Emergency Medicine Australasia最新文献

{"title":"Review article: The nature of terror medicine","authors":"George Braitberg MBBS, FACEM, FACMT, FRACMA, MBioethics, MHlthServMt, Dip Epi Biostats","doi":"10.1111/1742-6723.14486","DOIUrl":"10.1111/1742-6723.14486","url":null,"abstract":"<p>In recent years, the landscape of disasters, conflicts and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber-attacks, inequality and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalised lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots and chemical agents. The chaotic aftermath of such attacks demands rapid triage, prioritisation and strict adherence to scene safety protocols. Moreover, terrorist events have profound psychological impacts on victims and responders alike. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. Terror medicine also brings unique ethical and legal challenges, such as patient confidentiality, mandatory reporting and mass casualty management. Effective responses to terror incidents necessitate close collaboration between healthcare providers and law enforcement. Familiarity with terror medicine principles fosters better communication and coordination, ultimately improving response efficiency and patient outcomes. This review offers a comprehensive approach to understanding terror medicine, defining the concept of ‘terror’, its significance for emergency physicians, and the known health impacts on patients, healthcare workers and responders. By delving into these aspects, the review aims to equip medical professionals with the knowledge and skills needed to navigate the complexities of terror-related emergencies effectively.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008517","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":"Factors associated with difficult intravenous access in the paediatric emergency department: A prospective cohort study","authors":"Lucy Dunstan MBBS,&nbsp;Amy L Sweeny MPH,&nbsp;Clayton Lam MD,&nbsp;Bianca Goucher BN,&nbsp;Stuart Watkins MBChB,&nbsp;Shane George MBBS, MPH,&nbsp;Peter J Snelling MBBS, MPHTM","doi":"10.1111/1742-6723.14477","DOIUrl":"10.1111/1742-6723.14477","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty-two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient-centred goals of reducing pain and improving success.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888795","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":"Impact of the Southeast Melbourne Virtual Emergency Department on reducing transfers from residential aged care facilities","authors":"Muhuntha Sri-Ganeshan BSc, MBBS, DTMH, FACEM,&nbsp;Biswadev Mitra MBBS, MHSM, FACEM, PhD,&nbsp;Georgia Soldatos MBBS, FRACP,&nbsp;Rachel Rosler MBChB, FACEM,&nbsp;Neil Goldie MBBS, FACEM,&nbsp;Robert Meek MBBS, FACEM,&nbsp;Madeleine Howard MBBS, FACEM,&nbsp;Michelle Bertolucci MBBS, FACEM,&nbsp;Diana Egerton-Warburton MBBS, MPH, M Clin Epi, FACEM,&nbsp;Rachel Manderson MBBS,&nbsp;Vince Luzuriaga MBBS,&nbsp;Fergus McGee MBBS, FACRRM, DRCOG, DCH, DPDerm,&nbsp;Gerard M O'Reilly MBBS, MPH, MBiostat, AStat, FACEM, PhD,&nbsp;Peter A Cameron MBBS, MD, FACEM","doi":"10.1111/1742-6723.14481","DOIUrl":"10.1111/1742-6723.14481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of the Southeast Melbourne Virtual Emergency Department (SEMVED) on transfers from residential aged care facilities (RACFs) to traditional EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort study of residents requesting transfer to the ED via ambulance within participating health networks' catchments from April to June 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred thirty-eight VED consultations occurred with 79% (188/238) avoiding transfer. This represented an avoidance of 12% (188/1511) of all requests for transfer during operating hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SEMVED prevented unnecessary transfers and enabled in-facility care. Integration into community outreach programmes could enhance care delivery. Patient safety outcomes were not formally assessed by our methodology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888796","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":"Ocular trauma in badminton: A 5-year review of badminton-related eye injury emergency department presentations","authors":"Nicholas Dewhurst MBBS (Hons), BMedSci (Hons),&nbsp;Devangna Tangri BBiomedSc,&nbsp;Janan Arslan MSc, MBiostat, PhD,&nbsp;Gizem Ashraf BMedSc, MD, MPhil,&nbsp;Rahul Chakrabarti MBBS (Hons), BMedSc (Hons), MD, MSurgED (Hons), FRANZCO,&nbsp;Carmel Crock MD, FACEM, OAM","doi":"10.1111/1742-6723.14473","DOIUrl":"10.1111/1742-6723.14473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the nature and severity of badminton-related ocular injuries in Melbourne, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective chart review. A search of the medical records was conducted for patients presenting to the ED at The Royal Victorian Eye and Ear Hospital, with badminton-related eye injuries from June 2018 to May 2023. Data were extracted, focusing on injury mechanism, patient demographics and treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 88 patients were included in the study, comprising 64 (73%) men and 24 (27%) women. The mean patient age was 36.13 years. The most common injury was hyphaema (73%), followed by commotio retinae (45%). One patient sustained a penetrating eye injury when a shuttlecock shattered the spectacles he was wearing during play. Medical intervention was required for 90% of patients. The most common interventions were steroid eye drops (80%) and cycloplegic eyedrops (76%). A total of six (7%) patients required surgical management. For those 69 patients followed up at The Royal Victorian Eye and Ear Hospital, 77% of patients had a final best-corrected visual acuity of 6/6 or greater.