Emergency Medicine Australasia最新文献

{"title":"Emergency Physicians in Trauma Care: Expertise, Collaboration, and Coordination","authors":"Nicola Sandler,&nbsp;Eva Andreotti,&nbsp;Brittany Hulbert","doi":"10.1111/1742-6723.70114","DOIUrl":"https://doi.org/10.1111/1742-6723.70114","url":null,"abstract":"<div>\u0000 \u0000 <p>Trauma knows no boundaries and for many patients it marks the beginning of a complex journey through the healthcare system. In this issue of <i>Trainee Focus</i>, we explore the foundations of emergency trauma care, examining the balance between evidence-based protocols and the clinical judgement required to tailor care to the individual patient. Our contributors highlight the critical role of early interventions and explore the nuances of diagnostic tools integral to the initial management, such as ultrasound and CT. At the heart of this process lies the seamless collaboration between prehospital and hospital teams, with emergency physicians positioned at the fulcrum of initial care.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782179","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":"Yield of Continuous Cardiac Monitoring in Pre-Specified Low-Risk Patients: A Retrospective Cohort Study","authors":"Danny Marhaba,&nbsp;Conor O'Flynn,&nbsp;Conor Jones,&nbsp;Jamie Formosa,&nbsp;Dion Stub,&nbsp;De Villiers Smit,&nbsp;Biswadev Mitra","doi":"10.1111/1742-6723.70110","DOIUrl":"https://doi.org/10.1111/1742-6723.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to quantify the yield of continuous cardiac monitoring (CCM) in patients with pre-specified low-risk criteria, including those with mildly elevated troponin levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study of patients admitted to the ward from the emergency department (ED) with CCM. The primary outcome was the occurrence of clinically relevant arrhythmia. The secondary outcome was immediately life-threatening arrhythmia. Sub-group analyses were performed for patients presenting with chest pain, with initial mildly elevated and negative troponin levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1639 patients who were admitted to the ward from the ED with CCM, 403 met pre-specified low-risk criteria. Of those 403 patients, there were 16 (3.96%; 95% CI: 1.52%–6.38%) patients who had clinically relevant arrhythmia, and none had a critical arrhythmia. Among the subgroup of 84 patients presenting with chest pain who had a mildly elevated initial troponin, there was one clinically relevant arrhythmia (1.19%; 95% CI 0.00%–3.53%), and among the 174 patients presenting with chest pain and a negative troponin, there were five who had clinically relevant arrhythmia (2.94%; 95% CI: 0.44%–5.44%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CCM in pre-specified low-risk patients admitted to the ward from the ED did not capture any immediately life-threatening arrhythmia. The observation of clinically relevant arrhythmia suggests that some relatively lower risk patients may benefit from CCM. Elucidation of this cohort can reduce the number of referrals for CCM and potentially improve patient flow within a hospital.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782178","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":"‘Panscans’ for Trauma in the Emergency Department","authors":"Peter A. Cameron,&nbsp;Biswadev Mitra","doi":"10.1111/1742-6723.70117","DOIUrl":"https://doi.org/10.1111/1742-6723.70117","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782235","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":"Prevalence of GHB-Related Presentations to a Metropolitan Emergency Department in Melbourne","authors":"Hamed Akhlaghi,&nbsp;Jacqueline Maplesden,&nbsp;Greta Moon,&nbsp;Eden Pham,&nbsp;Felicia Zurzolo,&nbsp;Brendan Morrissey,&nbsp;Amanda Norman,&nbsp;Yvonne Bonomo,&nbsp;Sam Freeman,&nbsp;Jonathan Karro","doi":"10.1111/1742-6723.70112","DOIUrl":"https://doi.org/10.1111/1742-6723.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gamma-hydroxybutyrate (GHB) is a commonly used recreational substance. It has a narrow therapeutic index. The management of GHB overdose in the emergency department (ED) is labour and resource intensive. This study aims to provide a comprehensive analysis of GHB presentations at one of Victoria's largest tertiary hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>We conducted a retrospective study on GHB-related ED presentations between 2014 and 2024 and reported a case series of admissions to the Intensive Care Unit (ICU). For ICU admitted patients, confirmation of GHB presence in blood was collected through the Emerging Drug Network of Australia—Victoria (EDNAV) study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recorded 2631 cases of GHB-related presentations. The median age was 29 years and 42.3% of cases were female. The presentations of individuals under 25 years of age declined from 61.4% to 14.0%. The majority of patients (81.0%) were brought in by ambulance, with 12.5% accompanied by police. Most patients (93.9%) were managed and discharged from the ED or Short Stay Unit. Only a small proportion of patients (108, 4.1%) required ICU admission. The median stay in the ICU was 2 days. 88.7% of