Emergency Medicine Journal最新文献

Background: Rapid identification of individuals with acute respiratory infections is crucial for preventing nosocomial infections. For rapid diagnosis, especially in EDs, lateral flow devices (LFDs) are a convenient, inexpensive option with a rapid turnaround. Several 'multiplex' LFDs (M-LFDs) now exist, testing for multiple pathogens from a single swab sample. We evaluated the real-world performance of M-LFD versus PCR testing in detecting influenza A, B and SARS-CoV-2) in the ED setting.

Methods: After preliminary evaluation of an M-LFD (SureScreen) with laboratory-grown virus and PCR-negative clinical samples, it was evaluated in a real-world setting at the ED of St Thomas' Hospital (London, UK) from 1 December 2022 to 21 April 2023. Eligible participants were ≥18 years of age, admitted with respiratory symptoms and received concurrent M-LFD and PCR tests. Main endpoints were sensitivity to detect influenza A/B (primary) and SARS-CoV-2 (secondary) versus PCR. The probability of a true positive in relation to viral concentration (expressed as PCR cycle threshold (Ct)) was analysed using logistic regression.

Results: In total, 808 symptomatic participants were included (49.8% female; mean age 46.9 years). Test sensitivity (95% CI) was 67.0% (56.9% to 76.1%) for influenza A (n=100), 94.1% (71.3% to 99.9%) for influenza B (n=17) and 48.2% (39.7% to 56.8%) for SARS-CoV-2 (n=141). Sensitivity for SARS-CoV-2 was significantly lower than that for influenza A and B (p=0.0057 and p=0.00088, respectively). The probability of a true positive was 98% for Ct<25 for influenza A and SARS-CoV-2 (influenza B non-evaluable). No co-infections were identified by PCR or M-LFD.

Conclusion: The real-world performance of SureScreen M-LFD was consistent with laboratory evaluation and achieved a high sensitivity for individuals with high viral concentration, most likely to be infectious. Given the representative UK population sample, results could be generalised for use in other settings.

A short systematic review was undertaken to assess whether intradermal sterile water injections (ISWI) provide effective pain relief in adult patients presenting to the Emergency Department (ED) with renal colic. MEDLINE, Embase, Cochrane and Google Scholar databases were searched, identifying seven relevant studies. Study information, patient characteristics, key results and methodological weaknesses were tabulated. Our results indicate that ISWI provides rapid and effective pain relief within the first 15-30 min, comparable to non-steroidal anti-inflammatory drugs, with fewer adverse effects. The short follow-up periods, exclusion of more comorbid patients and variability in study design limit the generalisability of the findings. Further research is needed to establish the long-term effectiveness of ISWI in the management of renal colic in the ED.

Background: Growing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences in the utilisation of low-acuity ED visits between culturally and linguistically diverse (CaLD) migrants and English-speaking background (ESB) population.

Methods: A study based on a cross-sectional survey of individuals aged 45 or over linked to routinely collected ED visit records in New South Wales. We employed a negative binomial regression model to compare the number of yearly low-acuity ED visits between individuals from ESB and CaLD backgrounds after adjusting for relevant health-related and sociodemographic characteristics.

Results: We analysed 227 681 individuals with a mean age of 61, two-thirds of whom came from an ESB. Among individuals with a CaLD background, only those born in Australia had comparable rates of low-acuity ED visits as those with an ESB. In contrast, individuals with CaLD backgrounds who were born overseas were significantly less likely to make low-acuity visits to the ED compared with those from an ESB irrespective of year of arrival-for those who had migrated less than 20 years ago (relative risk (RR) 0.72, 95% CI 0.62 to 0.83) and those who migrated more than 20 years ago (RR 0.91, 95% CI 0.88 to 0.95).

Conclusion: Foreign-born migrants aged 45 and over from CaLD backgrounds tend to have the lowest rates of low-acuity ED visits, particularly those who migrated more recently indicating low-acuity visits by CaLD patients are unlikely to contribute to ED crowding.

Background: Evidence regarding high-dose inhaled corticosteroids (HDICS) in asthma exacerbations in adults is insufficient. This study compares the treatment outcomes of HDICS as add-on therapy to the outcomes of standard treatment in adult patients with acute asthma exacerbation in the ED.

Methods: This was a single-centre, triple-blind, randomised controlled trial conducted in the ED in Thailand between March 2022 and April 2023. Adult patients with asthma exacerbation were randomly assigned to receive either a placebo (normal saline) or HDICS (budesonide 9000 µg) nebulisation combined with beta agonist and ipratropium within the first hour. The primary endpoints were length of ED stay, hospital admission and ED revisit. The secondary endpoints were dyspnoea scale, pulmonary functions, length of hospital stay and home exacerbation after ED discharge.

Results: A total of 88 patients were randomly assigned to one of two groups: 44 patients received a HDICS and 44 patients were placed in the control group. The HDICS group had a significantly shorter ED length of stay (adjusted mean difference -133.6 min; 95% CI -242.4 to -24.8 min; p=0.016), and a higher proportion of ED discharged home within 8 and 16 hours compared with the control group. However, there were no significant differences between the two groups in hospital admission rates, ED revisit, dyspnoea scale, pulmonary functions, length of hospital stay or home exacerbation after ED discharge.

Conclusions: HDICS may be useful as an add-on therapy to standard treatment for asthma exacerbation in adults to reduce ED stay.

Trial registration number: TCTR20201214001.

Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid. Despite this clinicians still target arbitrary systolic blood pressure cutoffs as both goals and ceilings of therapy. In this paper, we suggest that perhaps more consideration should be given to the diastolic blood pressure in bleeding trauma patients. The diastolic blood pressure is critical for coronary perfusion, and in turn the cardiac output responsible for cerebral blood flow. We suggest that a move to reframing resuscitation in terms of physiology may change the way that we resuscitate these patients and allow for more nuanced treatment strategies.

Background: Sex-based disparities in acute coronary syndrome (ACS) presentations exist and women often have worse outcomes after an ACS event. Calling the emergency medical services (EMS) initiates prehospital diagnosis and treatment and reduces in-hospital time to treatment. This study aims to identify factors affecting the intention to call EMS and EMS usage in Australian women and men.

Methods: A retrospective cross-sectional analysis was conducted to identify sex differences and associated characteristics in the (1) intention to call EMS and (2) EMS use in the setting of ACS. Data sources included national survey data (2018-2020) and the Victorian Emergency Minimum Dataset (2016-2021). Multivariable analysis identified factors associated with intention and EMS use by sex.

Results: Of 34 328 survey participants, fewer men expressed an intention to call EMS if experiencing ACS symptoms than women (62.7% vs 70.4%, p<0.001). Associated factors in men included being of Aboriginal or Torres Strait Islander origin, living in Western Australia, having diabetes or having a lower education level. In both sexes, preferring a non-English language, having cardiovascular risk factors, poor symptom knowledge, living in the Northern territory or no/unclear EMS insurance status were associated with lower intentions to call EMS. Finally, women were less comfortable with calling EMS and more likely to hesitate (69.1 vs 76.7%, p<0.001).Among 51 165 ACS presentations (33.6% women) to Victorian public hospitals, fewer men presented by EMS (62.5% vs 67.7%, p<0.001), however, no associated male-specific characteristics were identified. Women preferring a non-English language or living in outer regional/remote Victoria were less likely to use EMS. Being born overseas or being referral by a healthcare provider was associated with lower EMS use in both sexes.

Conclusion: Sex differences were identified in the intention and use of EMS during an ACS event based on cultural background, preferred language and residential regionality. These subgroups' characteristics can be targeted with education to improve EMS use.