Emergency Medicine Australasia最新文献

{"title":"Validation of Rapid Rule-Out Criteria Using the Beckman Access hsTnI Assay for Patients With Suspected Myocardial Infarction in a Cardiac Emergency Department","authors":"Robert Meek,&nbsp;Oliver Weiner,&nbsp;Somesh Venkatesan,&nbsp;Georgina Hayden,&nbsp;Adam Damianopoulos,&nbsp;Tippiporn Morgan,&nbsp;Elise McLeod,&nbsp;Alex Duong,&nbsp;Diana Egerton-Warburton","doi":"10.1111/1742-6723.70085","DOIUrl":"https://doi.org/10.1111/1742-6723.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To externally validate the current Monash Health criteria for rapid rule-out (RRO) of myocardial infarction (MI) at a tertiary cardiac emergency (CE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients with suspected MI at the Victorian Heart Hospital (VHH) CE from April to June 2023 were eligible. Those with ST-elevation MI diagnosis from the initial ECG were excluded. The Monash Health RRO thresholds for the Access hsTnI laboratory high-sensitivity cardiac-troponin-I (hs-cTnI) assay are &lt; 6 ng/L (females) or &lt; 11 ng/L (males). The RRO criteria, derived at a general emergency department (ED) also require symptom onset &gt; 2-h pre-hs-cTnI test and an ECG with no new ischaemic changes. MI diagnosis was determined by cardiologist-emergency physician consensus. The primary objective was the demonstration of RRO criteria performance in the VHH CE population, with sensitivity and negative predictive value (NPV) for index MI &gt; 99%. Patient characteristics were also compared for those meeting RRO criteria or not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For the 1253 eligible patients, median age was 66 years [IQR: 53, 78] and 686 (54.7%) were male. Of the total, 334 (26.7%) met RRO criteria. The NPV for MI was 100% (95% CI: 98.9, 100.0), with sensitivity 100% (95% CI: 96.5, 100.0). Those meeting RRO criteria were younger (60 [IQR: 49, 72] vs. 68 [IQR: 56, 80] years) and less likely to be admitted (21.9% [95% CI: 17.5, 26.7] vs 49.6% [95% CI: 46.3, 52.9]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RRO criteria derived in a general ED population had a similarly high sensitivity and NPV for MI at a tertiary CE department. This supports external validity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339517","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":"Balancing Act: Digoxin Antidote Supply and Demand in New South Wales, Australia","authors":"Julia Jeong,&nbsp;Nicholas A. Buckley,&nbsp;Rose Cairns,&nbsp;Betty S. Chan","doi":"10.1111/1742-6723.70082","DOIUrl":"https://doi.org/10.1111/1742-6723.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to evaluate the supply and demand of digoxin antibody (Digoxin-Fab) in New South Wales (NSW) hospitals before and after the updated Therapeutic Guidelines (TG) for digoxin poisoning introduced in August 2020. We also aim to propose standardised stocking recommendations for NSW public hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective multicentre study analysed data from the New South Wales Poisons Information Centre (NSWPIC) to assess Digoxin-Fab demand, and from the Life Saving Drugs Register (LSDR) to assess supply in NSW hospitals between January 2017 and December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 166 cases of digoxin poisoning were identified in NSW: 149 chronic cases across 34 hospitals and 17 acute cases across 14 hospitals. Following the updated TG, the proportion of chronic cases where clinical toxicologists advised Digoxin-Fab (either ‘immediately’ or ‘if clinically indicated’) decreased from 39.5% to 31.7% (Risk Difference [RD]: 0.08, 95% Confidence Interval [CI]: −0.09 to 0.23, <i>p</i> = 0.39). For acute cases, recommendations decreased from 75% to 60% (RD: 0.15, CI: −0.31 to 0.62, <i>p</i> = 0.60). LSDR data showed NSW hospitals stocked 238 vials in 2018 and 246 in 2020, with uneven distribution. During the study period, two chronic cases and one acute case lacked Digoxin-Fab at the treating hospital when advised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>With few exceptions, Digoxin-Fab supply in NSW hospitals exceeds demand. Based on usage patterns and guideline updates, a more cost-effective and standardised stocking approach is recommended for NSW hospitals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315226","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":"Performance Review of Emergency Care Management Plans Pre- and Post-Implementation of Electronic Records","authors":"Daryl Yeak,&nbsp;Abdi D. Osman,&nbsp;Paul MacGibbon,&nbsp;Amy Van Der End,&nbsp;Negar Mansouri,&nbsp;Michelle Matarazzo,&nbsp;George Braitberg","doi":"10.1111/1742-6723.70083","DOIUrl":"https://doi.org/10.1111/1742-6723.