Emergency Medicine Australasia最新文献

{"title":"The diagnostic utility of prehospital hyperglycaemia in major trauma patients: An observational study","authors":"Jordi Shahab MD, BMedSc(Hons),&nbsp;Michael Noonan MBChB(Hons), BPthy(Hons), MMEd, AFRACMA, FACEM,&nbsp;Shelley Cox PhD, GradCert Biostats, BAppSc(Hons), BA,&nbsp;Ziad Nehme PhD,&nbsp;Matthew Shepherd BSC Nursing, GradDip Emergency Nursing, B Paramed, GradDip MICA, GradCert Aero Medical Retrieval,&nbsp;Ben Meadley BAppSci, PhD, FACPara,&nbsp;Biswadev Mitra MBBS, MHlthServMt, PhD, FACEM,&nbsp;Alexander Olaussen MBBS(Hons), BEH BMedSc(Hons), MACPara, FHEA","doi":"10.1111/1742-6723.14521","DOIUrl":"10.1111/1742-6723.14521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Stress-induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in-hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been established. To investigate the role of prehospital SIH as a predictor of in-hospital mortality following major trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of non-diabetic, adult major trauma patients was undertaken to determine the association between prehospital SIH and in-hospital mortality. Secondary outcomes included ED disposition and ED length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1179 trauma patients included, 89 (8%) had SIH. Prehospital SIH was associated with higher Injury Severity Scores (median (interquartile range): 25 (17–33) <i>vs</i> 17 (14–25)), lower GCS (GCS 3–7: 48.3% <i>vs</i> 10.9%, <i>P</i> &lt; 0.001), lower systolic BP (mean (SD): 122 (44.0) <i>vs</i> 133 (30.3)), lower oxygen saturations (mean (SD): 88% (16) <i>vs</i> 96% (7)) and abnormal heart and respiratory rate. The in-hospital mortality rate was 9.9% in non-SIH patients and 42.7% among patients with SIH (odds ratio (OR): 6.8; 95% confidence interval (CI): 4.3–10.8, <i>P</i> &lt; 0.001). The area under the receiver operating curve for blood glucose alone in predicting mortality was 0.65 (95% CI: 0.60–0.70). Prehospital blood glucose was an independent predictor of mortality after adjustment for age, sex, GCS and vital signs (adjusted OR = 2.9; 95% CI: 1.5–5.5, <i>P</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present study demonstrated an association between prehospital SIH and in-hospital mortality following major trauma. Further prospective research is warranted to examine the utility and integration of prehospital SIH into predicting models of trauma care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590196","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":"Experience, knowledge, practices and attitudes of emergency department medical staff regarding teledermatology","authors":"Sophie Walter BMed, MD, BSc(Med)(Hons),&nbsp;Angela L Chiew BSc(Med), MBBS(Hons), FACEM, PhD,&nbsp;Linda K Martin BA, BSc(Med), MBBS(Hons), MMed, FACD","doi":"10.1111/1742-6723.14530","DOIUrl":"10.1111/1742-6723.14530","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-nine staff completed the questionnaire. Photographic technique and compliance with medicolegal policies were variable: 1% obtained written consent and 45.6% documented verbal consent for photography. 54.4% of respondents had concerns about the quality of their photographs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544434","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 use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study","authors":"Daniel Brouillard MD, FRCPC, FACEM,&nbsp;Geoffrey Melville PhD,&nbsp;Mary K Lam PhD, MHIM, FAIDH, CHIA,&nbsp;Jessie Woods BNursing, BParamedicSc, MD,&nbsp;James Martoo MD, B.Radiog,&nbsp;Gabrielle Wilkie MD,&nbsp;Hughes Makoni MBChB, FACEM,&nbsp;Ataur Rahman MBBS, MD, AACEM (Advanced),&nbsp;Emezie Odigboh MBBS, MSc, FRCEM, FACEM,&nbsp;Thomas Carrigan MBSS (Syd), FRCS (Ed), A&E, DA (UK), FACEM,&nbsp;Simon Binks BM BS BMedSci FACEM,&nbsp;Naomi Fielding MN(NP),&nbsp;Kate Curtis PhD","doi":"10.1111/1742-6723.14516","DOIUrl":"10.1111/1742-6723.14516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497212","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":"Prevalence of clinical deterioration in the pre-hospital setting","authors":"Emma Bourke-Matas PhD,&nbsp;Tan Doan PhD,&nbsp;Kelly-Ann Bowles PhD,&nbsp;Emma Bosley PhD","doi":"10.1111/1742-6723.14511","DOIUrl":"10.1111/1742-6723.14511","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Some degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%–4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497211","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":"Review article: Electronic screening and brief intervention for alcohol-related trauma: A systematic review and meta-analysis","authors":"Matthew Woliansky MD, BDS GDip, MPhil,&nbsp;Kai Lee BDSc, MBBS, MMedSci, FRACDS (OMS) Unit,&nbsp;Santosh Tadakamadla BDS, MDS, PGD-HP, GCert Uni Learn Teach, PhD, FHEA, MRACDS (DPH)","doi":"10.1111/1742-6723.14506","DOIUrl":"10.1111/1742-6723.14506","url":null,"abstract":"<p>This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460750","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":"Sources and content of advice sought by parents/guardians prior to emergency department attendance","authors":"Scott McNeil MD,&nbsp;Nikita Goyal MD,&nbsp;Mandy Parr MBBS, FRACP,&nbsp;John Cheek MBBS, FACEM,&nbsp;Gary Freed MD, MPH,&nbsp;Alastair Meyer BSc (Hons), BMedSci, MBBS, FACEM, FRCEM (Lond), FRCP (Edin), FRACGP,&nbsp;Adam West MBBS (Hons), DRANZCOG, FACEM, MHSM,&nbsp;Simon Craig MBBS (Hons), FACEM, MHPE, MPH, PhD","doi":"10.1111/1742-6723.14514","DOIUrl":"10.1111/1742-6723.14514","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460751","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":"Effectiveness of a Disability Liaison Officer service in a metropolitan emergency department","authors":"Elizabeth O'Shannessy BOccThy, MPH,&nbsp;Carly Talarico BA, BHSc, MPH, MHA,&nbsp;Douglas McCaskie BSpPath, GDipHRM, MHA,&nbsp;Ali Lakhani BBA, MA, MES, PhD,&nbsp;Christine Koolstra CCRN,&nbsp;Janine Standen BSpPath, MHA,&nbsp;Karen