Emergency Medicine Australasia最新文献

{"title":"Use of accurate and effective terminology in trauma studies: ‘Seriously injured patients’ and ‘high-energy impact’ instead of ‘major trauma’","authors":"Sarper Yilmaz, Gülbin Aydoğdu Umaç","doi":"10.1111/1742-6723.70002","DOIUrl":"10.1111/1742-6723.70002","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064542","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":"Adverse events and paramedic interventions during extended ground transport in a rural pharmaco-invasive STEMI program","authors":"Steven C Faddy MScMed,&nbsp;Sarah Edwards MFDS,&nbsp;Georgina Luscombe PhD,&nbsp;Estelle Ryan MNg (Cardiac),&nbsp;Ruth Arnold FRACP","doi":"10.1111/1742-6723.70005","DOIUrl":"10.1111/1742-6723.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Although guidelines recommend angiography and coronary intervention occur within 24 h of thrombolysis when percutaneous coronary intervention (PCI) is not available within 120 min, this target is difficult to achieve in rural and remote areas of New South Wales (NSW), Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this is secondary analysis we examine the impact of extending the existing 90-min road transport limit for patients in rural and remote areas of western NSW who have received initial treatment for ST-elevation myocardial infarction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The patient cohort consisted of 86 patients who were transported by road ambulance with transport times more than 90 min. Adverse events occurred in 20% of patient transports and rates were similar in patients transported directly from the scene or from a community hospital. The most common adverse events were hypotension and bradycardia. There was one cardiac arrest, four minor bleeding events and no major bleeding events. The main treatments provided were morphine analgesia, nitrates and anti-emetic medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The primary study showed a significant reduction in time from first clinical contact to arrival at the PCI hospital. In this secondary analysis, we demonstrate that the rate of adverse events during long-distance road transport is low, the adverse events are mostly minor in nature and are within the scope of paramedic practice to manage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064502","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":"Triage gap? Analysis of admission rates, service utilisation and mortality for First Nations patients compared to non-First Nations patients, stratified by ED triage category","authors":"Lucinda Parsonage BMed,&nbsp;Stephen Gourley MBBS,&nbsp;Shahid Ullah PhD,&nbsp;Richard Johnson MBBS","doi":"10.1111/1742-6723.14558","DOIUrl":"10.1111/1742-6723.14558","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>First Nations patients often experience poorer health outcomes than non-First Nations patients. Despite emergency triage primarily focusing on severity, implying comparable outcomes for patients in the same triage group regardless of demographics, the precision of triage for First-Nations Australians may be undermined by multiple factors, although research in this area is scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare admission rates, service utilisation and mortality for First Nations and non-First Nations patients, based on their triage categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilised data for all adults presenting between January 2016 and May 2021, to Alice Springs Hospital; totalling 175 199 presentations from 39 882 individual patients. Data were analysed for differences between First Nations and non-First nations patients for outcomes including 30-day mortality, admission to hospital and admission to ICU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>First Nations patients had significantly higher admission than non-First Nations patients across all triage categories (<i>P</i> &lt; 0.001). First Nations patients in categories 3 and 4 had a significantly higher 30-day mortality (<i>P</i> = 0.039, <i>P</i> = 0.045, respectively). First Nations patients in categories 2 and 3 were significantly more likely to be admitted to ICU (<i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>First Nations patients appear to have worse outcomes than non-First Nations patients in the same triage category. Socio-economic factors and high discharge against advice rates from wards may explain the significantly higher admission rate. Under-recognition of serious illness at triage could be attributed to communication issues or a ‘well bias’. The results raise many questions and further investigation is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046002","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":"The determinants for death in hospital following moderate to severe traumatic brain injury in Australia","authors":"Gerard M O'Reilly MBBS, FACEM, MPH, MBiostat, AStat, PhD,&nbsp;Afsana Afroz PhD,&nbsp;Kate Curtis RN, PhD, Grad Dip Crit Care Nurs, MNurs (Hons), FCENA,&nbsp;Biswadev Mitra MBBS, MHSM, PhD, FACEM,&nbsp;Yesul Kim BA, Grad Dip Psychol, PhD,&nbsp;Emma Solly PhD,&nbsp;Courtney Ryder BScBEng (Biomed) (Hons), PhD,&nbsp;Kate Hunter BAppSc (Nursing), GradDipEd (Nurse Education), MPH, PhD,&nbsp;Delia V Hendrie BSc, BA, MA, PhD,&nbsp;Nick Rushworth BA (Hons), MA, AMusA,&nbsp;Jin Tee BMSC, MBBS, MD, FRACS,&nbsp;Mark C Fitzgerald MBBS, MD (Research), GradCertInet, FACEM, AFRACMA","doi":"10.1111/1742-6723.14562","DOIUrl":"10.1111/1742-6723.14562","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>Retrospective analysis of Australia New Zealand Trauma Registry (ANZTR) data. Cases were included if they presented to a participating hospital between 1 July 2015 and 30 June 2020 and had an Abbreviated Injury Severity (AIS) score – head greater than 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Death in hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 16 350 patients. Their mean age was 51 years and 71% were male. After adjusting for measures of injury severity, there was an increased odds of in-hospital death for patients whose injury occurred outside daylight hours or first mode of transport was road ambulance, who were not transferred from another hospital, had an endotracheal tube placed prior to definitive hospital arrival or received their definitive hospital care outside Victoria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among people presenting to a major trauma hospital in Australia following moderate to severe TBI, there were multiple factors independently associated with death in hospital. The potentially modifiable determinants of in-hospital death included out-of-hours access to emergency care, mode of transfer from the scene of the injury, prior facility care and pre-definitive hospital endotracheal intubation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022783","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":"Advanced Paediatric Life Support: A 25-year journey in Australia","authors":"Stephen SS Teo MBBS, FRACP, MClinEd, DipPaed, PGDip Epidemiology,&nbsp;Jane Stanford RN, CCC, GDipAdEd, MEval","doi":"10.1111/1742-6723.14556","DOIUrl":"10.1111/1742-6723.14556","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Over twenty-five years ago the first Advanced Paediatric Life Support (APLS) course was held in Australia. Through the lens of quality culture in educational organisations, we can identify factors which have underpinned the evolution, sustainability and success of this course.