PROFESSIONALS
Referral Support
Most neurosurgical referrals and discussion now take place using electronic messages. The following are commonly used statements (‘MedSerts’) that can be helpful to ensure the right information is requested or given, efficiently.
Triage
Symptomatic? cSDH identified on CT, uncertain whether it is causing any symptoms
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It is important to establish if the cSDH identified is causing any symptoms. Please explore with the patient, or alternatively the relative and/or carer if a collateral history is required, if there is any subacute history (deterioration over days to weeks) in walking or balance, worsening headache, nausea or vomiting, change in cognitive status or speech, and/or weakness on one side of the body.
Fitness for Surgery? cSDH identified on CT, confirm fitness for surgery
Please confirm (1) if the patient is taking any anticoagulants, their Hb, Platelets and Clotting Function, and if any management has taken place to optimise them (2) if there are any signs of infection (e.g. temperatures, raised CRP or WCC) and (3) their level of independence before the onset of symptoms.
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Treat
Asymptomatic? Local Management
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As the cSDH is not causing any symptoms, this can be managed non-operatively. Asymptomatic cSDH generally resolve without intervention, although it is not possible to predict this. Please advise the patient to return to their local ED for a further CT scan, if any concerns, such as any deterioration in walking or balance, worsening headache, nausea or vomiting, change in cognitive status or speech, and/or weakness on one side of the body.
Symptomatic? Transfer when bed available
We will transfer the patient for further assessment and management. Please await contact from our bed managers to facilitate this. The patient can eat and drink. Please hold any anticoagulation. Please ensure the transfer paperwork includes the next of kin details, latest blood results and an ECG. Please update us if any clinical deterioration, but otherwise signpost to the patient/relatives that the transfer can take a few days.
Symptomatic? Urgent Transfer
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Please transfer patient urgently to our emergency department. Please hold any anticoagulation and ensure the patient is nil by mouth. Please ensure the transfer paperwork includes the next of kin details, latest blood results and an ECG.
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Discharge
Please include re-anticoagulation advice. This is not prepared as a MedSert, as advise differs between surgeons and centres.
Discharge Home
Please arrange an appointment with your practice nurse in X days, to remove the stitches or staples. If you hold a driving license, please contact the DVLA to confirm your eligibility to drive after surgery. If you have any concerns with how your wound is healing, and/or if your symptoms start to return, please attend your local emergency department for assessment.
Repatriation
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Please remove the stitches or staples in X days.
If there are any concerns with wound healing, please contact the Neurosurgical On-Call Service with up to date FBC and CRP. If there are any concerns that symptoms are returning (e.g. a deterioration in mobility, headache, nausea or vomiting, confusion, dysphasia or lateralising weakness), please arrange a further CT scan and contact the Neurosurgical On-Call.
Information Leaflets
Guidelines
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The Society of British Neurological Surgeons (SBNS) with the Neuro Anaesthesia & Neuro Critical Care (NACCs) are currently putting together the first UK Clinical Practice Guideline. This is supported by a range of differential professional organisations and made possible by an award from the National Institute of Academic Anaesthesia (NIAA). The guidelines are expected early 2024. Further information can be found at https://www.improving-care.in/
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