Emergency Medicine Australasia最新文献

{"title":"Trauma Under the Influence: A Cross-Sectional Registry Audit of Drug and Alcohol-Related Major Trauma in North Queensland.","authors":"Michael Ryan, Breeanna Spring, Benjamin J Crowley, Bryannii Perks, Anna Grant, Christiaan Pretorius, Matan Ben David, Andrew Amos","doi":"10.1111/1742-6723.70330","DOIUrl":"10.1111/1742-6723.70330","url":null,"abstract":"<p><strong>Objective: </strong>Alcohol and drug use is an established factor contributing to traumatic injury globally, yet regional and remote prevalence and impact are poorly characterised. This study examines associations between alcohol and drug use and clinical outcomes among major trauma patients in North Queensland.</p><p><strong>Methods: </strong>A retrospective audit of major trauma patients in Townsville University Hospital Trauma Registry between October 2022-2023. Patients were classified by alcohol and drug use based on toxicology results and electronic medical record. Demographic, injury and outcome variables were compared using descriptive and non-parametric analysis.</p><p><strong>Results: </strong>Of 319 eligible patients, 110 (34.4%) patients were identified within the alcohol and drug cohort. Alcohol was most frequently detected (82.7%), followed by cannabis (20.0%) and amphetamines (12.7%), with 18.2% demonstrating polysubstance use. Alcohol and/or drug-positive patients were significantly younger (40.7 vs. 49.0 years, p = 0.002) and more likely to sustain assault-related injuries (OR 6.9 (95% CI: 3.1-15.3), p < 0.001). No statistical significance was found between groups for ICU admission rate, ICU LOS or hospital LOS. Discharge and mortality outcomes did not differ between groups.</p><p><strong>Conclusion: </strong>This study highlights the impact of alcohol and drug use in regional major trauma patients. Standardised testing, targeted prevention and tailored clinical pathways may improve outcomes and reduce the burden of alcohol and drug-related trauma. Inconsistent screening practices mean the true prevalence remains uncertain, warranting further research to determine the impact and guide interventions.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":"e70330"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763755","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":"Implementing a Cold Debrief Program in the Emergency Department: A Framework for Reflection and System Improvement.","authors":"Jennifer Jamieson, Deborah Edwards, Rebekah Cole","doi":"10.1111/1742-6723.70321","DOIUrl":"https://doi.org/10.1111/1742-6723.70321","url":null,"abstract":"<p><p>The aims of debriefing can be diverse and may include psychological support, departmental quality improvement or an educational focus. There has been increased attention on 'hot debriefs', however, competing clinical and departmental demands can limit the ability of response teams to meaningfully reflect on critical cases. 'Cold debriefs' are a delayed form of debriefing, occurring days to weeks after the critical event. This article reflects on the implementation of a cold debriefing model within a tertiary emergency department in Australia utilising Lewin's Theory of planned change. Over a 12-month period, 16 referrals for cold debriefs were received, of which 11 were selected to proceed to a formal debrief, with all clinical and non-clinical staff involved in the critical event invited to participate. A standardised and reproducible framework was introduced for facilitators to ensure psychological safety. By offering a cold debriefing process for specific critical events, cold debriefs not only support the clinical team but may also harness opportunities for systems improvement. Ensuring the sustainability of the Cold debrief program required integration and familiarisation within the emergency department, building a stable pool of facilitators and providing remuneration for participants attending outside of rostered work hours.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":"e70321"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789660","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":"Family, Domestic and Sexual Violence Presentations to a Virtual Emergency Department: A Retrospective Cohort Study","authors":"Eleanor R. Johnson,&nbsp;Kristina Edvardsson,&nbsp;Jennifer Hutton,&nbsp;Leesa Hooker,&nbsp;Brianna Pike,&nbsp;Bijaya Pokharel,&nbsp;Jessica E. Moulton,&nbsp;Rebecca L. Jessup","doi":"10.1111/1742-6723.70316","DOIUrl":"https://doi.org/10.1111/1742-6723.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Family, domestic and sexual violence (FDSV) is a global health issue affecting one in four women. Emergency departments (EDs) are often the first point of healthcare contact for people experiencing FDSV. Virtual emergency departments have been introduced in Australia to improve access to care and reduce pressure on physical EDs, but little is known about FDSV presentations in this setting. This study aimed to identify and describe FDSV presentations to the Victorian Virtual Emergency Department (VVED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study examined FDSV presentations to VVED between 1 July 2023 and 30 June 2024. Cases were identified using VVED, injury surveillance, and clinician documentation data. Records were filtered by age, sex and injury intent, followed by file review to confirm eligibility. Demographic and presentation characteristics were summarised using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one FDSV presentations were identified among 173,936 VVED presentations (0.012%). All were female, median age 37 years. Most were born in Australia (86%) and lived in socioeconomically disadvantaged areas (62%). Intimate partner violence was the most common form of FDSV (81%), and injuries above the clavicle (head, face and neck injuries) were the most frequent presentation (53%). Most patients were referred via healthcare professionals (76%). One-third were directed to physical EDs, while most were managed virtually with follow-up arranged through general practitioners or other healthcare providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FDSV presentations were rarely identified in the virtual emergency setting, suggesting under-detection. Virtual EDs offer opportunities to support people experiencing violence, but improved clinician training, documentation and referral pathways are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148647877","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":"The Safety of Single Aminoglycoside Dose in Emergency Departments (SAD-ED) Among Patients With and Without Chronic Kidney Disease: A Retrospective Cohort Study","authors":"Grace Lau,&nbsp;Charles Xin,&nbsp;Roy Kadira,&nbsp;Sylvia Andrew,&nbsp;Iouri Banakh","doi":"10.1111/1742-6723.70318","DOIUrl":"https://doi.org/10.1111/1742-6723.70318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Nephrotoxicity has been reported with prolonged use of aminoglycosides but is considered low-risk with single-dose empirical therapy. However, limited data exist in patients with chronic kidney disease (CKD). The aim of this study was to determine the safety of single-dose aminoglycosides (SDA) in Emergency Departments (ED) in patients with and without CKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was performed in four tertiary hospitals within a multi-site Australian metropolitan hospital network. Electronic medical records of all adult patients who presented to ED and received SDA between August 2019–July 2024 were screened for inclusion. The primary outcome was AKI incidence within 1 week of SDA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 6636 aminoglycoside administrations were identified, 1835 screened and 660 patients were included. Patients received gentamicin (74.1%), tobramycin (25.6%), or amikacin (0.3%). Patients with CKD were older (81.3 vs. 64.1 years, <i>p</i> &lt; 0.001) and had more comorbidities. AKI incidence within 1 week of hospitalisation was higher in patients with vs. without CKD (30.9% vs. 13.4%, <i>p</i> &lt; 0.001). Patients with CKD had more severe AKI (stage 2: 10.1% vs. 2.6%, <i>p</i> &lt; 0.001) and had numerically, but not statistically, higher mortality and intensive care unit admission rates compared to patients without CKD. CKD was associated with a higher likelihood of AKI incidence (OR 2.88 [95% CI: 1.76–4.71], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with CKD who received single-dose aminoglycosides were more likely to have AKI compared to patients without CKD. Clinicians should carefully balance the risks and benefits of empiric aminoglycosides in patients with CKD and consider such therapy only if no other suitable alternatives exist.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148647794","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":"Vaccine Preventable Diseases in the Emergency Department","authors":"Daphne Cohen,&nbsp;Emefa Kporku","doi":"10.1111/1742-6723.70317","DOIUrl":"https://doi.org/10.1111/1742-6723.70317","url":null,"abstract":"<div>\u0000 \u0000 <p>Vaccine-preventable diseases (VPDs) are re-emerging worldwide, with declining vaccination coverage since the COVID-19 pandemic resulting in outbreaks of previously rare infections in Australasia. Emergency departments are increasingly at the forefront of recognising and managing these diseases while responding to their broader public health implications. This editorial examines the factors contributing to the resurgence of VPDs and declining immunisation rates, and their implications for ACEM training and EM practice. The accompanying articles in this issue provide practical perspectives on managing diphtheria and measles in the emergency department, addressing vaccine hesitancy and preparing for VPD-related examination questions.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148647795","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":"Does the Emergency Department Have a Role in Immunisation? Yes—But Not as a Routine Vaccine Clinic","authors":"Thomas Aaron Ricks,&nbsp;Stéphane Laurent Bouchoucha","doi":"10.1111/1742-6723.70312","DOIUrl":"10.1111/1742-6723.70312","url":null,"abstract":"<div>\u0000 \u0000 <p>EDs are not routine immunisation settings, yet they often provide care for patients whose immunisation needs may be unrecognised, unmet or not recently reviewed. This is particularly relevant for people who experience fragmented access to healthcare, vulnerability, language or cultural barriers, or who have questions or concerns about immunisation. Immunisation care in emergency departments should be opportunistic and proportionate rather than framed as universal vaccine delivery. For emergency clinicians, the practical task is to assess where a presentation reveals an immunisation-related need and respond in a way that fits the patient, clinical presentation and local service capacity. This may include administering an indicated vaccine, providing education, addressing concerns, documenting unmet need or supporting follow-up with relevant immunisation services in the community. Consistent with the National Immunisation Strategy 2025–2030, a team-based approach is important to support immunisation care in ED settings.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600767","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 Sydney Triage to Admission Risk Tool With Artificial Intelligence (START-AI) to Support Decision Making in Emergency Departments: Model Explainability and Feature Importance Analysis","authors":"Michael Dinh,&nbsp;Elizabeth Corbett,&nbsp;Thuy Truc Ngo,&nbsp;Eliot Salmon,&nbsp;Saleem Ahmed Khan,&nbsp;Farhana Pethani,&nbsp;Nicholas Moore,&nbsp;Irena Koprinska","doi":"10.1111/1742-6723.70285","DOIUrl":"10.1111/1742-6723.