SAH (Subarachnoid Hemorrhage)VASO-TCNCT06560372
Incidence, Characteristics and Evolution of Cerebral Vasospasm With Clinical Impact in Moderate to Severe Traumatic Brain Injury Complicated by Subarachnoid Hemorrhage at Martinique University Hospital
A study testing Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CV in people with SAH (Subarachnoid Hemorrhage) and Cerebral Vasospasm, run by University Hospital Center of Martinique at 1 site in France.
Trial summary
Context : Moderate to severe head trauma with altered state of consciousness is an extremely common pathology (between 60 and 120 cases per 100 000 people per year depending on the country and age group), and is responsible for 30% of deaths by trauma. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- SAH (Subarachnoid Hemorrhage), Cerebral Vasospasm, Moderate Traumatic Brain Injury
- What is being tested?
- Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CV
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 154 participants
- Where
- 1 siteFrance
- Study dates
- 6 Nov 2024to 6 Dec 2028
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adult patient aged 18 or over,
- Hospitalized at the Martinique University Hospital for the treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on the cerebral CT scan,
- Patient if capable, or representative of the patient in case of incapacity, having been informed of the research, and having given free, informed and written consent,
- After an emergency inclusion procedure if the patient's representative is initially unreachable and written agreement, informed within the first 48 hours of inclusion by the representative or the patient if his neurological condition allows it,
- Be affiliated to a social security system.
Who cannot join
- Pregnant woman,
- Presence of an aneurysmal pathology known or diagnosed at initial treatment,
- History of chronic kidney failure stage 4 (creatinine clearance measured less than 30ml/min),
- Imminent death of the patient,
- Patient presenting criteria for non-admission to critical care (death expected within 48 hours, progressive fatal pathology with vital prognosis in less than 30 days, patient in palliative situation),
- Known allergy to iodized contrast products,
Show all 15Show fewer
- Be placed under legal protection, guardianship or curatorship,
- Patient or representative who refused to allow the patient to participate in the study.
- Additional Exclusion Criteria after patient's inclusion:
- Death of the patient expected within the first 48 hours,
- Minor,
- Release from hospitalization against medical advice,
- Transfer to another establishment before the 13th day of treatment (outside the Martinique University Hospital),
- Change of opinion of the patient's representative (after neurological recovery) regarding the patient's participation in research,
- Withdrawal of consent to participate in the study being supported with refusal to use the data collected until withdrawal of participation,
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
France1 site, 1 recruiting
- Recruiting
University Hospital Center of Martinique
Fort-de-France, 97261
Yann Mopsus, MSc, yann.mopsus@chu-martinique.fr
Marie SABIA, PhD
About this study
Context :
Moderate to severe head trauma with altered state of consciousness is an extremely common pathology (between 60 and 120 cases per 100 000 people per year depending on the country and age group), and is responsible for 30% of deaths by trauma. It is complicated in 30-60% of cases by subarachnoid hemorrhage (SAH), which makes it the leading cause of SAH. SAH and its complications are well described when the origin is aneurysmal, notably cerebral vasospasm (CV) because it promotes delayed cerebral ischemia with a major prognostic impact. This is why the screening and prevention of this vasospasm are well established in the literature and in practice, in the nosological context of aneurysmal SAH.
Read more
Research problem :
However, when it comes to post-traumatic SAH, CV is a more maligned entity, with a much less detailed description. However, when we know the prognostic interest that it could have for patients, it seems legitimate to seek to define its physiopathological and epidemiological contours. On a prospective cohort of 290 subjects, Oertel et al. (2005) demonstrated, in head trauma patients, an incidence of approximately 40% of compatible signs with the recognized criteria of CV.
To date, the literature remains sparse on this subject.
Proposed study :
In view of the incomplete scientific literature, the study team wish to carry out a prospective epidemiological study in moderate to severe head trauma patients complicated by SAH and hospitalized at the Martinique University Hospital, with the aim of better characterizing the incidence of the occurrence, and evolution of CV with clinical impact in these patients.
