Emergency Medicine Australasia最新文献

{"title":"Retrospective Evaluation of the STONE Score and Modified Stone Score for Prediction of Renal Tract Stones","authors":"Kezia Mansfield,&nbsp;Anne-Maree Kelly,&nbsp;Freya Resendez","doi":"10.1111/1742-6723.70259","DOIUrl":"10.1111/1742-6723.70259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Computed tomography (CT) imaging remains the gold standard for diagnosis of renal tract stones; however, recurrence is common leading to the risk of radiation exposure with repeated scans. Predictive scoring systems have been suggested to aid decision-making and reduce unnecessary imaging; however, their accuracy has been challenged. This study aimed to assess the diagnostic performance of the STONE score and modified STONE score (MSS) in predicting ureteric calculi in an Australian population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of patients aged &gt; 18 years, who were suspected of having ureteric colic and underwent CT renal tract. Patients were excluded if they had fever, recent urological surgery or trauma, active cancer or unstable vital signs. Score performance was evaluated by clinical performance analysis and receiver operating curve (ROC) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>191 patients were studied; 62.3% had confirmed urolithiasis and 6.3% had a confirmed alternative diagnosis. The STONE score demonstrated an AUC of 0.806 (95% CI 0.745–0.862), and the MSS had an AUC of 0.796 (0.734–0.858) for predicting ureteric stones. If the high score (high probability urolithiasis) group patients had not undergone a CT scan, 8.9% of scans could have been avoided if the STONE score was applied compared to 54.8% with the MSS (<i>p</i> = 0.0004). There was poor classification agreement between the scores (Cohen's kappa −0.03; <i>p</i> = 1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both the STONE and MSS demonstrated moderate accuracy in predicting ureteric stones in an Australian emergency department (ED) population; however, the proportion of scans potentially avoided was markedly different. It is not clear whether these scores are superior to clinician gestalt.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Retrospective Evaluation of Blood Administration Practices Within LifeFlight Medicine","authors":"Bradley Robert Richardson,&nbsp;Tara Pidgeon,&nbsp;Susanna Cramb,&nbsp;Ben Powell,&nbsp;Ben Aston","doi":"10.1111/1742-6723.70253","DOIUrl":"10.1111/1742-6723.70253","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To define and compare the incidence, patient demographics, tasking characteristics, and clinical features associated with packed red blood cell (PRBC) administration within the LifeFlight Medical Services (LFM) retrieval network during the 2024 calendar year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study examined all LFM missions in 2024 involving PRBC administration. Missions were included when PRBCs were administered by, or at the direction of, an LFM doctor. Primary missions and interfacility transfers (IFT) were analysed and compared with the overall mission cohort. Collected variables included transport platform, indication for transfusion, patient demographics, blood product utilisation, wastage, and compliance with adjunctive therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 7791 missions, PRBCs were administered on 226 missions (2.9% of all missions), including 100 primary missions (7.6% of all primary missions) and 126 IFT's (1.9% of all IFT's). A total of 492 units were transfused, with 3.0% wastage. Primary trauma accounted for 59% of transfusions and medical/surgical causes for 41%, most commonly upper gastrointestinal bleeding. Rotary-wing and road-based platforms demonstrated the highest transfusion incidence. No significant age differences were identified between transfused and non-transfused patients. Compliance with blood warming, tranexamic acid, and calcium administration was high at 81%, 83%, and 85%, respectively. Use of O-positive blood in females under 50 years was rare, occurring in 0.3% of primary missions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PRBC transfusion within LFM is infrequent but essential across all missions. This analysis provides the first comprehensive Australian description of real-world PRBC utilisation across retrieval platforms, supporting transfusion governance, operational planning, and future outcome-focused research within Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Suspected Stroke Clinical Pathway Use in Tasmanian Emergency Departments: A Retrospective Study","authors":"Innocent Tawanda Mudzingwa,&nbsp;Sarah Jane Prior,&nbsp;Phoebe Griffin,&nbsp;Emma Tavender,&nbsp;Viet Tran","doi":"10.1111/1742-6723.70254","DOIUrl":"10.1111/1742-6723.70254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Stroke is a leading cause of disability and healthcare burden in Australia, affecting over 440,000 people. Timely diagnosis and intervention are essential for improving outcomes, and national ED standards emphasise rapid assessment, imaging and treatment. Clinical pathways aim to standardise care and reduce delays, yet regional disparities persist. This study examined suspected acute stroke pathway use in Tasmanian EDs, assessing guideline adherence, waiting times and inter-hospital variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study analysed 205 suspected stroke presentations across four public Tasmanian EDs in 2021. Data from digital medical records were evaluated for pathway utilisation, adherence to key clinical elements and time metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean patient age was 70.5 years, with 56% male. Suspected stroke pathway use varied significantly between hospitals (27%–62%). In unadjusted analyses, pathway-managed patients more frequently completed ROSIER and NIHSS assessments (<i>p</i> &lt; 0.0025) and were more likely to receive thrombolysis, though causality cannot be inferred. Pathway use was also associated with shorter times to initial ED assessment (&lt; 10 min) and faster CT imaging (&lt; 45 min) compared with non-pathway care (&gt; 50 and &gt; 130 min) across EDs statewide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Use of the suspected acute stroke pathway appeared to vary across the four EDs, suggesting differences in pathway use and integration into everyday clinical workflows. Pathway use was associated with higher adherence to evidence-based guidelines and improved timeliness of care. However, these findings are subject to confounding by other factors and should therefore be interpreted with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are We Measuring What Matters? Re-Examining National Out-of-Hospital Cardiac Arrest Outcome Indicators","authors":"Jason Belcher,&nbsp;Stephen Ball,&nbsp;Judith Finn","doi":"10.1111/1742-6723.70256","DOIUrl":"10.1111/1742-6723.70256","url":null,"abstract":"<div>\u0000 \u0000 <p>The Australian Government Productivity Commission Report on Government Services (ROGS) includes three out-of-hospital cardiac arrest (OHCA) indicators within its ambulance services chapter, all using return of spontaneous circulation (ROSC) at hospital arrival as the outcome measure. This outcome definition has remained unchanged since its introduction in 2003, despite significant maturation of Australia's OHCA data infrastructure. We propose the current indicators be changed to reflect patient-centred outcomes, enable meaningful benchmarking and align with international standards. Specifically, we suggest that survival to hospital discharge (or 30 days), the outcome recommended by international consensus, should be the primary outcome measure; that the shockable rhythm indicator should incorporate witness status to align with the international reporting standard; and that paramedic-witnessed arrest reporting should be stratified by initial rhythm. With all Australian ambulance services now maintaining OHCA registries and contributing to the Australasian Resuscitation Outcomes Consortium Epistry, our recommended changes to the reporting are achievable.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Handover as Craft, Not Checklist","authors":"Aloha Hufana Ambe,&nbsp;Nathan Brown,&nbsp;Daniel Bodnar,&nbsp;Tobias Grundgeiger,&nbsp;Sean Rothwell,&nbsp;Ben Matthews","doi":"10.1111/1742-6723.70247","DOIUrl":"10.1111/1742-6723.70247","url":null,"abstract":"<p>Handover is one of the most studied elements of clinical care and its importance to the good continuity of care and patient outcomes is well-accepted. Unfortunately, efforts to improve the quality of clinical handovers have led to an environment of compliance exemplified by mnemonics, templates and audits that assume or suggest handovers to be stable, reproducible processes that can be judged by conformity to checklists. However, handovers are highly heterogenous, personalised and nuanced events that do not easily fit into tightly structured models. We draw on observational work in a 2-year, ongoing collaboration between a large emergency department and a human-centred design research team, and argue that handover is essentially a craft: a skilled practice shaped by timing, uncertainty, recipient needs and jurisdictional boundaries. We suggest that standardisation of handovers can work against quality, and that simple checklists threaten to flatten rather than enhance their true craft or value. Shifting how clinical handover is understood, taught, assessed and supported, by emphasising the importance of craft over completeness may be the secret to ensuring quality.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in Swedish Healthcare: Balancing Individual and System Responsibility—And Some Practical Examples From Sweden","authors":"Cechael Sebghati Sparrfelt","doi":"10.1111/1742-6723.70255","DOIUrl":"10.1111/1742-6723.70255","url":null,"abstract":"<div>\u0000 \u0000 <p>Sustainability in healthcare is something we cannot look away from as it is critical to the future. However, the complex question of individual versus system responsibility remains debatable. Clinical priorities must focus on patient safety, with sustainability designed to support and never compromise the delivery of care. The need for sustainability needs to be addressed from the highest level of decision making while frontline innovation also plays an important role. This reflective piece provides some examples from Karolinska University Hospital in Stockholm, Sweden. Karolinska has a strategy for embedding sustainability into the organisation, including setting environmental targets, accessible infrastructure, staff education and regularly measuring progress. In Sweden there are good examples of initiatives from clinicians themselves becoming the gold standard. Sustainable healthcare is most effective when it is supported by systems that enable health care workers to act responsibly and provide opportunities to be innovative, without adding cognitive burden.