Amanda Holford, Keith Harris, Andrew Staib, Katherine Isoardi
Objectives
Clinical toxicology units in Australia manage patients presenting to hospital with a range of poisonings. We aim to describe poisoning presentations over the first decade of a clinical toxicology service.
Methods
This is a prospective observational series of poisoned patients managed by a Queensland clinical toxicology unit between 15 May 2014 and 14 May 2024. All patient presentations were recorded in a relational database. Data extracted included demographic information, exposure details, clinical features, treatment, complications and outcome.
Results
There were 20,609 presentations over the period involving 13,855 unique patients, with a median age of 32 years (Range: 0–98 years), males 7286 (52.6%). Most presentations (10,454, 50.7%) were for deliberate self-poisoning, followed by recreational intoxication (9107, 44.2%). Paracetamol was the most common pharmaceutical reported in overdose (2458, 11.9%), and methamphetamine was the most common recreational drug (5110, 24.8%). Methamphetamine exposures rose over the period from 158 presentations in 2014 to 717 presentations in 2024. Most patients (15,335, 74.4%) were managed through the Emergency Department Short Stay Treatment Area. The median length of stay was 13.1 h (IQR 7.2–19.8 h). Fifty-nine patients died with 24/59 (41%) deaths attributable to opioids.
Conclusions
Recreational intoxication increased over the study period, with methamphetamine intoxication overtaking paracetamol overdose to become the most common poisoning presentation in this series. Opioids account for the majority of overdose-related deaths.
目的：临床毒理学单位在澳大利亚管理病人呈现到医院与一系列中毒。我们的目标是描述中毒的表现在第一个十年的临床毒理学服务。方法：这是2014年5月15日至2024年5月14日期间由昆士兰州临床毒理学部门管理的中毒患者的前瞻性观察系列。所有患者的报告都记录在一个关系数据库中。提取的数据包括人口统计信息、暴露细节、临床特征、治疗、并发症和结果。结果：在此期间有20,609例报告，涉及13,855例独特患者，中位年龄32岁（范围：0-98岁），男性7286例（52.6%）。故意自我中毒最多（10454例，50.7%），其次为娱乐性中毒（9107例，44.2%）。对乙酰氨基酚是最常见的药物过量报告（2458,11.9%），甲基苯丙胺是最常见的娱乐性药物（5110,24.8%）。甲基苯丙胺暴露量从2014年的158例上升到2024年的717例。大多数患者（15,335例，74.4%）通过急诊科短期住院治疗区进行管理。中位住院时间为13.1 h （IQR为7.2 ~ 19.8 h）。59名患者死亡，其中24/59（41%）的死亡可归因于阿片类药物。结论：娱乐性中毒在研究期间有所增加，甲基苯丙胺中毒超过对乙酰氨基酚过量，成为本系列中最常见的中毒表现。阿片类药物占过量相关死亡的大多数。
{"title":"A Prospective Series of Poisonings in Brisbane, Australia 2014–2024: A Changing Pharmaceutical Landscape and the Rise of Recreational Intoxication","authors":"Amanda Holford, Keith Harris, Andrew Staib, Katherine Isoardi","doi":"10.1111/1742-6723.70173","DOIUrl":"10.1111/1742-6723.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Clinical toxicology units in Australia manage patients presenting to hospital with a range of poisonings. We aim to describe poisoning presentations over the first decade of a clinical toxicology service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective observational series of poisoned patients managed by a Queensland clinical toxicology unit between 15 May 2014 and 14 May 2024. All patient presentations were recorded in a relational database. Data extracted included demographic information, exposure details, clinical features, treatment, complications and outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 20,609 presentations over the period involving 13,855 unique patients, with a median age of 32 years (Range: 0–98 years), males 7286 (52.6%). Most presentations (10,454, 50.7%) were for deliberate self-poisoning, followed by recreational intoxication (9107, 44.2%). Paracetamol was the most common pharmaceutical reported in overdose (2458, 11.9%), and methamphetamine was the most common recreational drug (5110, 24.8%). Methamphetamine exposures rose over the period from 158 presentations in 2014 to 717 presentations in 2024. Most patients (15,335, 74.4%) were managed through the Emergency Department Short Stay Treatment Area. The median length of stay was 13.1 h (IQR 7.2–19.8 h). Fifty-nine patients died with 24/59 (41%) deaths attributable to opioids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Recreational intoxication increased over the study period, with methamphetamine intoxication overtaking paracetamol overdose to become the most common poisoning presentation in this series. Opioids account for the majority of overdose-related deaths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhiram Hiwase, Mahni Foster, Christopher Dillon Ovenden, Kit Yan Wong, Ngee Foo, Lola Kaukas, Benjamin Reddi, Adam J. Wells, Daniel Y. Ellis
Objective
The Clauss fibrinogen (CF) assay is the clinical standard for detecting hypofibrinogenaemia in traumatic intracranial haemorrhage (TICH). This assay, however, is time-intensive limiting rapid coagulopathy management. FIBTEM, a module of the rotational thromboelastometry (ROTEM) Sigma device, alternatively provides a rapid point-of-care assessment of fibrin contribution to clot firmness. In many centres, FIBTEM is used as a surrogate for CF. Recently, the FIBTEM cartridge has been modified to include tirofiban in addition to cytochalasin, shifting from a single to dual anti-platelet formulation. The impact of this change on the established FIBTEM–CF relationship remains uncertain, and it is unclear if FIBTEM thresholds typically thought to corroborate with reduced CF remain valid.
