Study Design: observational study over time

Objectives: 1. To investigate the effect of right and left radiculopathy on driver brake-reaction time (DBRT) 2. Determine the effect of selective nerve root block (SNRB) on DBRT

Summary of Background Data: DVLA guidelines for fitness to drive after orthopaedic procedures remain vague. DBRT has been assessed using different driving simulators in several surgical and non-surgical conditions. To date the effect of sciatica and SNRB on DBRT has not been studied.

Methods: DBRT s of 20 patients with sciatica (10 right, 10 left) were measured using a custom-built car simulator. Each patient was tested pre-SNRB, immediate post-SNRB, 2 and 6 weeks post-SNRB. As controls 20 age-matched normal subjects were tested once. Full departmental, institutional and ethical committee approval were obtained.

Results: The mean reaction time of the control group was 459 ms. The mean reaction times of the patients at different points of assessment were as follow:

Conclusions:

This study confirms the intuitive impression that patients with sciatica have prolonged DBRT compared to normal population. This represents an extra absolute increase in traveling distance of 2.4 meters in a 70 mph speed zone.

Type of study: Case-series comparison.

Patients: 20 patients (2 males); average age 15.5 years; mean follow-up 22 months. 10 patients (Lenke type 1) had anterior correction and instrumentation; 10 patients (Lenke type 2) had posterior operations. All patients had a selective thoracic fusion (with the type 2 curves having instrumentation incorporating the proximal thoracic curve).

Outcome measures: Complications, radiological parameters (Cobb correction of major & compensatory curves); trunk shape (rib hump / scoliometer), and SRS-22 questionnaires.

SRS-22 outcomes: There was no significant difference in the pre-operative individual domain scores (pain, self-image, function, mental health, satisfaction) between the two groups. There were no differences in the postoperative results (including self-image) apart from pain. The anterior surgery group had more persistent pain, but at a similar level than preoperatively (3.2 [0.8] vs 4.6 [0.3], p~0.03).

Conclusion: For right thoracic (Lenke curve types 1& 2) late-onset idiopathic scoliosis both types of surgery deliver similar radiological and trunk-shape results. SRS-22 self-image and function post-operative results are also similar. The anterior procedure did not however improve the pre-operative pain score.

Background Hospital Episode Statistics (HES) is often used by hospital managers and politicians as a reflection of departmental workload. The accuracy of this data is often questioned. We aimed to ascertain the reliability of this database for trauma admissions.

Method Between August 2002 and July 2003, all admissions were recorded by doctors using a separate departmental database. Data was collected during the daily trauma meetings. This data was compared with the HES return for the same period.

Results 2496 patients were recorded in the trauma admissions database. Overall, 36.4% of the patients were either not recorded by the HES database or wrongly coded in terms of type of admissions or diagnosis.

HES data for all 2496 records was analysed by type of admissions and speciality.

4.2% of trauma patients were incorrectly classified as elective or day cases.

2.9% of trauma patients admitted to hospital were not recorded in the HES data as orthopaedics admission.

The accuracy of HES diagnosis coding was tested on 300 records randomly selected by a statistical package.

HES recorded the wrong diagnosis in 29.3% of cases.

Conclusion A significant number of trauma cases were not counted in the HES data. This may have significant implications for trauma funding.

HES data does not accurately record diagnoses and therefore can not be used as a research tool for specific injuries.

Data recording practice should be changed to improve HES data accuracy.

Background Hip fracture is a common clinical problem that leads to considerable morbidity and mortality in the United Kingdom. Recommendations in our hospital suggest that elderly patients suffering from these fractures should have surgery within two calendar days from admission.

Methods From August 2002 to July 2003, we studied 407 patients over the age of 65 who had a fracture of the hip. (Cases were recorded prospectively in our department trauma database). This was to determine the effect of operative delay and patients age on in-hospital mortality and on post operative length of stay. An operative delay was defined as an interval more than two calendar days between the time of admission to the hospital and the operation.

Results In 199 (47%) cases, operation was performed within two calendar days from admission. The in-hospital mortality rate was 11%. The mean length of stay was 17 days.

In the cases studied, neither the operative delay nor the age of the patient had a significant effect on the length of stay post operation.

There was an increase in the in-hospital mortality rate associated with the operative delay, although this was not significant statistically.

There was a statistically significant increase in the inhospital mortality rate with an increase in the patients age (5 % if less than 80 years old, 11% if between 80 and 89 years old, 19% if 90 years or older, p is less or equal to 0.05). In all three age groups the mortality rate did not statistically significantly decrease if the surgery was performed within two calendar days from admission.

Conclusion Early surgery is not associated with significantly improved in-hospital mortality rate. Early surgery is not associated with decreased length of stay. Age is a prime factor in predicting the in-hospital mortality rate. We recommend early medical input for patient optimisation to reduce the proven high mortality rate.