One of the original aspects of the proposed study is the use of CT scan with perfusion sequence, which has shown its superiority to Transcranial Doppler. The other particularity is its prospective aspect and triggered by an alteration in the clinical state of the patient presenting a traumatic SAH, then directly linking the pathophysiology (cerebral ischemia) and the clinical impact. Thus, the diagnosis of traumatic CV will be made on a cerebral CT scan by the association of the 50% reduction in the caliber of one or more cerebral arteries and a perfusion defect in the perfusion sequence in a context of alteration of neurological clinical examination or deterioration of neurological monitoring parameters. Finally, few studies have monitored the evolution of these patients at 1 and 6 months after the initial event.
Hypothesis :
The research hypothesis is that in the population of moderate to severe head trauma patients hospitalized at the Martinique University Hospital, when a new neurological symptomatology or a deterioration in the state of consciousness occurs, it could be a post-truamatic CV in 15 to 20% of cases.
Indeed, the rare studies find frequencies of radiologically confirmed CV in head trauma patients of around 30-45%, with low numbers of subjects, retrospective studies, or not correlated with the clinic and with the clinical and paraclinical data necessary for the positive diagnosis of this entity. The reported frequency of traumatic CV with clinical impact ranges between 15-20%.
The study team therefore expect an incidence of 15 to 20% of CV with clinical impact in patients with traumatic SAH in Martinique. CV could be responsible for sudden deterioration of the neurological state in patients suffering from traumatic SAH between the 3rd and 12th day inclusive of treatment (according to retrospective studies already carried out) and responsible for its specific morbidity linked to cerebral ischemia localized in the spasmed area manifested by a worsening of the neurological prognosis on the modified Rankin scale.
- Conditions
- SAH (Subarachnoid Hemorrhage), Cerebral Vasospasm, Moderate Traumatic Brain Injury, Severe Traumatic Brain Injury
- Being tested
- Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CV
- Keywords
- SAH (Subarachnoid Hemorrhage), Cerebral Vasospasm, Moderate and severe Traumatic Brain Injury, CT scan, Cerebral perfusion
- Medical subject headings
- Subarachnoid Hemorrhage, Vasospasm, Intracranial, Brain Injuries, Traumatic, Lymphoma, Follicular
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CVProcedure or surgery
Neurological monitoring by daily TCD will be carried out.
- If monitoring finds, between 3rd and 12th day of treatment, a neurological deterioration or an uncontrolled increase in intracranial pressure, a new cerebral CT scan will be performed, as recommended in such a case.
- As part of this research, a specific interventional act will be implemented: additional brain perfusion scan sequence which would allow the radiological diagnosis of CV.
- Interventions related to improving cerebral perfusion and reducing intracranial pressure recommended in head trauma patients will be implemented without modification of management linked to protocol.
The additional perfusion sequences will be analyzed independently and blindly by 2 experienced interventional neuroradiologists (double reading blinded to the patient's characteristics).
| Study group | Role | What they receive |
|---|---|---|
| Treatment or monitoring of a moderate or severe TBI presenting with SAH on initial cerebral CT scan | Experimental | Patients hospitalized at Martinique University Hospital for treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on initial cerebral CT scan.
Any head trauma patient with an altered level of consciousness must benefit, as part of routine care, from clinical monitoring and a CT imaging assessment, as well as the opinion of the doctor on duty in the resuscitation department.
If the patient has a traumatic SAH on the cerebral CT scan, he must benefit from an injected sequence exploring the supra-aortic trunks. If there is evidence of intracranial hypertension on cerebral CT or abnormal transcranial doppler, they will benefit, according to the service protocol, from the placement of a parenchymal intracranial pressure sensor. These patients also benefit from clinical monitoring in critical care, as well as a daily biological assessment. Receives: Procedure: Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CV |
What is being measured
The primary outcome is the main question the study is designed to answer.
Estimate the incidence of cerebral vasospasm (CV) with clinical impact in moderate to severeTBI patients complicated by subarachnoid hemorrhage (SAH) at Martinique University Hospital.