Methods
We conducted a retrospective observational cohort study between February 2022 and 2025, evaluating the relationship between FIBTEM and CF before and after the cartridge modification at our institute. Eligible participants were patients with TICH and a Glasgow Coma Scale ≤ 14 who underwent FIBTEM and CF testing on simultaneously drawn samples.
Results
The linear relationship between FIBTEM and CF was not influenced by cartridge type (p = 0.82). Diagnostic performance (AUROCs: 0.94 versus 0.95; p = 0.71) and the optimised cut-point (FIBTEM A5 8 mm) for the detection of hypofibrinogenaemia were also comparable between the single and dual anti-platelet systems.
Conclusions
Similar relationships between FIBTEM and CF were observed for single and dual anti-platelet FIBTEM systems in TICH. Thresholds for fibrinogen replacement may be generalisable between single and dual anti-platelet FIBTEM systems; however, external validation is necessary.
目的：克劳斯纤维蛋白原（Clauss fibrinogen， CF）测定法是检测外伤性颅内出血（TICH）低纤维蛋白原血症的临床标准。然而，这种检测是耗时的，限制了快速凝血病的治疗。fitem是旋转血栓弹性测量（ROTEM） Sigma设备的一个模块，可提供纤维蛋白对凝块硬度的快速即时评估。在许多中心，fitem被用作CF的替代品。最近，fitem药筒经过修改，除细胞松弛素外，还包括替罗非班，从单一抗血小板配方转变为双重抗血小板配方。这种变化对已建立的FIBTEM-CF关系的影响仍然不确定，并且不清楚通常被认为与CF减少相一致的FIBTEM阈值是否仍然有效。方法：我们在2022年2月至2025年2月期间进行了一项回顾性观察队列研究，评估了我院药筒改造前后FIBTEM和CF之间的关系。符合条件的参与者是TICH和格拉斯哥昏迷评分≤14的患者，他们同时抽取样本进行fitem和CF测试。结果：fitem与CF的线性关系不受药筒类型的影响（p = 0.82）。检测低纤维蛋白原血症的诊断性能（auroc: 0.94 vs 0.95; p = 0.71）和优化的切割点（fitem A5≤$$ le $$ 8 mm）在单一和双重抗血小板系统之间也具有可同性。结论：在TICH患者中，单抗和双抗血小板fitem系统与CF之间存在类似的关系。纤维蛋白原替代的阈值在单抗和双抗血小板fitem系统之间可能是通用的；然而，外部验证是必要的。
{"title":"What the Sigma? Exploring the Change From Single to Dual Anti-Platelet ROTEM on the FIBTEM to Clauss Fibrinogen Relationship in Neurotrauma","authors":"Abhiram Hiwase, Mahni Foster, Christopher Dillon Ovenden, Kit Yan Wong, Ngee Foo, Lola Kaukas, Benjamin Reddi, Adam J. Wells, Daniel Y. Ellis","doi":"10.1111/1742-6723.70170","DOIUrl":"10.1111/1742-6723.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The Clauss fibrinogen (CF) assay is the clinical standard for detecting hypofibrinogenaemia in traumatic intracranial haemorrhage (TICH). This assay, however, is time-intensive limiting rapid coagulopathy management. FIBTEM, a module of the rotational thromboelastometry (ROTEM) <i>Sigma</i> device, alternatively provides a rapid point-of-care assessment of fibrin contribution to clot firmness. In many centres, FIBTEM is used as a surrogate for CF. Recently, the FIBTEM cartridge has been modified to include tirofiban in addition to cytochalasin, shifting from a single to dual anti-platelet formulation. The impact of this change on the established FIBTEM–CF relationship remains uncertain, and it is unclear if FIBTEM thresholds typically thought to corroborate with reduced CF remain valid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational cohort study between February 2022 and 2025, evaluating the relationship between FIBTEM and CF before and after the cartridge modification at our institute. Eligible participants were patients with TICH and a Glasgow Coma Scale ≤ 14 who underwent FIBTEM and CF testing on simultaneously drawn samples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The linear relationship between FIBTEM and CF was not influenced by cartridge type (<i>p</i> = 0.82). Diagnostic performance (AUROCs: 0.94 versus 0.95; <i>p</i> = 0.71) and the optimised cut-point (FIBTEM A5 <span></span><math>\u0000 <semantics>\u0000 <mrow>\u0000 <mo>≤</mo>\u0000 </mrow>\u0000 <annotation>$$ le $$</annotation>\u0000 </semantics></math> 8 mm) for the detection of hypofibrinogenaemia were also comparable between the single and dual anti-platelet systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Similar relationships between FIBTEM and CF were observed for single and dual anti-platelet FIBTEM systems in TICH. Thresholds for fibrinogen replacement may be generalisable between single and dual anti-platelet FIBTEM systems; however, external validation is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlotte Yim, Nicholas A. Buckley, Rose Cairns, Betty S. Chan
Background
The four Australian Poisons Information Centres handle over 200,000 calls annually, with 1.5%–4.1% referred to clinical toxicologists. However, the types of drug poisonings most frequently referred and how these patterns change over time remain unclear. This study aims to analyse referral patterns to clinical toxicologists by the New South Wales (NSW) Poisons Information Centre.
