CERVICOFACIAL INFECTION PROJECT OVERVIEW
This project aims to assess the usefulness of high dose cortocosteroids in the treatment of cervicofacial infections. Most of these infections are caused by teeth. This respresents one of the most common emergency presentations to maxillofacial departments. There is a paucity of evidence in the literature to support current treatment.
The mainstay of treatment is removal of the source of infection (usually a tooth) and drainage of pus through incisions in the mouth or neck.
The role of high dose corticosteroids is not clear. Some believe that their use can reduce oedema, shorten length of admission and make airway loss and surgical airway less likely.
Our project aims to quantify the usefulness of high dose steroids in this setting.
The project consists of 3 rounds of investigation;
1. UK wide audit of current management of cervicofacial infection in maxillofacail units (now complete).
2. UK wide prospective data capture of 1000 hospital admissions of airway threatening cervicofacial infections in maxillofacial units (data collection complete)
3. Multicentre controlled trial assessing the addition of high dose corticosteroids to standard surgical and medical management of airway threatening cervicofacial infection
Passed NHS ethics with only minor changes, and now registering the trial with MHRA before we can commence with the feasibility trial. It is so exciting to be moving towards the UK's first trainee collaborative led interventional trial in Oral and Maxillofacial Surgery.
SODA has now secured sponsorship from University of South Wales and will be considered for NHS ethics approval on 1st June. The protocol has been further refined and we are looking forward to getting MTReC’s first feasibility study up and running as soon as possible!
As part of our continued commitment to open collaborative research you can find the data set variables for the SODA audit in this document. If you have an analysis plan then please submit this to MTReC via email. As per section 7 of the constitution, the study steering group and data manager will assess the request and release the data as required.
We now have additional papers accepted and pending publication in the BDJ and BJOMS, so look out for your citation if you collaborated on the snapshot audit! SODA continues to move towards an RCT, with protocol changes being made after first submission to NHS ethics in November 2020 and aiming for re-submission early 2021.
The SODA trial (Steroid administration Outcomes in hospital treatment of Dental Abscesses) is the next stage in determining whether steroids alter outcomes in patients with CFI. The protocol has been refined over the summer, and is now nearing full University ethics approval. The trial will initially be a feasibility study, recruiting 50 patients who will be randomised in a 1:1 ratio to steroids + standard treatment or standard treatment alone. Feasibility study primary outcomes will be recruitment, and the full trial will look at pain, nausea, time to normal mouth opening, and length of stay. The protocol will be submitted to the NHS ethics committee in the coming weeks. Our recent letter in BJOMS highlights the importance of this study.
The analyses of the prospective snapshot audit continue to be published, with the latest pre print appearing in BJOMS in August. Though the collaborating authors do not appear in this document, BJOMS have agreed that they will all be pub med searchable, and cited as collaborating authors. We have four further manuscripts accepted (BDJ, BJOMS) and in press (CMF, eOMFS), and when they are fully published (with collaborating authors cited) we will be sharing details of how to cite them.
MTReC have made a big impression at BAOMS 2019 in Birmingham; together we have presented some of the initial findings from the Cervicofacial Infection Project Snapshot Audit. We successfully presented a total of 5 oral presentations and 1 poster, all of which generated a lot of interesting discussion. We are currently meeting with a statistician and busy writing up the findings of the Snapshot Audit before moving to the next phase. Once again, we would like to acknowledge and thank all of our hardworking and enthusiastic collaborators
Data input via REDCAP for the Cervicofacial Infection Snapshot Audit has been completed. We have collected data on over 1000 hospital admissions. This is a huge data set and will help us pave the way for the next phase. Congratulations to everyone involved
Chris and Alastair announced recruitment for new JTG members for the MTReC team and the JTG conference in Cambridge, Thanks to all those who showed so much enthusiam and interest. SNew team members will be announced soon!
***Call form new project team / committee members***
Due to the overwhelming success of our snapshot audit, we are looking for further trainees to join our project team.
We will be recruiting both Fellows in Training and Junior Trainees.
Fellow in Training applications are open and will close on the 15th December.
Applications for Junior Trainees will open after the JTG conference in the new year.
We have done it! After collating the latest update on recruitment numbers we are happily closing recruitment to the cervicofacial snapshot. We have hit and exceeded our target (we have over 1200 patients recruited) and achieved it in a much shorter time than we had expected.
This is all down to your hard work.
What to do now-
Stop data collection!
We are now entering a phase of data consolidation.
Please gather all data collection forms from your participating sites. Make sure they are correctly numbered by site as described in the data collection guidelines (available in the Resources section)
Please review each form. If there is any missing data try and complete this retrospectively. Having completely filled in forms is key to the validity of the dataset and the research we can use it for.
What the MTReC team are up to;
While you are squirrelling away with the data collection forms we are building and piloting a remote data entry system (REDCAP) to link your hospital with our secure MTReC server.
We’ll tell you lots more about this soon and how to set it up in your hospital.
We can only start data entry once you have finished the consolidation phase and find any missing data.
We are achingly close to completing this round of data collection - just one last final push from all our teams will sail us past our target of 1000 patients recruited.
This is a huge achievement for a trainee network and represents by far the biggest study of its type ever undertaken.
It is also one of the largest studies ever performed by a trainee network and will really put us on the map as a specialty with research active trainees.
We have already sent out the first round of certificates recognising the input of our regional leads and local collaborators. Many more will come in the near future.
And remember everyone who contributes to the project will be cited on all our papers and presentations - these are pubmed listed and recognised citations for ISCP and your CV.
We are in the final stages of putting our data entry software in place. This will allow each region to securely enter data onto our central MTReC server. This will be a superb resource for future projects.
But don't stop yet! One final push is all we need!
The MTReC AGM was held at the BAOMS annual meeting in Birmingham. It was great to meet some of our regional leads and collaborators.
We discussed our progress so far and were all in agreement we are well on track to collect data on 1000 patients.
Our national questionnaire has produced 5 national and international presentations, a national prize, 2 posters and a submitted manuscript - all contributers to this part of the study can cite their involvement - their details are on our Publications page. Many, many more publications to come!
Data collection is progressing at pace. We will break the 800 patient barrier any day now. Astounding work by the whole of the MTReC network.
The second round of the Cervicofacial Infection Audit started on 6th March 2017. Project leads have been identified in every region of the UK.
If you still want to get involved see the Resources section and get in touch with the project lead for your area.
We have now completed the first phase (audit of current management)
•267 questionnaires distributed to 17 maxillofacial units across the UK
•86 questionnaires distributed at JTG 2016 conference
•Consultants n = 121, Registrar n = 120, SHO n = 61, Unknown n = 22
•High response rate, wide distribution: 91.7% (n=324)
•Widespread use of steroids; >10% routinely prescribe steroids
•Variation in antibiotic regimens
•23% of patients wait >24 hours to get to theatre
•Clinical equipoise exists.
It is now clear that there are significant differences in practice between and within maxillofacial units in the UK in managing cervicofacial infections, please see the attachment for an overview. This data has been presented at European Association for Cranio-Maxillofacial Surgery Congress London, September 2016 and the NFORC Research Summit London, December 2016 and the BAOMS JTG meeting January 2017 (winner of best presentation).
Dirk Stephanus Brandsma
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