Australasian Emergency Care最新文献

{"title":"A retrospective cohort review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever.","authors":"Samantha Ryan, Elizabeth Forster, Anna Sullivan, Natalie Phillips, Bronwyn Griffin","doi":"10.1016/j.auec.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.009","url":null,"abstract":"<p><strong>Aims: </strong>To identify, analyse, and synthesise retrospective data regarding the characteristics and risk factors that primary immune deficiencies (PIDs) inhibit to enhance patient outcomes and improve healthcare professional knowledge.</p><p><strong>Background: </strong>There is currently limited research regarding the management of this high-risk paediatric cohort when they present to an emergency department (ED). This review analyses clinical data in the management, treatment and outcomes for these patients.</p><p><strong>Design: </strong>This retrospective cohort review analysed patient characteristics, including the ED presentation and treatments, and hospital outcomes for children with a PID.</p><p><strong>Method: </strong>Data from electronic medical records were extracted at a large tertiary paediatric hospital in South-East Queensland according to inclusion and exclusion criteria. Identified cases deidentified, analysed and reported. Baseline variables summarised using descriptive statistics.</p><p><strong>Results: </strong>Out of 789 ED presentations relating either to fever or PID, 126 cases met the inclusion criteria. Overall, the length of time to be seen by a clinician in ED was a mean of 83 min, 27.8 % did not receive any treatment. Eleven patients had no investigations performed at all, of those who did, 5 % returned positive blood cultures. The immunology team were not consulted for 52 % of patients, and among those admitted, 70.3 % were classed as having a complex medical history.</p><p><strong>Conclusions: </strong>There is limited consistency surrounding the management of children with a PID who present to the ED with a fever. Further research and resources are needed to facilitate enhanced emergency management to increase positive outcomes for this rare, but at-risk cohort of paediatric patients.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651226","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":"RESCUE - Rapid, Effective, Safe Communication in Emergency Departments: A cross-sectional e-survey.","authors":"Syeda Kashaf Batool, Syed Sarim Naqvi","doi":"10.1016/j.auec.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.011","url":null,"abstract":"","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577043","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":"Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study.","authors":"Amminadab L Eliakundu, Joosup Kim, Karen Smith, Monique F Kilkenny, Mulugeta M Birhanu, Kathleen L Bagot, Emily Nehme, Shelley Cox, Bruce C V Campbell, Ben Clissold, Helen M Dewey, Jodie Rabaut, Henry Ma, Christopher F Bladin, Dominique A Cadilhac","doi":"10.1016/j.auec.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.auec.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.</p><p><strong>Method: </strong>Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest.</p><p><strong>Results: </strong>Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life.</p><p><strong>Conclusions: </strong>EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568137","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 rise of consensus methods in paramedicine research: A bibliographic analysis.","authors":"Rachael Vella, Amy Hutchison, Paul Simpson, Robin Pap","doi":"10.1016/j.auec.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.008","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus-based studies are increasingly common in paramedicine research. Whilst there are four main consensus methodologies, recent analyses in other disciplines describe great diversity in method characterised by frequent modifications.</p><p><strong>Aim: </strong>To describe the application and characteristics of consensus research methodologies in paramedicine.</p><p><strong>Methods: </strong>A bibliographic analysis was conducted of published research reporting use of a consensus methodology, drawing data from MEDLINE, EMBASE, CINAHL. Two researchers performed abstract screening, full text review, and data extraction. A descriptive analysis was conducted.</p><p><strong>Results: </strong>There were 161 paramedicine consensus studies published between 1997 and 2024. Delphi technique was most frequent (83 %), followed by NGT (12 %). The US accounted for the most studies with 44 (26 %), followed by UK with 33 (20 %), Canada 15 (9 %), Norway 12 (7 %) and Australia 12 (7 %). Modifications were reported by authors in 54 % of studies. Of 141 Delphi studies, 31 % demonstrated the use of published reporting or methodological guidance.</p><p><strong>Conclusion: </strong>The prevalence of consensus research has increased considerably, dominated by Delphi methodology. Significant methodological heterogeneity was observed, and engagement with methodological and reporting guidelines appeared uncommon. There may be a need for stronger methodological guidance within the paramedicine research space to ensure quality in consensus research.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565468","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":"Prehospital nurse adherence to abdominal pain guidelines in Sweden and possible association with educational level.","authors":"Camilla Dannvall, Hilda Öhman, Johan Herlitz, Magnus Andersson Hagiwara, Carl Magnusson","doi":"10.1016/j.auec.