Number of incident cases of post-traumatic CV with cerebral perfusion defect observed in the event of new symptoms or neurological worsening in moderate to severe TBI between 3rd and 12th day of treatment post-traumatic in critical care during the study period.
Incidence will be calculated by reporting the number of incident cases of traumatic CV over the total number of patients at risk (traumatic SAH) observed during the study period.
Measured: 42 months
Secondary outcomes (8)
Describe the characteristics of traumatic CV diagnosed in the study sample.
Characteristics of post-traumatic CV diagnosed in the study sample: topography (affected cerebral artery and impacted brain area)
Measured: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Characteristics of post-traumatic CV diagnosed in the study sample: time to onset
Measured: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Characteristics of post-traumatic CV diagnosed in the study sample: time to possible recurrences
Measured: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Characteristics of post-traumatic CV diagnosed in the study sample: duration of each CV episode
Measured: 42 months
Analyze the risk factors for the occurrence of traumatic CV.
Supposed risk factors for post-traumatic CV described in the scientific literature:
- SAH intensity (Fisher and WFNS Score, VASOGRADE Score),
- State of consciousness at treatment (Glasgow Coma Scale at treatment),
- Pre-existing high blood pressure,
- Tobacco consumption,
- Left ventricular hypertrophy,
- Age,
- Sex.
The association between the presence of these factors and the occurrence of post-traumatic CV will be quantified by measures of association (odds ratio) resulting from the implementation of appropriate modeling techniques (logistic regression).
Measured: 42 months
Compare the neurological morbidity at 30 days and 6 months of patients with and without post-traumatic CV in the study sample.
Neurological morbidity: Modified Rankin score at 1 month and 6 months after initial treatment.
The modified Rankin Score is a disability scale used in the long-term assessment of disability linked to acute neurological pathologies (scale ranging from 0-autonomy to 6-death).
Neurological morbidity at 1 and 6 months will be compared between patients with and without post-traumatic CV in the study sample.
Measured: 42 months
Analyze the association between the worsening of the neurological prognosis 6 months after initial patient management, and the presence of a traumatic CV.
The association between the presence of post-traumatic CV and the worsening of the neurological prognosis (Rankin Score ≥ 4) will be quantified by the association measures (odds-ratio) resulting from the implementation of modeling techniques adequate (logistic regression).
Measured: 42 months
Assess quality of life at 6 months
Level of quality of life at 6 months after initial treatment, assessed by the McGill questionnaire for measuring patients quality of life (McGill Quality of Life Questionnaire, revised version, MQOL-R).
Measured: 42 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Aug 2024
- Study start6 Nov 2024
- Primary completion6 Nov 2028 (estimated)
- Study completion6 Dec 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for SAH (Subarachnoid Hemorrhage)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- Patients hospitalized at Martinique University Hospital for treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on initial cerebral CT scan
- Masking
- None (open label)
- Enrolment
- 154 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University Hospital Center of Martinique
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Marie SABIA, PhD, Principal investigator, University Hospital Center of Martinique
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06560372
- Sponsor's protocol ID
- 23_RIPH2-14
- Acronym
- VASO-TC
- Status last verified
- Mar 2025
- First submitted
- 23 Jul 2024
- Last updated
- 31 Mar 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 31 Mar 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Incidence, Characteristics and Evolution of Cerebral Vasospasm With Clinical Impact in Moderate to Severe Traumatic Brain Injury Complicated by Subarachnoid Hemorrhage at Martinique University Hospital
- ClinicalTrials.gov ID
- NCT06560372
- Acronym / sponsor ID
- VASO-TC / 23_RIPH2-14
- Conditions
- SAH (Subarachnoid Hemorrhage), Cerebral Vasospasm, Moderate Traumatic Brain Injury, Severe Traumatic Brain Injury
- Keywords
- SAH (Subarachnoid Hemorrhage), Cerebral Vasospasm, Moderate and severe Traumatic Brain Injury, CT scan, Cerebral perfusion
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 154 participants (estimated)
- Lead sponsor
- University Hospital Center of MartiniqueUniversity, hospital or other
- Study start
- 6 Nov 2024 (actual)
- Primary completion
- 6 Nov 2028 (estimated)
- Study completion
- 6 Dec 2028 (estimated)
- First posted
- 19 Aug 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Context :
Moderate to severe head trauma with altered state of consciousness is an extremely common pathology (between 60 and 120 cases per 100 000 people per year depending on the country and age group), and is responsible for 30% of deaths by trauma. It is complicated in 30-60% of cases by subarachnoid hemorrhage (SAH), which makes it the leading cause of SAH. SAH and its complications are well described when the origin is aneurysmal, notably cerebral vasospasm (CV) because it promotes delayed cerebral ischemia with a major prognostic impact. This is why the screening and prevention of this vasospasm are well established in the literature and in practice, in the nosological context of aneurysmal SAH.