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hyphaema, commotio retinae and traumatic uveitis were the most commonly diagnosed injuries. The majority of patients with badminton-related eye injuries required medical treatment, and some necessitated surgical intervention. To mitigate these risks, there is a pressing need to develop an eye safety policy for Australian badminton players, and players should exercise caution when wearing spectacles during play to prevent potential penetrating eye injuries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874494","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":"Is clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey","authors":"Piers Truter M. Clin. Phty,&nbsp;Irene Pelletier FACEM,&nbsp;Sophie Coates M. Clin. Phty,&nbsp;Louise Giglia-Smith PG Dip Manips,&nbsp;Karen Richards D. Clin. Physio,&nbsp;David Mountain FACEM,&nbsp;Caroline Bulsara PhD,&nbsp;Katrina Spilsbury PhD,&nbsp;Dale W Edgar PhD","doi":"10.1111/1742-6723.14474","DOIUrl":"10.1111/1742-6723.14474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine ED clinician's current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred sixty-two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%–76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6–3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2–25.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874493","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":"Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating thematic analysis","authors":"Abdi D Osman DrPH,&nbsp;Daryl Yeak MBBS,&nbsp;Michael Ben-Meir MBBS, MBA,&nbsp;George Braitberg MBBS, MHlthServMt","doi":"10.1111/1742-6723.14476","DOIUrl":"10.1111/1742-6723.14476","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018–2019 and 2022–2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of ‘front loading’ clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate for the questionnaire was 61% (<i>n</i> = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (<i>P</i> = 0.05, 0.00 to 0.04). ‘Valuable/vital resource’ featured as a common response. Early decision-making, patient safety, staff and patient satisfaction emerged as consistent themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874491","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":"Impact of an educational intervention utilising a three-dimensional-printed model for ultrasound-guided intra-articular injections of the dislocated shoulder","authors":"Conor Cosgrave MB BCh BAO, FACEM,&nbsp;Megan Anakin PhD, AFANZAHPE, AFAMEE,&nbsp;Phil Blyth BHB, MBChB, PhD,&nbsp;Louisa Baillie PhD, DFA, BHSc,&nbsp;Sierra Beck MD","doi":"10.1111/1742-6723.14470","DOIUrl":"10.1111/1742-6723.14470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Intra-articular injection of local anaesthetic provides safe and effective analgesia for patients with shoulder dislocation. We designed a three-dimensional-printed ultrasound model of the shoulder to educate ED clinicians on use of this technique. We aimed to evaluate the impact of a 1-h training session using this model on participants' knowledge, skills and clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective study of the clinicians working at two EDs in New Zealand. Participants (<i>n</i> = 20) took part in a 1-h educational session. We tested participants' performance before the session, afterwards and at 3 months using a 10-point objective structured clinical examination. We reviewed clinical records to determine whether there was increased utilisation of this technique among ED patients before and after the training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was improvement in participants' OCSE performance (median pre-training score = 4.00, median 3-month post-training score = 7.00, <i>P</i> = 0.044) and self-reported competence and knowledge, which were sustained to the end of the study.</p>\u0000 \u0000 <p>There was increased use of intra-articular injection among ED patients with shoulder dislocation: 2 of 68 patients (3%) before and 11 of 76 patients (14.5%) after the study. Notably, most were performed by clinicians who did not take part in the study (<i>n</i> = 9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A 1-h training session using a three-dimensional-printed model improved participants objective structured clinical examination performance in ultrasound-guided injection of the shoulder joint. Although there was minimal change in the practice of participating clinicians, overall use of the procedure increased.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874492","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":"‘You mean you're not doing it already?’ A national sentinel toxico-surveillance system for detecting illicit, emerging and novel psychoactive drugs in presentations to emergency departments","authors":"Daniel M Fatovich MBBS, FACEM, PhD,&nbsp;Paul Dessauer,&nbsp;Nadine Ezard MBBS, FAChAM, MPH, PhD,&nbsp;the EDNA Investigators","doi":"10.1111/1742-6723.14478","DOIUrl":"10.1111/1742-6723.14478","url":null,"abstract":"<p>Patients presenting to the ED after using illicit drugs, including novel psychoactive substances, are a unique source of information on substances that are directly causing acute harm in the community. Conventionally, illicit drug intoxications are assessed and managed in EDs based on self-report and presenting symptoms, with no objective data on the causative agent. The Emerging Drugs Network of Australia (EDNA) is a national toxico-surveillance system that provides analytic data on these drugs, from sentinel Emergency Departments. It is a collaborative national network of emergency physicians, toxicologists, forensic laboratories and public health authorities. The key benefit of EDNA is the capacity to provide timely laboratory-confirmed toxicology data on emerging drug-related threats in the community. This leads to improvements in clinical, forensic laboratory and public health harm reduction responses, reflecting rapid translation of the research.