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002100","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":"Children exposed to family and domestic violence perpetrated against their mother are at an increased risk of emergency department attendance in childhood","authors":"Carol Orr BA, BSc(Hons), MSc, PgCert Ed, PhD,&nbsp;Scott Sims MBiostats,&nbsp;Colleen M Fisher BA, PhD,&nbsp;Melissa O'Donnell BPsych(Hons), MPsych, Dip Ed, PhD,&nbsp;Rebecca A Glauert BPsych(Hons), PhD,&nbsp;David B Preen BSc(Hons), PhD","doi":"10.1111/1742-6723.14557","DOIUrl":"10.1111/1742-6723.14557","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the association between family and domestic violence (FDV) exposure and ED attendance in Australian children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present study comprised a population-based retrospective cohort study using deidentified linked administrative data of children born 1987–2010, in Western Australia (<i>n</i> = 58 352). Multivariate Cox proportional hazards modelling was used to estimate the association of FDV exposure with ED attendance. Estimates are presented as adjusted and unadjusted hazard ratios (HR) with Wald 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children exposed to FDV had a 35% (HR = 1.35, 95% CI: 1.32–1.38) increased risk of ED attendance than non-exposed children. Following model adjustment for sociodemographic and clinical characteristics a statistically significant increased risk of 21% (HR = 1.21, 95% CI: 1.18–1.23) was observed in FDV-exposed children compared to their non-exposed counterparts. When stratified by Aboriginal status, an increased risk for ED attendance was observed in both Aboriginal and non-Aboriginal children exposed to FDV, when compared to non-exposed counterparts (aHR = 1.13, 95% CI: 1.11–1.16; aHR = 1.42, 95% CI: 1.37–1.47, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Exposure to FDV is associated with an increased risk of ED attendance in childhood. The findings add to the limited literature providing further support that FDV exposure impacts children's health service utilisation and further supports that children's exposure to FDV as an area of public health concern. Attendance at the ED presents an opportunity for intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002200","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":"Zero risk doesn't exist; using test thresholds to balance harms and benefits","authors":"Michael Lousick,&nbsp;Gerben Keijzers,&nbsp;Richard AF Pellatt","doi":"10.1111/1742-6723.14560","DOIUrl":"10.1111/1742-6723.14560","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002211","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":"De-implementing low-value care in emergency medicine: A framework for sustainable improvement","authors":"Fahad Yousif MBChB, FACEM,&nbsp;Elyssia M Bourke MBBS, BMedSci, MPH","doi":"10.1111/1742-6723.14535","DOIUrl":"10.1111/1742-6723.14535","url":null,"abstract":"<p>The continued use of low-value care interventions is a persisting challenge across the healthcare system despite targeted international efforts to reduce their use. These practices result in considerable economic and carbon costs. We present a model used to successfully de-implement four low-value care practices in a tertiary ED in Victoria, Australia. We outline the interventions and the proportions by which they were reduced. We provide a step-by-step framework that provides a model for other hospital departments or primary care centres to initiate their own de-implementation process for low-value care practices within their setting.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002153","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":"Should we be reassured by a zero? A comment on “Utility of computed tomography brain scans in intubated patients with overdose”","authors":"Aaron Bola,&nbsp;Rana Biary","doi":"10.1111/1742-6723.14561","DOIUrl":"10.1111/1742-6723.14561","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002157","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":"Review article: Efficacy of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning – A systematic review","authors":"Emily King MD,&nbsp;Joe A Rotella MBBS, BSc, MMedTox, FACEM","doi":"10.1111/1742-6723.14554","DOIUrl":"10.1111/1742-6723.14554","url":null,"abstract":"<p>Serotonin toxicity is a potentially fatal condition caused by increased serotonergic activity in the central nervous system. Cyproheptadine, a serotonergic antagonist, is recommended for treatment; however, there is a lack of evidence to support its use. The present study aimed to evaluate the evidence for the use of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning. Publications from 2003 were identified by searching electronic databases Cochrane, MEDLINE, EMBASE and PsycINFO. The inclusion criteria for studies to be included were determined <i>a priori</i> and consisted of studies published in English (or where an English translation was available) where the primary diagnosis of serotonin toxicity (or syndrome) following deliberate self-poisoning and cyproheptadine was administered as the sole serotonergic antagonist. Studies were evaluated for quality and risk of bias. Twelve articles were identified, of which 11 were case reports and one was a case series. Serotonin toxicity was most attributed to selective serotonin reuptake inhibitors and all cases fulfilled Hunter serotonin toxicity criteria. Cyproheptadine regimen varied widely with respect to reporting of initial dose, repeat doses, frequency and duration. Few reports commented on clinical resolution and therefore efficacy was not established. All studies were graded as being of very low evidence and at high risk of bias. There is a lack of evidence to support the efficacy of cyproheptadine or its recommendation in clinical guidelines pertaining to the management of serotonin toxicity.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946578","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}