internal medicine

To LP or not to LP? A service evaluation investigating the prevalence of subarachnoid haemorrhage in patients undergoing a lumbar puncture in the acute medical setting

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Subarachnoid haemorrhage (SAH) is a potentially life-threatening cause of acute severe headache. This service evaluation aimed to investigate the prevalence of SAH in patients referred to acute medicine with acute severe headache who underwent a lumbar puncture (LP) at a tertiary teaching hospital, over a four-year period. Of the 677 samples analysed for CSF bilirubin, 619 were negative (91.5%), 48 indeterminate (7%), and 10 classified as positive (1.5%). Only one patient (0.1%) was diagnosed with an aneurysmal SAH and underwent intervention. Therefore, the diagnostic yield of an LP to exclude SAH in this setting is extremely low. This service evaluation challenges the dogma that LP is necessary in all patients with acute severe headache.

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Evaluation of a basic point-of-care ultrasound course for residents in internal medicine

Correspondence, Volume 21, Issue 3, Pages 121-164 (2022)

Point-of-care ultrasound (POCUS) integrates imaging into the physical examination at the bedside. This offers the advantage of instant clinical information and has shown to speed up the diagnostic process, and to improve diagnostic accuracy and correct treatment.

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Using trends in electronic recordings of vital signs to identify patients stable for transfer from acute hospitals

Original Articles, Volume 18, Issue 4, Pages 205 – 264 (2019)

Patients who are stable might not be required to remain in hospital. We aimed to create objective criteria to indicate stability based on vital signs. An index based on NEWS (NBI) was compared to a Patient Stability Index (PSI) algorithm created by random forest analysis.

Data from the VITAL II study was used to train the algorithm and data from the VITAL III study to validate it. Failure rate of the algorithms was set close to the rate of readmission to UK hospitals at 15%. After a training period of two days the NBI identified stability with acceptable failure rates only after a further 96 hours with a subsequent release of 2143 bed days compared to the PSI which identified stability after only 12 hours leading to potential earlier release of 2652 bed days.

Vital sign-based algorithms might be able to predict safe transfer from hospital and inform management of flow.

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