School of Health and Related Research projects

Projects:

Do blood biomarkers predict clinically important deterioration in alert (GCS13-15) patients with traumatic brain injury identified on CT imaging?

Main Supervisor

Dr Carl Marincowitz (c.marincowitz@sheffield.ac.uk)

Second Supervisor

Professor Fiona Lecky (f.e.lecky@sheffield.ac.uk)

Aim and Objectives

We aim to assess whether blood biomarkers:
1) predict clinical deterioration including need for neurosurgery or death in GCS13-15 patients with traumatic brain injuries identified on CT imaging
2) whether use can improve clinical decision making regarding need for hospital admission in this group.

Research Methodology

We have previously identified a cohort of 1050 GCS13-15 patients with with traumatic brain injuries identified on CT imaging in the large multi-centre CENTRE TBI cohort study and used this to validate a decision rule to select low risk patients for early discharge from the Emergency Department.

A student conducting this project would be expected to complete a short literature review regarding potential biomarkers that may predict clinical deterioration in this population of patients with traumatic brain injury.

All patient recruited to the CENTER-TBI cohort study had a range of biomarkers measured in blood samples taken at time of hospital attendance. With supervision regarding use of statistical methods and software packages like SPSS and STATA the association between presence/concentration of biomarkers and clinical deterioration will be assessed in the cohort of 1050 patients. We would assess whether inclusion of biomarkers improves performance of our previously derived decision rule.

Expected Outcome

1) Literature review regarding biomarkers and prediction of clinical outcomes in traumatic brain injury
2) Analysis regarding whether biomarkers predict deterioration in this group
3) Analysis regarding whether inclusion of biomarkers improves performance of decision rule to select low risk patients for discharge from the Emergency Department

This would be expected to be submitted as a conference abstract and form the basis of a journal submission.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

Training in relevant statistical methods.

Evaluation of NEWS2 as an Emergency Department Triage Tool

Main Supervisor

Professor Steve Goodacre (s.goodacre@sheffield.ac.uk)

Second Supervisor

Dr Gordon Fuller (g.fuller@sheffield.ac.uk)

Aim and Objectives

The National Early Warning Score version 2 (NEWS2) is a simple clinical score based on routinely recorded clinical measurements that is used across the NHS as a standardised way of assessing acute illness severity. NEWS2 is recorded on all patients arriving at the Emergency Department (ED) with acute illness. It can be used to assist ED triage decisions, involving prioritising patients for urgent treatment, but it is not known how well NEWS2 predicts the need for urgent treatment. This project aims to determine the accuracy of NEWS2 in predicting the need for urgent treatment among patients attending the ED.

Research Methodology

Quantitative retrospective observational cohort study. The student will use the ED IT system to select a cohort of patients who attended the ED with acute illness, and extract data recording their characteristics, NEWS2 scores, treatments, and outcome. They will then review ED records of cases with selected treatments or outcomes to determine whether they needed urgent treatment. Statistical analysis will involve estimating the accuracy of NEWS2 in predicting the need for urgent treatment, and decriptive analysis of false negatives (patients requiring urgent treatment not prioritised by NEWS2) and false positives (patients prioritised by NEWS2 but not requiring urgent treatment).

Expected Outcome

The study will determine the potential role of NEWS2 in ED triage. It will inform ED care and the development of future research in this area. Previous emergency medicine BSc projects have resulted in presentation at a national conference and publication in a peer-reviewed journal. If successfully completed, this project would be expected to achieve the same.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

The project will involve additional training in information governance, data management, and statistical analysis using software, such as SPSS.

Urgent and Emergency Care (UEC): managing demand and flow

Main Supervisor

Professor Suzanne Mason (s.mason@sheffield.ac.uk)

Second Supervisor

Mr Colin O'Keeffe (c.okeeffe@sheffield.ac.uk)

Aim and Objectives

To identify opportunities for improving management of demand in the urgent and emergency care (UEC) system

Research Methodology

After an iterative process with the supervisors a topic and research questions for the project will be decided. This will focus on either 1) an understanding of demand from a selected patient group (e.g. frail older people, mental health) or the impact of a particular service model (e.g ED frail older model, ED psychiatric liaison). A literature review will be undertaken to determine a comprehensive understanding of the agreed topic. The project will also include a further research methodology to be determined by the research question, but may include statistical analyses of datasets, survey or interviews with health professionals.

Expected Outcome

This work is part of the ARC Urgent and Emergency Care Research Theme, based in ScHARR. The work will be a project within the research programme which started in October 2019 and is developing knowledge and interventions to improve urgent and emergency (UEC) care within Yorkshire and Humber. The outcomes of the project will be to produce outputs and undertake dissemination activities to key stakeholder groups in UEC. An example would be delivering an abstract to the Royal College of Emergency Medicine Scientific Conference (RCEM). A journal article may also be produced from findings of the study.

Type of Project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional Training

As part of a thriving and busy research environment within ScHARR, the student will have guidance of experienced researchers within their chosen methodology.