Emergency Medicine Australasia最新文献

The diagnosis of spinal epidural abscess (SEA) is often delayed, as initial symptoms may be undifferentiated or mimic musculoskeletal disorders. The aim of this systematic review was to elucidate the demographics, symptoms and signs of patients with SEA. A systematic review of relevant manuscripts published from 1990 to September 2023 was performed. Quality appraisal of the studies was performed using the Newcastle-Ottawa Scale (NOS). The prevalence of each risk factor, symptoms and signs were extracted and pooled using a random effects model. There were 79 manuscripts included in this review. Most patients with SEA were male (61.3%), with an average age of 55.7 years. Most patients underwent surgical treatment (n = 4950; 69%). Overall mortality was reported in 759 (11%) patients from 44 studies. There were 17 variables identified as risk factors for SEA, with bacteraemia, smoking, and diabetes most commonly reported. The most common symptoms were back pain and fever. The most frequently observed signs were motor and sensory deficit, though 40% presented without neurological deficit. A wide range of risk factors and clinical presentation have been attributed to SEA. While heterogeneity in the literature precludes confidence in accurately classifying the variables, the range of variables corresponded to the anatomy and pathophysiology of the disease. Knowledge of the more commonly reported variables is essential for earlier diagnosis of this critical condition.

Ordinal outcomes are becoming increasingly common in clinical research because they can incorporate multiple clinical states into a single outcome, offer increased statistical power compared to binary outcomes, and can be applied across a range of illness severities. However, ordinal outcomes may be unfamiliar to many clinicians and researchers. In this paper, we aim to provide a practical conceptual overview of ordinal outcomes in the context of emergency medicine, discuss their pros and cons, and describe the associated effect measures and statistical methods that can be used to estimate them. We describe the different types of ordinal outcomes, including hierarchical composite endpoints (e.g., Desirability of Outcome Ranking or DOOR); outline the target parameters that may be of interest, such as the common odds ratio and win ratio; and describe the statistical methods for estimating these parameters, including their assumptions and limitations. Ordinal outcomes offer a flexible, efficient, and nuanced way to measure treatment effects but require careful planning for how treatment effects will be estimated and communicated. We hope this review will make these outcomes more accessible for clinical researchers.

There is a growing intersection between genomics and emergency medical care following recent advancements in both capability and accessibility. This is of particular significance in the management of cardiovascular emergencies, where conditions such as sudden cardiac arrest, cardiac arrhythmia and syncope can be due to an inherited condition. The ability to identify a genetic cause for such presentations challenges what may have previously been conceded as a ‘known unknown’. This has often been the case in adult presentations, where a genetic cause may not be considered or deemed beyond available diagnostic capabilities. The purpose of this article is to inform emergency medicine clinicians about the role of genomics in adult and paediatric cardiovascular emergencies and provide a practical guide to recognising relevant presentations where referral to a cardiovascular genomic service may be relevant.

This edition of Trainee Focus is the first to introduce the topic of Clinical Forensic Medicine (CFM). Despite its inclusion in the ACEM curriculum, forensic medicine and the associated medicolegal frameworks remain an unfamiliar and poorly understood area of medicine for most trainees. Laws vary between jurisdictions, limiting the generalisability of training. Interactions with Police officers and the criminal justice system can be nerve-wracking, whether on the floor during a shift or when tasked to give evidence at a later date. Misunderstandings about legal process are common among clinicians, due not only to limited training and exposure, but also inaccurate media depictions, contributing to confusion and apprehension. This edition provides a broad overview of the role of CFM in the ED and in the community and demystifies common legal processes. We hope it will give trainees confidence when caring for forensic patients in the ED, wherever they practice.

Forensic medical services vary in structure and practice between metropolitan and rural centres in Australia. Limited access to trained forensic clinicians, resource constraints, and geographical isolation create challenges for rural clinicians—particularly trainees. The ACEM policy outlines the ED's dual role in managing medical needs and ensuring timely evidence collection and reporting. In rural settings, it's not always possible for a forensic medical officer to assess patients on site. Early evidence kits (EEKs) can preserve the chain of evidence by enabling the patient to self-collect. Emphasising continuing education, forensic management protocols, and incorporating EEK training into staff induction can improve clinician awareness in forensic cases.