Emergency Medicine Australasia最新文献

Objective

To determine CT head imaging rates, yield and emergent intervention rate (neurosurgery, cessation or reversal of anticoagulants) in residential aged care facility (RACF) residents presenting to ED with an unwitnessed fall. Secondary objectives included a description of shared decision-making discussions with patients or substitute decision makers regarding ED transfer and CT head imaging.

Methods

Retrospective cross-sectional study of residential aged care residents aged over 65 years presenting with unwitnessed falls at two university-affiliated tertiary EDs between 1 January and 30 June 2024. Dual independent data extraction of medical records assessed CT imaging use and yield, which was defined as new intracranial haemorrhage on the radiology report. Change of management and shared decision-making were defined by documentation in the medical record. Data analyses were descriptive, and associations were reported using the odds ratio with 95% confidence intervals.

Results

Of 398 patients, 235 (59%) underwent CTH imaging and intracranial haemorrhage was identified in 10 patients (4.3%). No patients underwent neurosurgery. Anticoagulation was ceased in four patients. Shared decision-making was documented for hospital transfer in 14.1% of patients, 13.8% of patients receiving CTH and 25.1% among patients who did not undergo imaging. Patients with signs of head injury, on anticoagulation or evidence of polytrauma were more likely to receive a CTH.

Conclusions

CT head imaging was common among RACF residents with unwitnessed falls despite low diagnostic yield and infrequent changes in management, with no neurosurgical intervention in our cohort. Limited documentation of SDM calls for stronger integration of meaningful patient-centred discussions to reduce avoidable transfers and imaging.

Objectives

Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.

Methods

A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018–2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.

Results

There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1–6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.

Conclusion

Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.

Objectives

To estimate the proportion of Emergency Department (ED) headache patients without neurological features who are diagnosed with a serious secondary headache cause.

Methods

Unplanned secondary analysis of HEAD Study/HEAD Colombia data. Patients without a known history of cerebral conditions and with a normal neurological assessment were included. The outcome of interest was the proportion of patients diagnosed with a serious secondary headache cause.

Results

One hundred ninety-one patients were diagnosed with a serious secondary headache cause (191/3951, 4.8%, 95% CI 4.2%–5.5%).

Conclusion

Absence of neurological features alone cannot be used to reliably exclude a serious secondary headache cause in ED patients.

Objective

This study aimed to identify presentations to the Alice Springs Emergency Department that could be managed in an Urgent Care Centre (UCC).

Methods

We reviewed 1 year of ED presentation data at Alice Springs Hospital (ASH) from August 2022 to August 2023 and used a sequence of exclusion criteria to identify patients most likely to be eligible for UCC management.

Results

Our model indicated that 35.0% of ED presentations at ASH during this period could have been managed in a UCC. Only 41.5% of these presentations (14.5% of total presentations) occurred during UCC operating hours.

Conclusions

According to this model, a significant proportion of ED presentations could potentially be managed in a UCC, although a large proportion of these occurred outside of UCC opening hours. The impact of the introduction of a UCC into a remote community on ED presentations, patient experience, patient outcomes and the broader system requires further study.

Background

Viscoelastic haemostatic assays (VHAs) guide transfusion decisions in bleeding patients. We assessed testing volumes, clinical indications and patient characteristics in a statewide population in Australia.

Methods

This retrospective study included all patients who underwent rotational thromboelastometry (ROTEM) or thromboelastography (TEG) across Queensland Health hospitals (1 January 2019 to 15 April 2025), using data from AUSLAB, the statewide laboratory information system and surveyed all hospitals for VHA device availability.

Result

Of 39 VHA devices, 31 were transmitting to AUSLAB, with 43,220 tests performed in 21,178 patients, during 18,389 admissions and 6418 ED presentations; 92.0% were ROTEM (n = 39,776) and 8.0% TEG (n = 3444). Most tests occurred during inpatient care (n = 35,527, 82.2%) versus ED (n = 7693, 17.8%). Indications included trauma (n = 23,875, 55.2%), non-variceal gastrointestinal bleeding (n = 4238, 9.8%), obstetrics (n = 3307, 7.7%) and chronic liver disease (CLD) (n = 3853, 8.9%), including 1097 (2.5%) with variceal bleeding.

Emergency department (ED) use increased overall (IRR 1.14; 95% CI 1.12–1.15), including trauma (IRR 1.15), CLD (1.16), variceal bleeding (1.12) and non-variceal bleeding (1.12) (all p < 0.001); obstetric use in ED did not change significantly (IRR 0.93; 95% CI 0.86–1.00). Inpatient use also increased (IRR 1.21; 95% CI 1.21–1.22), including trauma (IRR 1.22), CLD (1.16), variceal (1.10), non-variceal bleeding (1.17) and obstetrics (1.07) (all p < 0.001).

Conclusion

VHA use increased in both ED and inpatient settings, with prominent use in trauma and CLD. The results indicate growing recognition by clinicians of VHA's value in guiding haemorrhage management. The need for a consistent, evidence-based approach to testing and interpretation of results is paramount.