Emergency Medicine Australasia最新文献

Objective: The present study analyses Oceania's protest and conflict events (2021-2022) to aid healthcare systems better understand the scope of the issue.

Methods: Data from the Armed Conflict Location & Event Data database were examined for event types and fatalities.

Results: A total of 2743 events were recorded, mainly protests (83.3%). Fatalities stemmed from battles, violence against civilians and riots. Australia had the most events (56.1%); Papua New Guinea the highest fatality rate (1.03/event).

Conclusions: Australia faced pandemic-related protests; Papua New Guinea grappled with tribal violence, posing healthcare challenges. A comprehensive approach emphasising disaster preparedness, regional cooperation and addressing root causes is crucial to bolster healthcare systems.

Objective: To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes.

Methods: One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures.

Results: VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury.

Conclusion: Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

The ED is increasingly the first point of contact for people who have no alternative when they are in a mental health crisis. However, there is mounting evidence of inadequate and negative responses to mental health crises in the ED, which has been identified as a 'human rights flashpoint'. This paper presents the desired crisis support from people who have accessed the ED in a mental health crisis and offers significant opportunities to use lived experience knowledge to reshape crisis care. These key messages arise from a phenomenological analysis of in-depth interviews with 31 users of ED services, a PhD study conducted by a lived experience researcher. The paper concludes with six recommendations that combine collective wished-for responses with tangible examples of how these desired responses can be translated into crisis care practice.

Objective: To assess the impact of the AstraZeneca (AZ) vaccine roll-out on an ED. Primary outcomes are ED length of stay (LOS), investigation ordering and costs. Secondary measures are compliance with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) Vaccine-Induced Thrombotic Thrombocytopaenia Syndrome (VITT) guidelines.

Methods: This retrospective observational study examined a level 5 ED in Sydney, Australia. Triages mentioning the AZ vaccine between 7 July 2021 and 8 November 2021 were reviewed. Cases were limited to a single day of the week. Researchers reviewed clinical notes to identify patients that presented due to AZ vaccine concern and abstracted relevant data. Costings were calculated using an ED activity-based funding algorithm.

Results: One thousand three hundred and fifty cases were identified, with 167 analysed (12%) and 97 presented (7%). Median LOS was 195 min (IQR: 152-232 min, 95% CI [184, 217]). Median age was 43 years (IQR: 35-65 years, 95% CI [44, 51]). Median Australian Triage Category was 4. Ninety-eight percent were discharged directly home. Ninety-four percent underwent pathology and 41% radiology. Compliance with the THANZ guidelines was 16%. No findings were related to VITT. AZ vaccine concern contributed 12% of August ED caseload. Over the 16-week study period a cost of AUD$486 747.99 was extrapolated.

Conclusions: A high number of young, low acuity patients presented to the ED with AZ vaccine concerns and were associated with financial and workload implications. The quantity of ED presentations appears to be associated with vaccine administration rates. There was poor compliance with the THANZ guidelines, and they appear to have contributed to the high volume of investigations.

Objectives: 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.

Methods: 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.

Results: Of 1179 trauma patients included, 89 (8%) had SIH. Prehospital SIH was associated with higher Injury Severity Scores (median (interquartile range): 25 (17-33) vs 17 (14-25)), lower GCS (GCS 3-7: 48.3% vs 10.9%, P < 0.001), lower systolic BP (mean (SD): 122 (44.0) vs 133 (30.3)), lower oxygen saturations (mean (SD): 88% (16) vs 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, P < 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, P = 0.001).

Conclusion: 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.

Objectives: The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology.

Methods: Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia).

Results: 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.

Conclusions: Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.