Emergency Medicine Australasia最新文献

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.

Aim: To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child.

Methods: 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.

Results: 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.

Conclusions: 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.

Objectives: 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.

Methods: 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.

Results: 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; P < 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; P < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99-2.80; P = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65-1.23; P = 0.50), there was no significant association of the DLO service with time to disposition.

Conclusions: 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.

Objective: 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.

Methods: 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.

Results: Thirty responses from 96 emails with a range of feedback.

Conclusion: ED Doctors place high value on the PSP.

Objective: 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.

Methods: Deidentified clinical and analytical data were gathered from patients enrolled in the Emerging Drugs Network of Australia system.

Results: 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.

Conclusion: 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.

Objective: 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.

Methods: 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 t test. Patients were categorised by offload destination within the ED and examined for age, TOC, disposition and specialty team if admitted.

Results: TOC for ambulance and ED data was 60.8% versus 64.1%, respectively (difference 3.33%, P < 0.001). Patients offloaded to acute care were older, with 61.9% being >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.

Conclusion: 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.

Objective: To determine whether undertaking procedural sedation in the low-acuity fast-track area is safe and effective in improving patient flow.

Methods: A retrospective cohort study reviewed patients who underwent procedural sedation in the Royal Brisbane and Women's Hospital Emergency and Trauma Centre between December 2020 and December 2021.

Results: A total of 411 cases were included. Performing sedation in the fast-track area was not associated with increased complication rates but was associated with reduced time to sedation (difference = 44.24 min, P < 0.001) and length of stay (difference = 60.64 min, P < 0.01).

Conclusion: The sedation of patients outside a high-acuity area is safe and significantly improves patient flow.

Objectives: Critical/urgent X-ray findings are not always communicated in an appropriate time frame to ED physicians. The practice of radiographers alerting referrers to clinically significant image findings (verbally, via image flags or written comment) is noted internationally but risk assessment data is unavailable in the literature. A hybrid radiographer comment and alert model was piloted in New South Wales and a risk-benefit assessment conducted for timely and safe communication of abnormal X-ray appearances to ED physicians.

Methods: Radiographer comments (n = 1102) were provided to five New South Wales EDs by 69 radiographers for a period of 3-12 months. Site auditors classified comments as true positive (TP), false positive (FP) or indeterminate (ID) with respect to the radiology report. FP comments were investigated with ED referrers and a low-medium-high-risk assessment was provided by two independent reviewers.

Results: A total of 42 FP (3.9%; 95% confidence interval [CI] 2.9-5.3) comments were analysed for any adverse outcomes. Risk assessments demonstrated 37 low, 5 low-moderate and no high-risk cases. A total of 282 direct or potential patient benefits were identified (26.4%; 95% CI 23.8-29.1). A total of 42 radiology report discrepancies were incidentally found: (3.9%; 95% CI 2.9-5.3). Audit results demonstrated areas where the radiographer comment could mitigate risk.

Conclusion: The provision of radiographer alerts with a written comment for ED was found to be low risk to patients in the pilot study. Radiographers communicating directly with the emergency team when abnormal image appearances are detected can reduce diagnostic error and improve patient safety and health outcomes.

Objective: To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.

Methods: Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.

Results: There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%).

Conclusions: Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.

Objectives: Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia.

Methods: Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020. Demographic, clinical features, mechanism of injury and spinal immobilisation practices were extracted.

Results: 2100 children were included; 61% were male and the median age was 13 years (interquartile range: 9-15). Over half of the children were transported to suburban (32.2%) and rural/regional (22.9%) EDs, with 37.5% taken to designated trauma centres. The most common mechanisms of injury were sports/activity, motor vehicle accidents and falls in 35.4%, 27.9% and 26.3%, respectively. Spinal precaution use was recorded in 93.7% of cases; cervical collar use was the most common procedure recorded (87.1%). Younger age groups were less likely to have spinal precautions initiated; 51% of children aged 0-3 years, compared to 96.3% of children aged 12 and older (odds ratio = 23.8; 95% confidence interval = 14.5-37; P < 0.001).

Conclusions: Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric-specific evidence into prehospital guidelines to risk stratify children.