cases admitted to the ICU required intubation. Eight ICU-admitted patients, recruited for the EDNAV study, had a confirmed presence of GHB and other co-ingestions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our study showed a significant increase in GHB-related presentations to our ED. There has been a notable shift in the demographics of patients presenting to EDs with GHB-related issues. GHB use poses a significant impact on EDs and intensive care services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767480","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 Presentations Are Increasing in Acuity in the State of Victoria, Australia—Statewide Hierarchical Regression Model for 2018–2024","authors":"Andy Lim","doi":"10.1111/1742-6723.70113","DOIUrl":"https://doi.org/10.1111/1742-6723.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency departments are seeing an ever-increasing number of patients each year due to various gaps in health services. The aim is to measure significant trends in patient numbers and acuity, considering statewide investment in diversion strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multilevel analysis to test for trend over time in emergency department presentations to public hospital emergency departments from 1st July 2018 to 31st June 2024, taking into account clustering of observations by triage category and by health service, and correcting for population growth. Data were extracted from the Australian Institute of Health and Welfare and Australian Bureau of Statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11,090,840 emergency presentations were reported by 31 health services. Compound annual growth rate calculation noted a rise in category one (8.6%), two (6.8%) and three (2.9%) presentations, and a corresponding reduction in category four (−3.1%) and five (−5.3%) presentations per year over the five-year period. Total presentations increased by 0.7%, while the state population increased by 1.2% per year over the same period. Multilevel modelling correcting for population growth noted a decrease in category four presentations (−2.4%, 95% CI −3.9, −1.0, <i>p</i> &lt; 0.001) and an increase in category three (4.0%, 95% CI 2.4, 5.6, <i>p</i> &lt; 0.001) and category two (10.2%, 95% CI 4.9, 15.5, <i>p</i> &lt; 0.001) presentations. There was no statistically significant growth in overall numbers (1.4%, 95% CI −3.2, 6, <i>p</i> = 0.552).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emergency department presentations appear to be increasing in acuity in the state of Victoria, Australia. This rising urgency should prompt the health system to anticipate and prepare accordingly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767485","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":"Leading the Way for Optimal Trauma Care.","authors":"Frances Williamson","doi":"10.1111/1742-6723.70116","DOIUrl":"https://doi.org/10.1111/1742-6723.70116","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":"e70116"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798510","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":"Evaluating the Introduction of Humidified High-Flow Nasal Cannula Therapy Into an Australian Aeromedical Service Within a Paediatric Population: A Retrospective Cohort Study","authors":"Cameron Yap,&nbsp;Adelaide Withers,&nbsp;Nicole Ghedina,&nbsp;Elaine O'Connell","doi":"10.1111/1742-6723.70105","DOIUrl":"https://doi.org/10.1111/1742-6723.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Humidified high flow (HHF) oxygen is increasingly used to treat acute respiratory illnesses in children; however, use during aeromedical transfer is not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study. Children who were transferred from rural locations and were initiated on HHF prior to transfer between 1 January 2015 and 31 December 2018 were identified from the Royal Flying Doctors Service database. Clinical variables prior to transfer, during flight and after transfer were collected from medical records and flight records. Variables were compared between those who continued and did not receive HHF inflight with Wilcoxon rank sum test and Fisher's exact test, with a <i>p</i>-value less than 0.05 indicating statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 61 cases were included, 29 did not receive HHF inflight, 32 continued HHF inflight. The median age of participants was 8 months (IQR 4). The most common reasons for transfer were bronchiolitis (55%) and pneumonia (33%). Children who had a higher respiratory rate (<i>p</i> = 0.021) or had severe work of breathing were more likely to continue HHF inflight (<i>p</i> = 0.012). Those who continued HHF inflight were more likely to continue HHF therapy in the tertiary hospital (<i>p</i> ≤ 0.001). There was no difference in hospital length of stay between the two groups and no significant complications associated with HHF use during flight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study adds to a growing body of literature that the use of HHF during aeromedical transfer is safe and does not lead to increased length of hospital stay.