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients who frequently present to the Emergency Department (ED) often have complex care needs, requiring substantial resources and resulting in longer stays. Emergency Care Management Plans (ECMPs) are designed to help clinicians adopt a person-centred approach, clarify goals, avoid unnecessary interventions, and reduce ED visit frequency and duration. ECMPs at our institution were previously stored in paper medical records, making timely access difficult. On April 2, 2012, ECMPs were scanned into the Electronic Medical Record (EMR), allowing easier access. This study assesses the impact of electronic ECMPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a retrospective observational design guided by the STROBE checklist, we evaluated whether the introduction of electronic ECMPs reduced the frequency and duration of ED visits. Data from all ED patients with electronic ECMPs were extracted and analysed to compare variables pre- and post-implementation, including demographics, most common triage data, visit frequency, length of stay (LOS), and discharge diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 115 patients (mean age: 53) were included. Ambulance transport was the most common (64%), and Australasian Triage Scale (ATS) category 3 was the most frequent (57%). Post implementation the mean number of presentations reduced from 16 to 9, and ED LOS (EDLOS) decreased from 4676 to 2577 min (<i>p</i> &lt; 0.001). Short Stay Unit LOS (SSULOS) decreased from 1359 to 638 min (<i>p</i> &lt; 0.001), leading to an overall reduction of 2802 min (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ECMPs effectively reduced both the frequency and duration of ED visits. Further research is needed to explore patient experience and other outcome measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300390","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":"Correction to “Imaging for Older Patients With Head Impact at Baseline Conscious State”","authors":"","doi":"10.1111/1742-6723.70084","DOIUrl":"https://doi.org/10.1111/1742-6723.70084","url":null,"abstract":"<p>B. Mitra, N. Ip, D. Khoosal, B. X. E. Lee, G. Blecher, and P. A. Cameron, “Imaging for Older Patients With Head Impact at Baseline Conscious State,” <i>Emergency Medicine Australasia</i> 37 (2025): e70046, https://doi.org/10.1111/1742-6723.70046.</p><p>The contribution of author Stephen Gilmartin was not adequately reflected in the initial version.</p><p>We apologise for this error.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273350","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":"Machine Learning Picks Vasopressin Sooner in Septic Shock","authors":"Sierra Beck,&nbsp;Tahnee Dunlop,&nbsp;Bridget Honan,&nbsp;Abhishek Mitra,&nbsp;Muhuntha Sri-Ganeshan,&nbsp;Joseph Ting","doi":"10.1111/1742-6723.70080","DOIUrl":"https://doi.org/10.1111/1742-6723.70080","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256415","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 Debriefing Characteristics in Australian and New Zealand Paediatric Emergency Departments: A PREDICT Study Revisited","authors":"Dami Denbali,&nbsp;Meredith L. Borland,&nbsp;Sharon O'Brien","doi":"10.1111/1742-6723.70068","DOIUrl":"https://doi.org/10.1111/1742-6723.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Clinical debriefing (CD) in emergency medicine improves team performance and patient care outcomes. Its use in Australian and New Zealand paediatric emergency departments (PED) was first described in 2009. We aimed to delineate changes in CD over 15 years and explore the barriers and enablers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An electronic survey was distributed to members of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network to explore their CD experiences and opinions of CD in PED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between February and March 2023, 170 PREDICT members were emailed the survey link with 48 surveys returned (return rate 28%). The respondents were senior doctors (33/48 (68.8%)), junior doctors (5/48 (10.4%)) or nurses/nurse practitioners (7/48 (14.6%)). Thirty respondents (63.8%) had more than 15 years of clinical experience, and 23 (47.9%) worked in tertiary paediatric hospitals. In the preceding year, 36/45 (80%) had participated in at least one debrief immediately following an event, and 27/45 (60%) at a scheduled debrief. Sixteen of 40 respondents (40%) used a department-specific debriefing tool. Resuscitation team leaders facilitated most CDs (27/40 (67.5%)) with 12 clinicians having prior facilitator training. Education, quality and service improvement, and psychological debriefing were reported as important objectives. Leadership and psychological safety were enablers, whereas departmental pressures and lack of training were major barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We demonstrated that CD implementation in paediatric EDs has increased over 15 years while individual clinician participation was infrequent. Key enablers were leadership, psychological safety, and promoting a debriefing culture. Facilitation training opportunities were identified as a need.