Steven Tominey - Academia.edu (original) (raw)

Papers by Steven Tominey

Stroke and Vascular Neurology

BackgroundHyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical ... more BackgroundHyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH.MethodsWe prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression.Results175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements we...

Supplemental material, INC900099 Supplemental Material for Community prescribing of potentially n... more Supplemental material, INC900099 Supplemental Material for Community prescribing of potentially nephrotoxic drugs and risk of acute kidney injury requiring renal replacement therapy in critically ill adults: A national cohort study by Steven Tominey, Alan Timmins, Robert Lee, Timothy S Walsh and Nazir I Lone in Journal of the Intensive Care Society

Additional file 1. Supplementary material.

Supplementary materials to accompany main published manuscript.

Additional file 1. Supplementary Material: search terms

Stroke, 2021

Objective: In UK Biobank (UKB), a large population-based prospective study, cases of many disease... more Objective: In UK Biobank (UKB), a large population-based prospective study, cases of many diseases are ascertained through linkage to routinely collected, coded national health datasets. However routinely collected coded data cannot always provide sufficient accuracy or granularity (i.e. sub-phenotypes) for research studies. For example, while ischemic stroke codes appear accurate, the precision for hemorrhagic stroke codes (intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) may be as poor as <50%. We investigated whether automated analysis of radiology reports could improve disease subtyping in UKB, using stroke as an exemplar disease. Methods: From a sub-population of 17,249 UKB participants, we ascertained those with an incident stroke code and ≥1 clinical brain scan report. We used automated methods (a combination of natural language processing and clinical knowledge inference) on brain scan reports to assign a stroke subtype (ischemic vs ICH vs SAH) for each p...

npj Digital Medicine, 2021

Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare ... more Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. A...

BMC Medical Informatics and Decision Making, 2021

Background Better phenotyping of routinely collected coded data would be useful for research and ... more Background Better phenotyping of routinely collected coded data would be useful for research and health improvement. For example, the precision of coded data for hemorrhagic stroke (intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) may be as poor as < 50%. This work aimed to investigate the feasibility and added value of automated methods applied to clinical radiology reports to improve stroke subtyping. Methods From a sub-population of 17,249 Scottish UK Biobank participants, we ascertained those with an incident stroke code in hospital, death record or primary care administrative data by September 2015, and ≥ 1 clinical brain scan report. We used a combination of natural language processing and clinical knowledge inference on brain scan reports to assign a stroke subtype (ischemic vs ICH vs SAH) for each participant and assessed performance by precision and recall at entity and patient levels. Results Of 225 participants with an incident stroke code, 207 had a r...

Journal of Neurosurgery: Pediatrics, 2020

OBJECTIVEContention exists regarding appropriate classification and management of spinal lipomas ... more OBJECTIVEContention exists regarding appropriate classification and management of spinal lipomas (SLs). Given the heterogeneity of SLs, omissions and overlap between surgically incomparable groups exist in conventional classification systems. The new classification of spinal lipoma (NCSL) recently proposed by Morota et al. delineates morphology by embryological pathogenesis and the resultant operative difficulty. Here, the authors aimed to validate the NCSL by applying it to patients who had been operated on at their institution.METHODSAll children who had undergone resection for SL between 2014 and 2018 were included in this analysis. MRI studies were independently reviewed and classified by three adjudicators. Baseline characteristics, inter-adjudicator agreement, coexisting anomalies and/or malformations, and postoperative outcomes and complications were analyzed.RESULTSThirty-six patients underwent surgical untethering for SL: NCSL type 1 in 5 patients (14%), type 2 in 14 patien...

Journal of the Intensive Care Society, 2020

Background Acute kidney injury demonstrates a high incidence in critically ill populations, with ... more Background Acute kidney injury demonstrates a high incidence in critically ill populations, with many requiring renal replacement therapy. Patients may be at increased risk of acute kidney injury if prescribed certain potentially nephrotoxic medications. We aimed to evaluate this association in ICU survivors. Methods Study design – secondary analysis of national cohort of ICU survivors to hospital discharge linked to Scottish healthcare datasets. Outcomes: primary – renal replacement therapy in ICU; secondary – early acute kidney injury (calculated using urine output and relative change from estimated baseline serum creatinine within first 24 h of ICU admission using modified-RIFLE criteria). Primary exposure: pre-admission community prescribing of at least one potential nephrotoxin: angiotensin-converting-enzyme inhibitors/angiotensin-receptor blockers, diuretics or nonsteroidal anti-inflammatory drugs. Statistical analyses: unadjusted associations – univariable logistic regression...

Background Hydrocephalus is a common, life threatening complication of human immunodeficiency vir... more Background Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify prognostic indicators, we aimed to compare survival and clinical outcome following VPS placement between all studied causes of hydrocephalus in HIV infected patients. Methods The following electronic databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL Plus, LILACS, Research Registry, the metaRegister of Controlled Trials, ClinicalTrials.gov, African Journals Online, and the OpenGrey database. We included observational studies of HIV-infected patients treated with VPS which reported of survival or clinical outcome. Data was extracted using standardised proformas. Risk of bias was as...

British Journal of Neurosurgery, 2021

Objectives To determine the indirect consequences of the COVID-19 pandemic on paediatric healthca... more Objectives To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on March 23, 2020. Design National retrospective cohort study. Setting Emergency childhood primary and secondary care providers across Scotland; two national Paediatric Intensive Care Units (PICUs); statutory death records. Participants 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years. Main outcome measures Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all datasets, rates during the lockdown period were compared to mean or aggregated rates for the equivalent dates in 2016-19. Results The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an odds ratio of 0.52 for likelihood of admission during lockdown (95% CI 0.37-0.73), compared to the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-19. Conclusions National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm. What is already known on this topic?  In different settings the COVID-19 pandemic has been shown to lead to a reduction in paediatric emergency department attendances and Paediatric Intensive Care Unit (PICU) admissions for respiratory causes.  The pandemic has also led to concerns amongst clinicians about delayed care-seeking for serious paediatric conditions, and a possible increase in non-accidental injuries.  The overall effects of the pandemic on national emergency healthcare utilisation in primary, secondary and critical care, and how this has impacted on severe paediatric disease, have yet to be quantified. What this study adds?  We found a reduction in paediatric emergency care utilisation rates at a national level associated with lockdown.  This reduction is likely to be due to a combination of changes in healthcare seeking behaviour, and a fall in the overall burden of paediatric infectious disease.  These measures did not appear to have been associated with evidence of severe harm to children in Scotland, as evidenced by severity scores on presentation to PICU or overall mortality.