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740558","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":"Where Are the Greatest Risks for Choosing Unwisely? A Survey of Emergency Department Clinicians","authors":"Joseph Tuxen-Vu,&nbsp;Gerard O'Reilly,&nbsp;Julia Morphet,&nbsp;Peter Jones,&nbsp;Diana Egerton-Warburton,&nbsp;Anselm Wong,&nbsp;Peter Cameron,&nbsp;Amith Shetty,&nbsp;Simon Craig","doi":"10.1111/1742-6723.70108","DOIUrl":"https://doi.org/10.1111/1742-6723.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quality improvement activities targeting low-value care are important to ensure that scarce healthcare resources are used responsibly. However, there has been little systematic research into what diagnostic testing is considered by emergency department (ED) clinicians to be at risk of unwarranted variation or potentially low value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to determine the views of ED clinicians on which diagnostic tests are highest risk for variation and/or low-value care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A voluntary electronic survey was distributed to emergency clinicians across Australia and Aotearoa New Zealand. Respondents were asked to identify which investigations were high risk for unwarranted variation and/or low value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 184 responses (75 doctors, 82 nurses, and 27 other) analysed. Investigations identified included D-dimer (42%), venous blood gas (VBG) (39%), C-reactive protein (CRP) (35%), and plain x-rays of the abdomen (35%). Compared to nursing staff, medical staff perceived CRP (51% vs. 24%), urine drug screening (55% vs. 21%), clotting profile (48% vs. 24%), salicylate level (29% vs. 7%), erythrocyte sedimentation rate (41% vs. 10%), and abdominal x-ray (67% vs. 16%) at higher risk. D-dimer and VBG were seen to be high risk by both groups. Routinely ordered tests (e.g., full blood examination) were considered relatively low risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several commonly used investigations are perceived to be at high risk of unwarranted variation or low-value care. These risks are perceived differently by different groups of emergency clinicians. Potential future directions include understanding the reasons for variation and efforts to reduce variation, including audit and feedback.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725388","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 Clinician Education on Emergency Department Mechanical Restraint: An Interrupted Time-Series Study","authors":"Daiv Lown,&nbsp;Anne-Maree Kelly,&nbsp;Joseph Miller,&nbsp;Ellis Keddie,&nbsp;Paul Buntine,&nbsp;Ainslie Senz,&nbsp;Judith Hope,&nbsp;Patrick J. Owen","doi":"10.1111/1742-6723.70104","DOIUrl":"https://doi.org/10.1111/1742-6723.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Examine the impact of an education-based intervention co-designed with clinicians on attitudes towards and skills in caring for people with behaviours of concern in an emergency department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This 20-month interrupted time-series study (and nested 8-month before-and-after study) was conducted at a metropolitan hospital ED in Melbourne, Australia. The primary outcome was episodes of mechanical restraint before (1 January 2023 to 31 January 2023) and after (1 March 2024 to 30 September 2024) exposure of staff to an educational intervention. Secondary outcomes were staff injuries caused by patients, rate of offering voluntary medication for agitation, and medication timing before (1 October 2023 to 31 January 2024) and after (1 March 2024 to 30 June 2024) the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Episodes of mechanical restraint were lower after the intervention (mean [SD] before: 5.5 [3.4] episodes per week; mean [SD] after: 2.5 [1.6] episodes per week; mean difference [95% CI]: 3.0 [1.7, 4.4] episodes per week, <i>p</i> &lt; 0.001). There was a change in the level (β [95% CI] episodes per week: 2.22 [−4.35, −0.09], <i>p</i> = 0.041), but not a pre-existing downward trend (−0.00 [−0.07, 0.06], <i>p</i> = 0.960), of mechanical restraint. Staff sustained injuries caused by patients were lower after the intervention (<i>φ</i> = 0.138, <i>p</i> = 0.032). No significant difference was observed for offers of voluntary medication (φ = 0.049, <i>p</i> = 0.717) nor time to medication (mean difference [95% CI]: 67.08 [−83.87, 218.03] minutes, <i>p</i> = 0.374).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A multifaceted educational intervention was associated with fewer episodes of emergency department mechanical restraint and fewer staff injuries caused by patients. Further work is needed to determine generalisability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717004","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":"Evacuation of Extradural Haematomas by Rural Non-Neurosurgeons Is Not Futile, but More Than a Burr Hole Will Be Required","authors":"Michael J. Stuart,&nbsp;Rachel E. Colbran,&nbsp;Eric P. Guazzo","doi":"10.1111/1742-6723.70107","DOIUrl":"https://doi.org/10.1111/1742-6723.70107","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714767","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}