation was torted testicular appendage (n = 278, 53%), followed by testicular torsion (n = 79, 15%). The number of testes by category of fixation were: 72 no documented fixation, 130 dartos pouch only, 34 absorbable sutures, 346 non-absorbable sutures and 3 unspecified sutures. There was no difference in the reattendance rate between groups after outliers were removed (p = 0.72). Thirty-seven patients experienced complications, most commonly ongoing pain. Nine patients required an ipsilateral reoperation, 25 underwent a contralateral operation at a later date. The complication rate appeared to be higher in the no fixation group compared to the dartos (p = 0.02) and sutured groups (p = 0.048). Testes in the no fixation group had a higher reoperation rate compared to the sutured group (p = 0.002)., Conclusions: The present study is a detailed analysis of a wide variety of emergency testicular fixation methods in a large cohort, including the routine fixation of non-torted testes. Whilst there appears to be a benefit to using sutured or dartos fixation, this merits cautious interpretation. It is likely that influences on complications and reoperations are multifactorial and cannot be attributed solely to the method of testicular fixation. Adoption of a standardised approach to emergency fixation of testes within or across institutions may be a potential avenue for future studies., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Published
2021
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20. Lockdown during the COVID-19 pandemic: impact on infants with pyloric stenosis.

Author

Research Network PST, Arthur F, Harwood R, Allin B, Bethell GS, Boam T, Chhabra S, Eastwood MP, Ford K, Rhodes H, Hotonu S, Rooney A, Billington J, Davidson JR, Dewar G, Durand C, Engall N, Green P, Jobson M, Starr A, and Tullie LG

Subjects
Humans, Infant, Pyloric Stenosis surgery, SARS-CoV-2, Female, Male, Infant, Newborn, Pandemics, COVID-19 prevention & control, COVID-19 epidemiology
Abstract

Competing Interests: Competing interests: None declared.

Published
2021
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21. Acute massive gastric dilatation: a rare, forgotten complication of fundoplication.

Author

Lau SE, Boam T, Parsons S, and Motiwale S

Subjects
Abdominal Pain etiology, Acute Disease, Child, Gastric Dilatation diagnostic imaging, Gastric Dilatation surgery, Humans, Male, Fundoplication adverse effects, Gastric Dilatation etiology
Abstract

An 8-year-old boy with a history of multiple neonatal laparotomies, including congenital diaphragmatic hernia repair and an open fundoplication, presented acutely with severe abdominal pain, distension, vomiting and shock. A large abnormal opacity in the left upper quadrant was visible on a plain abdominal radiograph. The patient was taken to the theatre for emergency laparotomy and was found to have a massively distended stomach, the fundus and body of which were necrotic. A subtotal gastrectomy was performed, sparing the viable tissue. The patient went on to make a full recovery. Acute massive gastric dilatation (AMGD) is a rare condition characterised by severe gastric distension. Gastric ischaemia results when intragastric pressure exceeds venous pressure, obstructing venous outflow. It is important to recognise AMGD as a severe complication of fundoplication due to closed-loop gastric obstruction. It should prompt consideration of an early laparotomy in cases where the diagnosis is suspected., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2020
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22. Adherence to vaccination guidelines post splenectomy: A five year follow up study.

Author

Boam T, Sellars P, Isherwood J, Hollobone C, Pollard C, Lloyd DM, Dennison AR, and Garcea G

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Hospitals, Teaching, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Guideline Adherence, Splenectomy, Vaccination
Abstract

Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2017
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23. Managing Soft Tissue Sarcomas in a Developing Health System.

Author

Boam T, Hueschelrath A, Tho L, da Costa TM, McMurrey A, and Gollogly J

Subjects
Adolescent, Adult, Aged, Child, Child, Preschool, Developing Countries, Female, Humans, Infant, Limb Salvage, Male, Middle Aged, Retrospective Studies, Sarcoma mortality, Survival Rate, Sarcoma surgery
Abstract

Background: The gold standard for treatment of soft tissue sarcomas (STS) includes wide local excision and limb salvage surgery. There is currently a lack of reports on the effectiveness of these techniques in a resource-poor setting with a lack of access to imaging and adjuvant therapies. This article reports the experience and outcome of patients presenting with STS to the Children's Surgical Centre (CSC), Phnom Penh, Cambodia., Methods: Patients with a diagnosis of STS and the operations they received were retrospectively sourced from the CSC database. Follow-up data were obtained through a telephone questionnaire and home visits., Results: Forty STS patients were identified. Definitive surgery was performed in 31 cases, the majority receiving initial local excision of the lesion (19/31), some went on to have secondary amputations (5/19), and the rest had primary amputation (12/31). Eight patients suffered perioperative complications: 6 had infections, 1 haemorrhage, and 1 patient suffered from prolonged pain. Follow-up information was available for 25 patients, 8 of whom survived whilst 17 had died. Two of the deceased and 2 of the surviving patients had received adjuvant therapy. Seven survivors reported that they had resumed employment. Estimated average survival for STS in Cambodia was 25 months with a 58 % 1-year survival rate in treated cases., Conclusions: Despite the loss to follow-up, some STS patients in Cambodia have been successfully managed by the CSC. An evolving increase in survival will hopefully be seen as access to adjuvant therapies and imaging technology improves.

Published
2016
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24. Anti-androgenic effects of flavonols in prostate cancer.

Author

Boam T

Abstract

Dietary-derived agents, such as the flavonoids, are of particular interest for prostate cancer (PCa) chemoprevention as they may offer a favourable safety and side-effect profile. An agent that demonstrates action on the androgen receptor (AR) axis may have value for preventing or treating castrate-resistant PCa. Four main flavonols - quercetin, myricetin, kaempferol, and fisetin - have been demonstrated in laboratory studies to have chemopreventive action in both castrate-resistant and castrate-sensitive PCa models. Mechanisms of flavonol action on the AR axis in PCa have been proposed to be inhibition of the 5α-reductase enzymes, direct androgen competition, suppression of the AR complex and transactivation by coregulators such as c-Jun, Sp1, and the PI3K/Akt pathway. It is, however, still unclear with current levels of evidence whether AR axis-mediated effects can fully account for the flavonols' chemopreventive action.

Published
2015
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25. Paediatric trauma with hyperamylasemia.

Author

Boam T, Durell J, Dagash H, and Rajimwale A

Subjects
Child, Humans, Male, Accidents, Traffic, Hyperamylasemia etiology, Isoamylase blood, Lipase blood, Motorcycles, Pancreas injuries
Abstract

In this case report, we describe a paediatric case of hyperamylasemia following parotid trauma. A 12-year-old boy was hit by a motorcycle, sustaining only superficial lacerations to the face overlying the parotid. A hyperamylasemia was noted, and further characterised by a fractionated isoamylase test, as being predominantly of the salivary type. Serum lipase levels were low. Based on these investigations, pancreatic injury was judged unlikely with the minor parotid trauma being the probable source of the hyperamylasemia. The patient was spared further unnecessary investigations and managed conservatively., (2015 BMJ Publishing Group Ltd.)

Published
2015
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