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244253","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":"Reflections on ECPR in New Zealand: Past, Present and Future","authors":"S. Wiebe,&nbsp;A. Boehm","doi":"10.1111/1742-6723.70071","DOIUrl":"https://doi.org/10.1111/1742-6723.70071","url":null,"abstract":"<div>\u0000 \u0000 <p>Extracorporeal cardiopulmonary resuscitation (ECPR) has gained increasing traction worldwide as a strategy to improve survival in carefully selected patients experiencing refractory cardiac arrest. Historically, New Zealand (NZ) stood at the forefront of extracorporeal membrane oxygenation (ECMO) use in the early 2000s, establishing one of the first national retrieval services in the world. Despite limited evidence and the nascent state of ECMO technology, this made NZ a pioneer. Over the following two decades, international guidelines evolved, ECMO systems became more streamlined, and research demonstrated the clinical and economic viability of ECPR in selected patient cohorts. However, NZ persisted with a single-provider framework, seemingly reluctant to adapt to global developments. Recent initiatives are addressing this by decentralising access to ECMO and formalising governance structures. This paper focuses on ECPR specifically, examining equity gaps in access and outcomes, discussing the country's position relative to global standards and proposing directions for the future.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244251","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":"Illicit Drug Induced Hyperthermia (IDIH)","authors":"Úna Nic Ionmhain,&nbsp;Kylie McArdle,&nbsp;Ingrid Berling","doi":"10.1111/1742-6723.70065","DOIUrl":"https://doi.org/10.1111/1742-6723.70065","url":null,"abstract":"<div>\u0000 \u0000 <p>Illicit drug induced hyperthermia (IDIH) is a life-threatening emergency requiring timely recognition and management. The pathophysiology of hyperthermia secondary to illicit drug toxicity can be associated with and complicated by additional precipitants such as exertion and high ambient temperature (&gt; 31°C). We present cases highlighting the clinical features, morbidity and mortality associated with IDIH. The priorities of management include interventions to decrease ongoing heat production, active cooling and targeted supportive care. Temperature control should ideally be achieved within 15 min to prevent irreversible organ injury. IDIH presentations may be viewed as a high acuity low occurrence (HALO) event. As such, we recommend the use of a specific IDIH protocol and early consultation with clinical toxicology specialists for hyperthermia presentations with suspected illicit drug use.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244252","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":"Prehospital ECPR for Out-Of-Hospital Cardiac Arrest","authors":"Brian Burns,&nbsp;Natalie Kruit,&nbsp;Mark Dennis,&nbsp;Alice Hutin,&nbsp;Dinis Reis Miranda,&nbsp;Demetris Yannopoulos","doi":"10.1111/1742-6723.70072","DOIUrl":"https://doi.org/10.1111/1742-6723.70072","url":null,"abstract":"<div>\u0000 \u0000 <p>This article discusses the role of prehospital extracorporeal CPR (ECPR) in improving survival in out-of-hospital cardiac arrest (OHCA). The Sydney PRECARE feasibility trial is discussed, highlighting the need for intensive interprofessional training and engagement when establishing a prehospital ECPR programme. The role of emergency physicians in the future of cardiac arrest care is also explored.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244754","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":"Emergency Department Presentations by International Migrants Requiring Interpreter Service: An Observational Study","authors":"Ya-Ling Huang,&nbsp;Amy Lynn Sweeny,&nbsp;Dinesh Palipana,&nbsp;Robert Lee,&nbsp;Brooke Calcagno,&nbsp;Shahina Braganza,&nbsp;Julia Crilly","doi":"10.1111/1742-6723.70077","DOIUrl":"https://doi.org/10.1111/1742-6723.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe interpreter services provided to international migrants in the emergency department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study used health service data pertaining to all patient presentations made to two public EDs between 2019 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 4560 patients required an interpreter. An 18-month subset data showed that an interpreter was requested for 47 of the 2509 patients in the ED. Thirty-eight patients received the service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study has identified a significant gap between interpreter service requirements and utilisation. Further research is recommended to explore the barriers and decision-making process of interpreter service utilisation in the ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213858","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}