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>Abdominal pain is a common symptom encountered by emergency medical services (EMS) in Sweden. EMS nurses follow a structured process involving clinical history, physical examination, and final assessment, as guided by regional protocols. However, little is known about EMS nurses' adherence to these guidelines.</p><p><strong>Objective: </strong>This study aims to evaluate adherence to regional guidelines for managing abdominal pain in EMS and explore whether EMS nurses' educational level is associated with adherence.</p><p><strong>Methods: </strong>A retrospective, descriptive review of EMS case records for patients with ESS Code 6 (abdominal pain) was conducted. Data were analyzed to compare adherence to guidelines between EMS nurses with and without specialized education.</p><p><strong>Results: </strong>A total of 600 cases were reviewed. Guideline adherence was suboptimal in several areas, such as pain intensity documented in only 36 % of cases, and abdominal palpation performed in 70 %. EMS nurses with specialized education were more likely to administer pain relief, perform abdominal palpation, and measure blood glucose.</p><p><strong>Conclusion: </strong>Adherence to guidelines for managing abdominal pain in EMS was limited, particularly in documenting pain intensity. The findings suggest that a higher level of education among EMS nurses may improve compliance with assessment and treatment protocols.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565467","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":"So close, yet so far: Understanding the relationship between ambulance mobilisation times and survival from out-of-hospital cardiac arrest in rural Western Australia.","authors":"Ashlea Smith, David Majewski, Gavin Pereira, Jason Belcher, Karen Stewart, Judith Finn, Stephen Ball","doi":"10.1016/j.auec.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Internationally, rural areas tend to have prolonged emergency medical service (EMS) response times, associated with a lower survival from out-of-hospital cardiac arrest (OHCA). We examined how the components of EMS response time to OHCA vary according to rurality in Western Australia (WA), and estimated the effect that reducing rural mobilisation times might have on OHCA survival.</p><p><strong>Methods: </strong>Using a retrospective cohort of medical OHCAs in WA with EMS-resuscitation attempted, from 2015 to 2022, we compared the components of response time (Triage, Mobilisation, Travel to the scene and Total Response), stratified by regional remoteness and proximity to nearest town. Using only the rural subgroup, we then used counterfactual simulation methodology to estimate the number of 30-day survivors if response times were reduced in rural areas.</p><p><strong>Results: </strong>Total EMS response time increased with increasing regional remoteness. Mobilisation time also increased with regional remoteness, even among OHCAs occurring within towns; in rural areas, median mobilisation time was 3.32 mins (1.43, 10.00) (mean 6.24, sd 6.61), with metropolitan areas having a median of 0.97 mins (0.63, 1.48) (mean 1.43, sd 2.65). If rural areas had the same mean mobilisation time as metropolitan areas, the relative increase in the estimated number of rural survivors (16.9 %) was not statistically significant.</p><p><strong>Conclusion: </strong>Mobilisation times were significantly longer in rural areas of WA than metropolitan. These results demonstrate that the effects of rurality on OHCA response time are not simply due to rural patients having increased distance from emergency services. Efforts to improve rapid bystander interventions may be particularly beneficial in rural towns for the crucial minutes before EMS personnel arrive.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555923","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 a paediatric emergency nurse practitioner service in South Australia: A retrospective analysis of 12 months of patient presentations.","authors":"Jeffery Faccenda, Natasha Jennings, Kathleen Tori","doi":"10.1016/j.auec.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.005","url":null,"abstract":"<p><p>Quality of patient care in emergency departments is a key indicator of healthcare performance. While the role of Nurse Practitioners (NPs) in adult emergency care is well established, limited research exists on Paediatric Emergency Nurse Practitioners, particularly in the Australian context. This study retrospectively evaluated patient demographics and emergency department service indicators-including waiting time and overall length of stay-for patients in the Paediatric Emergency Department of a tertiary hospital in South Australia. A descriptive exploratory design included all patients managed by Paediatric Nurse Practitioners for a complete episode of care between December 1, 2022, and December 1, 2023. 4849 patients were included, with more males (58.7 %, n = 2845) than females (41.3 %, n = 2004), and a median age of 9 years (IQR 5-13). Median waiting time was 36 min (IQR 18-68), and median length of stay was 129 min (IQR 92-178). Most patients (94.1 %, n = 4561) were discharged home. Common presentations included head wounds (16.1 %, n = 781), distal radius fractures (7.9 %, n = 386), and hand injuries (7.3 %, n = 355). This first evaluation offers insight into patient characteristics and service benchmarks, demonstrating need for further research to support comparisons with other Paediatric Emergency Department services.