Publications by authors named "Daniel Horner"

Article Synopsis
  • * Current treatment focuses on damage control resuscitation techniques like hemorrhage control, haemostatic resuscitation, and permissive hypotension, although the evidence for permissive hypotension is not as strong as for other therapies.
  • * The authors argue for a shift in focus towards diastolic blood pressure in bleeding trauma patients, as it is important for heart and brain function, proposing that this could lead to more effective resuscitation strategies.
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Article Synopsis
  • - The guidance for clinicians diagnosing cauda equina syndrome in England has improved, but lacks specific advice for patients with recent imaging showing no compression who return with new symptoms.
  • - This study analyzed case notes of 45 patients who sought care at an Emergency Department for cauda equina syndrome and underwent MRI, focusing on changes in symptoms from their first to subsequent visits.
  • - Results indicated that patients reporting an increase in symptoms were more likely to show cauda equina compression on their second MRI, suggesting that further imaging may be warranted even if previous scans were reassuring.
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Objectives: International guidelines recommend IV crystalloid as the primary fluid for sepsis resuscitation, with 5% human albumin solution (HAS) as the second line. However, it is unclear which fluid has superior clinical effectiveness. We conducted a trial to assess the feasibility of delivering a randomized controlled trial comparing balanced crystalloid against 5% HAS as sole early resuscitation fluid in patients with sepsis presenting to hospital.

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Introduction: The effect of eccentric exercise-induced muscle damage (EIMD) on cycling efficiency is unknown. The aim of the present study was to assess the effect of EIMD on gross and delta efficiency and the cardiopulmonary responses to cycle ergometry.

Methods: Twenty-one recreational athletes performed cycling at 70%, 90%, and 110% of the gas exchange threshold (GET) under control conditions (Control) and 24 h following an eccentric damaging protocol (Damage).

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Objectives: Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headache.

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Venous thromboembolism is the third most common cause of cardiovascular death globally and many diagnoses are preventable. The UK NHS has led international efforts to reduce VTE, particularly hospital-associated VTE, through coordinated national policy action and world-leading research. Despite this, VTE remains an important cause of morbidity and mortality in the UK, as underlined by the recent COVID-19 pandemic.

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Background: Pharmacological prophylaxis during hospital admission can reduce the risk of acquired blood clots (venous thromboembolism) but may cause complications, such as bleeding. Using a risk assessment model to predict the risk of blood clots could facilitate selection of patients for prophylaxis and optimise the balance of benefits, risks and costs.

Objectives: We aimed to identify validated risk assessment models and estimate their prognostic accuracy, evaluate the cost-effectiveness of different strategies for selecting hospitalised patients for prophylaxis, assess the feasibility of using efficient research methods and estimate key parameters for future research.

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Purpose: There is no guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using pharmacological agents (chemoprophylaxis) in patients undergoing skull base surgery. The aim of this study was to compare VTE and intracranial haematoma rates after skull base surgery in patients treated with/without chemoprophylaxis.

Methods: Review of prospective quaternary centre database including adults undergoing first-time skull base surgery (2009-2020).

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Objective: To determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.

Design: Decision analysis modelling study.

Setting: NHS hospitals in England.

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A short cut review of the literature was carried out to examine the evidence supporting antithrombotic treatment and/or endovascular therapy to reduce mortality and/or prevent future stroke following blunt cerebrovascular injury (BCVI). Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated.

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Background: D-Dimer testing is a diagnostic tool for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE). This study evaluated the diagnostic performance of the Tina-quant® D-Dimer Gen.2 assay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland) in patients with low/intermediate pre-test probability of DVT/PE using standard, age-, and clinical probability-adjusted cut-offs.

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Background And Objectives: There is a need to develop objective risk stratification tools to define efficient care pathways for trauma patients. Biomarker-based point of care testing may strengthen existing clinical tools currently available for this purpose. The dysregulation of pro- and anti-inflammatory cytokines in the pathogenesis of organ failure is well recognised.

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Background And Importance: Recommended indications for emergency computed tomography (CT) brain scans are not only complex and evolving, but it is also unknown whether they are being followed in emergency departments (EDs).

Objective: To determine the CT utilization and diagnostic yield in the ED in patients with headaches across broad geographical regions.

Design: Secondary analysis of data from a multinational cross-sectional study of ED headache presentations over one month in 2019.

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Article Synopsis
  • Surgical inpatients face a serious risk of venous thromboembolism (VTE), which can be reduced through thromboprophylaxis but comes with cost and bleeding risks; risk assessment models (RAMs) help identify high-risk patients.
  • The study aimed to evaluate the cost-effectiveness of various thromboprophylaxis strategies for adult surgical inpatients, excluding those undergoing major orthopedic surgery or critical care.
  • Results indicated that providing thromboprophylaxis for all inpatients was the most cost-effective approach, with findings showing that better outcomes were linked to interventions targeting VTE complications, influenced by factors like patient age and VTE risk.
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Background: Patients presenting with suspected sepsis to secondary care often require fluid resuscitation to correct hypovolaemia and/or septic shock. Existing evidence signals, but does not demonstrate, a benefit for regimes including albumin over balanced crystalloid alone. However, interventions may be started too late, missing a critical resuscitation window.

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Objectives: We evaluated the accuracy of using routine health service data to identify hospital-acquired thrombosis (HAT) and major bleeding events (MBE) compared with a reference standard of case note review.

Design: A multicentre observational cohort study.

Setting: Four acute hospitals in the UK.

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Background: Venous Thromboembolic disease (VTE) poses a diagnostic challenge for clinicians in acute care. Over reliance on reference standard investigations can lead to over treatment and potential harm. We sought to evaluate the pragmatic performance and implications of using an age adjusted D-dimer (AADD) strategy to rule out VTE in patients with suspected disease attending an emergency department (ED) setting.

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This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. A companion paper addresses the management of PE. Symptoms and signs of PE are varied, and emergency physicians frequently use testing to 'rule out' the diagnosis in people with respiratory or cardiovascular symptoms.

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Pulmonary embolism (PE) can present with a range of severity. Prognostic risk stratification is important for efficacious and safe management. This second of two review articles discusses the management of high-, intermediate- and low-risk PE.

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Background: Most headache presentations to emergency departments (ED) have benign causes; however, approximately 10% will have serious pathology. International guidelines recommend that patients describing the onset of headache as 'thunderclap' undergo neuroimaging and further investigation. The association of this feature with serious headache cause is unclear.

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