Research problem :
However, when it comes to post-traumatic SAH, CV is a more maligned entity, with a much less detailed description. However, when we know the prognostic interest that it could have for patients, it seems legitimate to seek to define its physiopathological and epidemiological contours. On a prospective cohort of 290 subjects, Oertel et al. (2005) demonstrated, in head trauma patients, an incidence of approximately 40% of compatible signs with the recognized criteria of CV.
To date, the literature remains sparse on this subject.
Proposed study :
In view of the incomplete scientific literature, the study team wish to carry out a prospective epidemiological study in moderate to severe head trauma patients complicated by SAH and hospitalized at the Martinique University Hospital, with the aim of better characterizing the incidence of the occurrence, and evolution of CV with clinical impact in these patients.
One of the original aspects of the proposed study is the use of CT scan with perfusion sequence, which has shown its superiority to Transcranial Doppler. The other particularity is its prospective aspect and triggered by an alteration in the clinical state of the patient presenting a traumatic SAH, then directly linking the pathophysiology (cerebral ischemia) and the clinical impact. Thus, the diagnosis of traumatic CV will be made on a cerebral CT scan by the association of the 50% reduction in the caliber of one or more cerebral arteries and a perfusion defect in the perfusion sequence in a context of alteration of neurological clinical examination or deterioration of neurological monitoring parameters. Finally, few studies have monitored the evolution of these patients at 1 and 6 months after the initial event.
Hypothesis :
The research hypothesis is that in the population of moderate to severe head trauma patients hospitalized at the Martinique University Hospital, when a new neurological symptomatology or a deterioration in the state of consciousness occurs, it could be a post-truamatic CV in 15 to 20% of cases.
Indeed, the rare studies find frequencies of radiologically confirmed CV in head trauma patients of around 30-45%, with low numbers of subjects, retrospective studies, or not correlated with the clinic and with the clinical and paraclinical data necessary for the positive diagnosis of this entity. The reported frequency of traumatic CV with clinical impact ranges between 15-20%.
The study team therefore expect an incidence of 15 to 20% of CV with clinical impact in patients with traumatic SAH in Martinique. CV could be responsible for sudden deterioration of the neurological state in patients suffering from traumatic SAH between the 3rd and 12th day inclusive of treatment (according to retrospective studies already carried out) and responsible for its specific morbidity linked to cerebral ischemia localized in the spasmed area manifested by a worsening of the neurological prognosis on the modified Rankin scale.