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546292","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":"Emergency ambulance care of families during death, dying, and bereavement: A document analysis of Australian and Aotearoa New Zealand clinical practice guidelines.","authors":"Eillish Satchell, Merryn Gott, Madeleine Juhrmann, Bridget Dicker, Natalie Elizabeth Anderson","doi":"10.1016/j.auec.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Ambulance personnel play an important role in supporting families during death, dying, and bereavement. Evidence-based clinical practice guidelines are crucial for ensuring high-quality ambulance care. However, it is unknown what guidance currently informs care of bereaved families. This document analysis examines ambulance guidelines pertaining to family care in out-of-hospital death in Australia and Aotearoa New Zealand.</p><p><strong>Methods: </strong>Clinical practice guidelines were sourced from all Australian and Aotearoa New Zealand ambulance services. Using qualitative document analysis, guidance addressing family care during death, dying, and bereavement was examined. Analysis was conducted using a customised coding framework informed by the Australian National Consensus Statement: Essential Elements for safe and high-quality end-of-life care.</p><p><strong>Results: </strong>While most guidelines included essential elements of end-of-life care, there was significant heterogeneity in the scope, detail and nature of guidance. Care instructions varied between services, populations and clinical scenarios. Guidance pertaining to culturally safe care was limited.</p><p><strong>Conclusions: </strong>Ambulance clinical guidance remains focused on technical skills during resuscitation, death, and dying. More guidance is needed to inform important elements of family care such as communication, family partnership, and cultural safety. Incorporating evidenced-based principles of end-of-life care presents an opportunity to improve ambulance support for bereaved families.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512743","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":"Frailty assessment in prehospital care: Bridging the gap in Malaysia's emergency services.","authors":"Mohd Idzwan Zakaria","doi":"10.1016/j.auec.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.002","url":null,"abstract":"<p><p>This letter highlights the lack of standardised frailty assessment in Malaysia's prehospital emergency care and contrasts it with emerging practices in Australia. It advocates for system-wide improvements including training, integration, and policy reform to support frailty screening, aiming to enhance outcomes for older adults in resource-limited settings.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499482","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":"Clinical presentation of tension pneumothorax among patients undergoing prehospital thoracostomy: A retrospective cohort study.","authors":"Angela Park, Richard Armour, Kate Cantwell","doi":"10.1016/j.auec.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.auec.2025.06.006","url":null,"abstract":"<p><strong>Background: </strong>Tension pneumothorax (TPTX) is a life-threatening condition requiring rapid diagnosis and management. However, accurate diagnosis is challenging in the prehospital environment. We sought to investigate the clinical presentation of TPTX in the prehospital environment. Secondary objectives were to investigate if any vital signs are independently associated with TPTX, and if any differences in vital signs of TPTX exist between patients based on ventilatory status.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients > 18 years of age, not in cardiac arrest, who received thoracostomy from paramedics in Ambulance Victoria between January 2020 and July 2023. Descriptive characteristics, vital signs and management data were collected. Patients were defined as having had a TPTX if they met a published definition criterion of TPTX. A secondary sub-group sample was created by dividing patients in the TPTX group based on their ventilatory status at the time of thoracostomy (positive pressure ventilated [PPV] or spontaneously ventilating [SV]). Descriptive statistics, univariate analysis and multivariate analysis via logistic regression were performed.</p><p><strong>Results: </strong>A total of 361 patients were included, with 179 (49.6 %) of these patients meeting the definition criteria of TPTX. Out of these, 67 were receiving PPV and 112 were SV. The median age of patients with TPTX was 44 years, most (79 %) were male, most occurred secondary to trauma (91.6 %). Out of patients with TPTX, 98 (87.5 %) had an altered conscious state, 128 (71.5 %) were tachycardic, 75 (41.9 %) were hypotensive, 33 (18.4 %) had an unrecordable blood pressure, 97 (54.2 %) had hypoxemia, and 82 (73.2 %) were tachypneic. Hypotension (aOR 2.04; 95 % CI 1.09-3.79; p = 0.025) and hypoxemia (aOR 2.12; 95 % CI 1.18-3.81; p = 0.011) were independently associated with the presence of TPTX in multivariate analysis. When comparing vital signs between SV and PPV patients with TPTX, no vital signs reached a statistically significant difference in multivariate analysis.</p><p><strong>Conclusion: </strong>The presence of hypoxemia and hypotension were independently associated with the presence of TPTX. Vital signs associated with the presence of TPTX did not differ by ventilatory status of the patient. Future research should report on conscious state assessment and respiratory rate when investigating the clinical presentation of TPTX.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509579","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}