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate the importance of specific variables contributing to a recently reported Artificial Intelligence (AI) prediction model called Sydney Triage to Admission Risk Tool with Artificial Intelligence (START-AI) to predict inpatient admission from the Emergency Department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A model explainability analysis was undertaken using single-centre ED electronic medical record data over 2 years. The START-AI model, which comprises ensemble machine learning and a transformer-based algorithm to enhance the original START tool, was re-run with each feature added sequentially to the model until the full model was complete. Feature importance was calculated using feature permutation or change in area under receiver operator curve (AUROC) and SHapley Additive exPlanations (SHAP) analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The original START tool alone had an AUROC of 0.78 (95% CI 0.77, 0.78) for prediction of inpatient admission, reaching an AUROC of 0.90 (95% CI 0.89, 0.90) after all features of the START-AI tool were added sequentially. Features associated with a stepwise increase in cumulative AUROC were triage comments, ED case history notes, any blood test result (in particular, lactate and C-reactive protein), and any CT order. Vital signs did not appear to be associated with stepwise increases in AUROC. Feature importance was highest for the presence of any blood test result, START score, and C-reactive protein with respect to overall model importance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A model explainability analysis provided a clearer understanding of the sequential and relative importance of specific features within the START-AI model, informing how the tool can be further developed and deployed in clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Reattendance Rates to the Emergency Department for Acute Illicit Drug Exposure in Western Australia: A Retrospective Registry Study","authors":"Courtney C. Weber,&nbsp;Daniel M. Fatovich,&nbsp;Ellie M. Kotkis,&nbsp;Jennifer L. Smith","doi":"10.1111/1742-6723.70314","DOIUrl":"10.1111/1742-6723.70314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Determine 1-year emergency department (ED) drug-related reattendance rates of patients enrolled in the Emerging Drugs Network of Australia across five Western Australian hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Index presentations and 1-year reattendances were extracted. Reattendance rates were calculated and stratified by confirmed novel or traditional illicit drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1141 patients, 5.0% (95% CI: 3.9%–6.4%) reattended the ED for drug exposure within 1 year. No statistical differences between novel and traditional illicit drugs were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A conservative but discernible reattendance rate with confirmed illicit drug exposure was demonstrated. Objective data can inform hospital-based harm reduction services and reduce future drug exposure risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600799","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":"What Is Old Is New Again: Tips and Tricks for Recognizing and Treating Vaccine-Preventable Diseases of Childhood Presenting to the Emergency Department","authors":"Dinithi Seneviratne,&nbsp;Roland Semakula","doi":"10.1111/1742-6723.70313","DOIUrl":"10.1111/1742-6723.70313","url":null,"abstract":"<div>\u0000 \u0000 <p>Across the globe, there has been a resurgence in vaccine-preventable diseases reflecting declining immunity, vaccine hesitancy and gaps in vaccine coverage. Vaccination was seen as one of the most successful public health interventions of the 20th century—as a consequence, many vaccine-preventable diseases such as measles and diphtheria were relegated to textbooks. With the re-emergence of vaccine-preventable diseases (VPDs), it is an urgent priority to equip emergency physicians with the knowledge to rapidly identify and manage potential cases and strengthen public health measures to curb transmission.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560993","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 Return of Diphtheria: Reflections From the Emergency Department","authors":"Atur Mahant","doi":"10.1111/1742-6723.70315","DOIUrl":"10.1111/1742-6723.70315","url":null,"abstract":"<div>\u0000 \u0000 <p>Diphtheria has re-emerged in Australia in 2026, prompting significant public health concern and placing additional demands on healthcare services. This article examines the early phase of the outbreak, with particular focus on its impact on EDs. The outbreak has disproportionately affected Indigenous communities, highlighting the influence of social determinants of health, geographical isolation, skin infections and waning vaccine-induced immunity on disease transmission and outcomes. Emergency clinicians faced challenges in identifying suspected cases due to the overlap of diphtheria presentations with common respiratory and skin infections. The rapid development of clinical guidelines and close collaboration with infectious disease specialists were essential in supporting clinical decision-making and standardising patient management. The outbreak also revealed a broader spectrum of cutaneous diphtheria presentations than previously recognised, raising concerns regarding healthcare worker exposure. Operational pressures, contact tracing requirements and staff isolation contributed to workforce strain and psychological stress. This experience underscores the importance of preparedness, vaccination and adaptable healthcare systems in responding to the re-emergence of infectious diseases.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577280","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}