Study design
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- Patients hospitalized at Martinique University Hospital for treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on initial cerebral CT scan
| Arm | Type | Receives |
|---|---|---|
| Treatment or monitoring of a moderate or severe TBI presenting with SAH on initial cerebral CT scan | Experimental | Procedure: Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CVPatients hospitalized at Martinique University Hospital for treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on initial cerebral CT scan. Any head trauma patient with an altered level of consciousness must benefit, as part of routine care, from clinical monitoring and a CT imaging assessment, as well as the opinion of the doctor on duty in the resuscitation department. If the patient has a traumatic SAH on the cerebral CT scan, he must benefit from an injected sequence exploring the supra-aortic trunks. If there is evidence of intracranial hypertension on cerebral CT or abnormal transcranial doppler, they will benefit, according to the service protocol, from the placement of a parenchymal intracranial pressure sensor. These patients also benefit from clinical monitoring in critical care, as well as a daily biological assessment. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Adult patient aged 18 or over,
- Hospitalized at the Martinique University Hospital for the treatment or monitoring of a moderate or severe TBI (Glasgow Score less than or equal to 13 at initial treatment) presenting with SAH on the cerebral CT scan,
- Patient if capable, or representative of the patient in case of incapacity, having been informed of the research, and having given free, informed and written consent,
- After an emergency inclusion procedure if the patient's representative is initially unreachable and written agreement, informed within the first 48 hours of inclusion by the representative or the patient if his neurological condition allows it,
- Be affiliated to a social security system.
Key exclusion criteria (15 listed)
- Pregnant woman,
- Presence of an aneurysmal pathology known or diagnosed at initial treatment,
- History of chronic kidney failure stage 4 (creatinine clearance measured less than 30ml/min),
- Imminent death of the patient,
- Patient presenting criteria for non-admission to critical care (death expected within 48 hours, progressive fatal pathology with vital prognosis in less than 30 days, patient in palliative situation),
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CVNeurological monitoring by daily TCD will be carried out. * If monitoring finds, between 3rd and 12th day of treatment, a neurological deterioration or an uncontrolled increase in intracranial pressure, a new cerebral CT scan will be performed, as recommended in such a case. * As part of this research, a specific interventional act will be implemented: additional brain perfusion scan sequence which would allow the radiological diagnosis of CV. * Interventions related to improving cerebral perfusion and reducing intracranial pressure recommended in head trauma patients will be implemented without modification of management linked to protocol. The additional perfusion sequences will be analyzed independently and blindly by 2 experienced interventional neuroradiologists (double reading blinded to the patient's characteristics). | Procedure or surgery | Treatment or monitoring of a moderate or severe TBI presenting with SAH on initial cerebral CT scan |
Primary outcome
Estimate the incidence of cerebral vasospasm (CV) with clinical impact in moderate to severeTBI patients complicated by subarachnoid hemorrhage (SAH) at Martinique University Hospital.
Time frame: 42 months
Number of incident cases of post-traumatic CV with cerebral perfusion defect observed in the event of new symptoms or neurological worsening in moderate to severe TBI between 3rd and 12th day of treatment post-traumatic in critical care during the study period. Incidence will be calculated by reporting the number of incident cases of traumatic CV over the total number of patients at risk (traumatic SAH) observed during the study period.
8 secondary outcomes
Describe the characteristics of traumatic CV diagnosed in the study sample.
Time frame: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Time frame: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Time frame: 42 months
Describe the characteristics of traumatic CV diagnosed in the study sample.
Time frame: 42 months
Analyze the risk factors for the occurrence of traumatic CV.
Time frame: 42 months
Compare the neurological morbidity at 30 days and 6 months of patients with and without post-traumatic CV in the study sample.
Time frame: 42 months
Analyze the association between the worsening of the neurological prognosis 6 months after initial patient management, and the presence of a traumatic CV.
Time frame: 42 months
Assess quality of life at 6 months
Time frame: 42 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 Mar 2025.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Marie SABIA, PhD principal investigator
University Hospital Center of Martinique
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Additional realization of a brain perfusion scan sequence which would allow the radiological diagnosis of CV in people with SAH (Subarachnoid Hemorrhage) and Cerebral Vasospasm, run by University Hospital Center of Martinique at 1 site in France.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 31 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Marie SABIA, PhD (05 96 55 10 54 ext. +596, marie.sabia@chu-martinique.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Estimate the incidence of cerebral vasospasm (CV) with clinical impact in moderate to severeTBI patients complicated by subarachnoid hemorrhage (SAH) at Martinique University Hospital. (time frame: 42 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Mar 2025.