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874495","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":"Risk factors for older people re-presenting to the emergency department with falls: A case–control analysis","authors":"Charlene San Juan MBBS(Hons), MPH,&nbsp;Linda Appiah-Kubi MBBS, BSc(Hons), MRCP, FRACP,&nbsp;Joanna Mitropoulos MBBS(Hons), FRACP, Dip Pall Med,&nbsp;Lorne Thomson MBChB, BSc,&nbsp;Athena Demosthenous MBBS(Hons),&nbsp;Anne-Maree Kelly MD, FACEM","doi":"10.1111/1742-6723.14471","DOIUrl":"10.1111/1742-6723.14471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Falls are a leading cause for ED presentations among older adults. Existing secondary falls prevention interventions have not been shown to decrease fall-related ED re-presentation, indicating a need to better understand contributing factors. Our aim was to evaluate risk factors for fall re-presentations among the older patient population presenting to the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single-centre case–control study. Cases were patients aged ≥65 years with two falls-related ED presentations within 6 months. Age- and sex-matched controls had a corresponding index, but no subsequent ED fall presentation. Data collected included falls risk factors and clinical features of the index presentation. Univariate and multivariate analyses were conducted to assess the relationship between potential exposures and fall re-presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 300 patients (mean age 83.8 years) were studied. On univariate analysis, factors significantly associated with ED fall re-presentation included increasing multimorbidity (<i>P</i> &lt; 0.0001), increasing number of medications (<i>P</i> &lt; 0.0001) and residing in residential aged care facility (RACF) (odds ratio [OR] 3.06, <i>P</i> &lt; 0.001). No factors remained significant on multivariate analysis. Post-hoc analyses for the RACF subgroup showed that psychotropic medication use (OR 1.65, <i>P</i> = 0.04) and prior fall within 12 months (OR 2.68, <i>P</i> &lt; 0.001) were significantly associated with re-presentation. Initial presentation with serious musculoskeletal injury was a significant protective factor (OR 0.21, <i>P</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present study failed to identify factors independently associated with ED fall re-presentation, suggesting that the factors are complex and inter-related. Two high-risk populations were identified – those from RACF and those initially presenting with falls not resulting in serious injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859381","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":"Trauma team activation for older patients with pelvic fractures: Are current criteria adequate?","authors":"Frances Williamson MBBS (Hons), FACEM, CCPU, PGDipClinUS, MScTrauma,&nbsp;Elaine Cole PhD, FHEA","doi":"10.1111/1742-6723.14472","DOIUrl":"10.1111/1742-6723.14472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The present study aimed to identify the impact of age on current trauma team activation (TTA) processes and outcomes for patients with pelvic fractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients with moderate and/or severe pelvic fractures (Abbreviated Injury Scale ≥ 2) between 1 January 2016 and 31 December 2021 were included utilising major trauma hospital data in Queensland. Characteristics of older (age ≥ 65) and younger patients including TTA, interventions and outcomes were examined. Multivariate analysis was used to determine factors associated with TTA in older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 637 patients was included. Despite comparable injury severity, a TTA was activated in fewer older people (older: 65% <i>vs.</i> younger: 79%, <i>P</i> &lt; 0.001). Older patients had more falls leading to the trauma presentation (54.4% <i>vs.</i> 22.6%, <i>P</i> &lt; 0.001), with higher initial systolic BP (131 <i>vs.</i> 125 mmHg, <i>P</i> = 0.04). Outcomes were worse for older people, with greater rates of in-hospital complications (27.2% <i>vs.</i> 16.4%, <i>P</i> = 0.004), and longer hospital stays (12 <i>vs.</i> 8 days, <i>P</i> = 0.04). Fewer older patients could be discharged independently to home (46.3% <i>vs.</i> 74.5%, <i>P</i> &lt; 0.001). In older patients, falls and haemodynamic parameters were strongly associated with the reduced likelihood of TTA (fall mechanism [odds ratio (OR)] 0.33; 95% confidence interval [CI] 0.15–0.74; <i>P</i> = 0.01; systolic BP [OR 0.98; 95% CI 0.97–0.99; <i>P</i> = 0.03], heart rate [OR 0.97; 95% CI 0.95–0.99; <i>P</i> = 0.02]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current TTA criteria based on higher energy mechanisms and traditional vital sign thresholds are inadequate for identifying injury in older patients. Sensitive triage criteria and increased clinician awareness are required to enhance injury recognition and improve outcomes in older trauma patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757830","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}