Sheffield Teaching Hospitals NHS Foundation Trust

Background

In 2018, Sheffield Teaching Hospitals NHS Foundation Trust was searching for an Orthopaedic Spinal referral platform that would ensure their patient referrals were monitored and dealt with quickly and efficiently. So, when they came across the Amplitude ReferBack™ system they knew they had found the right solution.

Five years later and the ReferBack™ system is currently used at 9 sites across South Yorkshire ICB:

• Barnsley Hospital
• Bassetlaw District Hospital
• Doncaster Royal Infirmary
• Northern General Hospital
• Rotherham General Hospital
• Royal Hallamshire Hospital
• Northern General Spinal Hub
• Weston Park Hospital
• Royal Chesterfield Hospital

In recent years, due to the amount of patient and clinical data that has been collected, the use of the ReferBack™ system at the Trust has naturally progressed into the world of clinical research.

In 2020/21, during a departmental Journal Club meeting, where relevant medical publications are critically reviewed, the New England Spinal Metastatic Score (NESMS) was of interest due to how it could be applied to clinical practice. Previously validated in the United States in 2021, NESMS has already been proven to be a reliable and accurate tool for predicting short-term major morbidity and mortality for patients undergoing surgery for Metastatic Spinal Disease within an affluent and metropolitan population.

Therefore, it was decided that an external validation study would take place within Sheffield Teaching Hospitals NHS Foundation Trust.

The Approach

The study Sheffield Teaching Hospitals NHS Foundation Trust is undertaking is the first of its kind in the United Kingdom. Therefore, before the research pilot was able to go ahead, the Trust first had to secure ethics approval in order to access the relevant patient data.

Once ethics approval had been granted, the study lead was able to use historical patient data, previously collected by the ReferBack™ system, to create their patient database. The data was taken from 2018 to 2021, in order to eliminate the impact of the Covid-19 pandemic and ensure the data was as reliable and unbiased as possible, and included between 100 and 140 patients.

Now that the data had been collected, the next step was to collate and analyze it. For this to be done, Sheffield Teaching Hospitals NHS Foundation Trust worked with Amplitude’s Reporting Specialist to create a bespoke report which enabled the inclusion of patients’ NHS Numbers.

The study aimed to determine if this same NESMS tool used in the United States study can be applied to patients in the United Kingdom, who are suffering from either metastatic spinal disease or spinal metastases.

The two main objectives of this study are as follows:

1. The primary outcome is to assess if the NESMS score is a reliable predictor of mortality for the cohort of patients in our healthcare institution.
2. The secondary outcome will be to assess if the NESMS score is associated with mortality rates at 3-month, 6-month and 12-month time intervals

The Result

The results of the pilot study have already been presented at national scientific meetings, and the study has subsequently won prizes due to its preliminary findings. The final results of the study are currently being analysed in conjunction with the Oncology research and statistics team in order for a joint scientific publication to take place.

The results of this validation will be useful in a clinical context, as it will facilitate an accurate prediction of mortality and allow patients to understand the natural history of their disease. This is particularly important when considering operative intervention, as it can take months to rehabilitate from surgical procedures, something which patients may not want to undertake if their risk of mortality is high.

In addition to this, Sheffield Teaching Hospitals NHS Foundation Trust are in preliminary talks regarding creating an online NESMS calculator.