Methods
This retrospective study examined referral patterns to clinical toxicologists at the NSW Poisons Information Centre. Calls involving human exposure were included; duplicate entries and recalls were excluded. Demographic and clinical data were analysed using descriptive statistics.
Results
Between 2017 and 2022, the NSW Poisons Information Centre received 657,072 calls. Of these, 12,475 (1.9%) were referred to clinical toxicologists. Referrals rose from 1527 of 99,772 calls (1.5%) in 2017 to 2196 of 117,280 calls (1.9%) in 2022, averaging 1.9% annually. The median age was 32 years (IQR: 17–51), 53.7% were female (n = 6700) and 53.4% (n = 6665) involved deliberate self-poisoning. There was a notable rise in cases with moderate Poisoning Severity Scores (34.5% in 2018 vs. 45.0% in 2022). Paracetamol was the most frequently reported substance in referred calls (13.7%), followed by quetiapine (7.8%) and snake bites (6.0%). Most common categories of drug poisonings included non-opioid analgesics (21.9%), antidepressants (19.8%), atypical antipsychotics (13.5%), and opioids (8.1%).
Conclusions
This study highlights a steady increase in Poisons Information Centre call volumes, accompanied by a rise in referral rates to clinical toxicologists and the number of cases with moderate Poisoning Severity Scores.
{"title":"Patterns of Clinical Toxicologist Referrals at the New South Wales Poisons Information Centre","authors":"Charlotte Yim, Nicholas A. Buckley, Rose Cairns, Betty S. Chan","doi":"10.1111/1742-6723.70171","DOIUrl":"10.1111/1742-6723.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The four Australian Poisons Information Centres handle over 200,000 calls annually, with 1.5%–4.1% referred to clinical toxicologists. However, the types of drug poisonings most frequently referred and how these patterns change over time remain unclear. This study aims to analyse referral patterns to clinical toxicologists by the New South Wales (NSW) Poisons Information Centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study examined referral patterns to clinical toxicologists at the NSW Poisons Information Centre. Calls involving human exposure were included; duplicate entries and recalls were excluded. Demographic and clinical data were analysed using descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2017 and 2022, the NSW Poisons Information Centre received 657,072 calls. Of these, 12,475 (1.9%) were referred to clinical toxicologists. Referrals rose from 1527 of 99,772 calls (1.5%) in 2017 to 2196 of 117,280 calls (1.9%) in 2022, averaging 1.9% annually. The median age was 32 years (IQR: 17–51), 53.7% were female (<i>n</i> = 6700) and 53.4% (<i>n</i> = 6665) involved deliberate self-poisoning. There was a notable rise in cases with moderate Poisoning Severity Scores (34.5% in 2018 vs. 45.0% in 2022). Paracetamol was the most frequently reported substance in referred calls (13.7%), followed by quetiapine (7.8%) and snake bites (6.0%). Most common categories of drug poisonings included non-opioid analgesics (21.9%), antidepressants (19.8%), atypical antipsychotics (13.5%), and opioids (8.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights a steady increase in Poisons Information Centre call volumes, accompanied by a rise in referral rates to clinical toxicologists and the number of cases with moderate Poisoning Severity Scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Young-Jamieson, Roy Bekkeli, Adelaide Michael, Rachael Smithson
Objective
To date, research on pre-hospital telehealth has primarily been observational or conducted in controlled settings. This study examines the feasibility of a novel pre-hospital telehealth initiative—the Virtual Triage Assessment and Care (VTAC) model—and its potential impact on the efficiency of patient flow through the emergency department (ED). This study aims to contribute evidence regarding the practical implementation and outcomes of pre-hospital telehealth interventions in real-world settings.