Roberts ClinScD (OT), MOT, BAppSc(OT),&nbsp;De Villiers Smit MBChB, FACEM, MBA (Exec),&nbsp;Biswadev Mitra MBBS, MHSM, PhD, FACEM","doi":"10.1111/1742-6723.14513","DOIUrl":"10.1111/1742-6723.14513","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23–1.69; <i>P</i> &lt; 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83–3.33; <i>P</i> &lt; 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99–2.80; <i>P</i> = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65–1.23; <i>P</i> = 0.50), there was no significant association of the DLO service with time to disposition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient- and carer-reported outcome measures and cost-effectiveness studies are indicated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460749","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":"Supporting clinicians post exposure to potentially traumatic events: Emergency department peer support program evaluation","authors":"Belinda Carne MBBS FRACGP FACEM FASLM DRANZCOG DCH, GradCertEmergHlth (Aeromedical Retrieval),&nbsp;Jeremy Furyk MBBS MPH&TM MSc PhD FACEM","doi":"10.1111/1742-6723.14518","DOIUrl":"10.1111/1742-6723.14518","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Workers in EDs are regularly exposed to potentially traumatic events. Since the COVID-19 pandemic, there has been exponential interest in peer support programs (PSPs) in a range of settings. We describe a PSP implemented in 2017 at University Hospital Geelong (UHG) ED together with results of a survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To describe the program such that others can replicate it in their settings in addition to feedback evaluation. Method involved a survey emailed to the ED doctors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty responses from 96 emails with a range of feedback.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ED Doctors place high value on the PSP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460752","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":"Ambulance offload performance, patient characteristics and disposition for patients offloaded to different areas of the emergency department","authors":"James L Mallows MBBS, MEd, FACEM,&nbsp;Mark D Salter MBBS (Hons), PGDip (Med Tox), FACEM,&nbsp;Mitchell Chapman BICT","doi":"10.1111/1742-6723.14517","DOIUrl":"10.1111/1742-6723.14517","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Ambulance transfer of care (TOC) is a key performance indicator for New South Wales EDs, with 90% of ambulances to be offloaded within 30 min of arrival. Nepean Hospital ED has a number of strategies to improve TOC, including ambulatory areas where patients can be offloaded immediately. Offload data are supplied by ambulance and there is no study into its accuracy. The aim is to audit the accuracy of ambulance data of TOC compared to times recorded in the Nepean ED information system, and to examine TOC and patient demographics for different offload destinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective observational study was performed for patients presenting by ambulance between 1 July and 31 December 2022. TOC was calculated from FirstNet and compared to ambulance data using a paired-sample <i>t</i> test. Patients were categorised by offload destination within the ED and examined for age, TOC, disposition and specialty team if admitted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TOC for ambulance and ED data was 60.8% <i>versus</i> 64.1%, respectively (difference 3.33%, <i>P</i> &lt; 0.001). Patients offloaded to acute care were older, with 61.9% being &gt;65 years; had a TOC of 37.3% compared to the resuscitation and ambulatory areas with TOC close to 90%; and were likely to be admitted with a 63.8% admission rate and 24.1% of admissions being under the geriatric service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients arriving by ambulance requiring an acute care bed were likely to be elderly and frail, and suffered substantial ambulance offload delays. Delays to ambulance offload for these patients is likely driven by acute care bed availability and access block.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399776","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":"A cluster of multi-drug intoxications involving xylazine, benzimidazole opioids (nitazenes) and novel benzodiazepines in South Australia","authors":"Emma Partridge BSc (Hons), Forensic Scientist (Toxicology),&nbsp;Peter Stockham BSc (Hons), Principal Forensic Scientist (Toxicology),&nbsp;Michaela Kenneally BSc (Hons), Senior Forensic Scientist (Toxicology),&nbsp;Andrew Luong MSc (Hons), Forensic Scientist (Toxicology),&nbsp;Chris Kostakis BSc(Hons), MAppSc, Manager (Toxicology),&nbsp;Sam Alfred MBBS, FACEM, Dip Tox, Emergency Medicine Physician, Clinical Toxicologist","doi":"10.1111/1742-6723.14512","DOIUrl":"10.1111/1742-6723.14512","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To highlight the detection of xylazine and nitrazolam in conjunction with benzimidazole opioids (nitazenes) and other novel benzodiazepines in a cluster of patients after putative heroin use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Deidentified clinical and analytical data were gathered from patients enrolled in the Emerging Drugs Network of Australia system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In December 2023, three adults presented to the ED with sedation following putative use of heroin. Toxicological analysis of blood samples identified xylazine, protonitazene, metonitazene, bromazolam and nitrazolam. Local health authorities subsequently issued an alert.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first signal of xylazine and nitrazolam use in Australia. These results demonstrate toxico-surveillance programmes with analytical confirmation of drugs are invaluable in monitoring illicit drug use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399775","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}