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threats to Humanity and Doctors' Duties","authors":"Neil Pickering","doi":"10.1111/1742-6723.70252","DOIUrl":"10.1111/1742-6723.70252","url":null,"abstract":"<div>\u0000 \u0000 <p>Doctors as doctors have plausible duties to do what they can to mitigate the impacts of the health system and their own practices on climate change, given that there is generally a duty to do good when one can. One objection to this claim is that the actions doctors could take fall outside doctors' specialist knowledge and legitimate ambit of influence. However, while this objection seems to apply in the case of political actions, it does not apply to actions doctors might take within medical institutions to mitigate climate impacts. A second objection is that within medical institutions, doctors should always prioritise patient care over any other duty. However, though this is true, it doesn't show that the duty in relation to the environment doesn't exist, and in practical terms, there seem likely to be opportunities to act upon it within existing day to day practice. The original claim still stands.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustaining Emergency Medicine: Workforce Wellbeing, Moral Integrity and the Power of Action","authors":"Sonia Chanchlani","doi":"10.1111/1742-6723.70250","DOIUrl":"10.1111/1742-6723.70250","url":null,"abstract":"<div>\u0000 \u0000 <p>Sustainability in emergency medicine is often framed in environmental terms, yet workforce wellbeing is equally central to the specialty's long-term viability. Across Australasia, EDs are experiencing sustained access block, rising demand and staffing pressures, contributing to high rates of burnout, moral injury and workforce attrition. These phenomena are not individual failings but signals of systemic strain. This article reframes ED workforce wellbeing and retention as core sustainability issues. It argues that clinician involvement in organisational redesign, high-value care initiatives and environmental sustainability programs can mitigate distress by restoring agency and professional purpose. Recent Australian initiatives, including the Sustainable and Quality Use of Diagnostics in Emergency Departments (SQuDs-ED) project and the University of Melbourne Hospital Sustainability Toolkit suggest that reducing low-value care can also improve patient outcomes and decrease environmental impact. Action, when supported by safe staffing and structural reform, may protect against burnout. Integrating workforce, quality and environmental sustainability is therefore essential to ensuring a resilient future for emergency medicine.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathology Testing for Patients With Low Back Pain in Australian Emergency Departments.","authors":"Claudia Côté-Picard, Qiuzhe Chen, Hugo Massé-Alarie, Peter Youssef, Michael Spies, Chris G Maher, Gustavo C Machado","doi":"10.1111/1742-6723.70260","DOIUrl":"10.1111/1742-6723.70260","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to describe the profile of patients with low back pain who received pathology testing in emergency departments or after inpatient admission, and to describe the ordered tests.</p><p><strong>Methods: </strong>A retrospective study of electronic medical records from three emergency departments in Sydney, New South Wales, Australia, from January 2016 to October 2021, was undertaken. We included patients diagnosed with a lumbar spine condition at discharge from the emergency department and extracted their demographic and episode of care characteristics.</p><p><strong>Results: </strong>Pathology tests were ordered in 23.8% of 15,300 episodes of care. Patients who received pathology testing were typically older, were female, had a non-English preferred language, required an interpreter, arrived by ambulance during working hours, had their condition triaged as urgent, had a diagnosis of a serious low back pain pathology, were admitted to inpatient wards, and had an increased length of stay. Full blood count, electrolytes, urea, creatinine (EUC) and liver function tests were the most ordered tests.</p><p><strong>Conclusions: </strong>The characteristics of patients with low back pain receiving pathology testing in emergency departments as well as those of the tests were described. The results suggest that guideline recommendations were partly followed, but an investigation into the appropriateness of pathology testing is needed to confirm this hypothesis and ensure the relevance of low back pain care in emergency departments.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":"e70260"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Accounting in Healthcare and the Ethical Questions It Raises.","authors":"Bridget Pratt","doi":"10.1111/1742-6723.70257","DOIUrl":"https://doi.org/10.1111/1742-6723.70257","url":null,"abstract":"<p><p>We face an ever-worsening environmental crisis to which healthcare systems substantially contribute. This article clarifies what the duty to minimise healthcare's environmental impact entails as a matter of environmental and ecological justice. Yet upholding the duty raises further ethical questions around responsibilities and trade-offs: Should responsibility lie at the individual (micro), organisational (meso), or systemic (macro) level? How far should those responsible go to fulfil the duty when it conflicts with ethical duties to deliver health and social goods to patients? This article considers those questions using the case of carbon accounting in the ED. It presents a range of plausible answers, drawing on current debates in the green bioethics space.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":"e70257"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}