Methods
This study adopted a mixed method approach to combine data from electronic medical records, observations and surveys across a breadth of stakeholders. Quantitative data were analysed in a matched cohort analysis. Qualitative data were inductively themed and triangulated.
Results
Twenty-six patients were identified as eligible for VTAC, and it was successfully piloted in 10 patient cases over 3 days in October 2023. Pilot evidence suggests that virtual patient review following ambulance retrieval enabled senior medical assessment 81 min earlier and expedited diagnostic orders, facilitating earlier treatment planning and resulting in a 14% (50 min) reduction in emergency department length of stay. However, no significant improvements were observed in Queensland Ambulance Service crew cycle times. Patients reported high satisfaction with VTAC, with all surveyed agreeing telehealth was an acceptable triage method.
Conclusions
Early data indicates that the VTAC model is feasible and may support ED patient journey efficiencies. It further identifies several real-world enablers for integration into practice, including greater availability of critical technologies and governance structures that integrate virtual workflows with current ED processes.
{"title":"Feasibility of a Pre-Hospital Virtual Triage and Care Model: A Mixed-Methods Pilot in Emergency Care","authors":"James Young-Jamieson, Roy Bekkeli, Adelaide Michael, Rachael Smithson","doi":"10.1111/1742-6723.70168","DOIUrl":"10.1111/1742-6723.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To date, research on pre-hospital telehealth has primarily been observational or conducted in controlled settings. This study examines the feasibility of a novel pre-hospital telehealth initiative—the Virtual Triage Assessment and Care (VTAC) model—and its potential impact on the efficiency of patient flow through the emergency department (ED). This study aims to contribute evidence regarding the practical implementation and outcomes of pre-hospital telehealth interventions in real-world settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study adopted a mixed method approach to combine data from electronic medical records, observations and surveys across a breadth of stakeholders. Quantitative data were analysed in a matched cohort analysis. Qualitative data were inductively themed and triangulated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-six patients were identified as eligible for VTAC, and it was successfully piloted in 10 patient cases over 3 days in October 2023. Pilot evidence suggests that virtual patient review following ambulance retrieval enabled senior medical assessment 81 min earlier and expedited diagnostic orders, facilitating earlier treatment planning and resulting in a 14% (50 min) reduction in emergency department length of stay. However, no significant improvements were observed in Queensland Ambulance Service crew cycle times. Patients reported high satisfaction with VTAC, with all surveyed agreeing telehealth was an acceptable triage method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early data indicates that the VTAC model is feasible and may support ED patient journey efficiencies. It further identifies several real-world enablers for integration into practice, including greater availability of critical technologies and governance structures that integrate virtual workflows with current ED processes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12620601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scott Wrigley, Andrew L. H. Huynh, Sanka Amadoru, Henry Zeimer, Irene Tan, Michael Woodward, George Braitberg, Paul Andrew Yates
Whilst the advent of novel disease-modifying medications for Alzheimer's disease represents potential benefit for patients and caregivers, they may be associated with adverse events that present important considerations for emergency and primary care. This article seeks to highlight some of the challenges Emergency Departments may encounter in relation to clinical presentations of people being treated with novel anti-amyloid monoclonal antibodies in the Australian context. Given the potential for harm if not recognised and managed appropriately, it is imperative that emergency clinicians are aware of possible treatment-related adverse events and have access to appropriate decision-making support and resources.
{"title":"Monoclonal Antibody Therapies in Alzheimer's Disease: A Guide for Emergency Physicians","authors":"Scott Wrigley, Andrew L. H. Huynh, Sanka Amadoru, Henry Zeimer, Irene Tan, Michael Woodward, George Braitberg, Paul Andrew Yates","doi":"10.1111/1742-6723.70167","DOIUrl":"10.1111/1742-6723.70167","url":null,"abstract":"<p>Whilst the advent of novel disease-modifying medications for Alzheimer's disease represents potential benefit for patients and caregivers, they may be associated with adverse events that present important considerations for emergency and primary care. This article seeks to highlight some of the challenges Emergency Departments may encounter in relation to clinical presentations of people being treated with novel anti-amyloid monoclonal antibodies in the Australian context. Given the potential for harm if not recognised and managed appropriately, it is imperative that emergency clinicians are aware of possible treatment-related adverse events and have access to appropriate decision-making support and resources.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145481078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To validate and simplify Marois Severity Score (MSS) for improved usability in the emergency department (ED) setting, and to compare its predictive accuracy with a newly developed Dengue Simplified Severity Score (D-SSS).
Methods
This retrospective, observational study included adult patients presenting with laboratory-confirmed dengue to Universiti Malaya Medical Centre ED from January 2023 to December 2023. D-SSS was developed by modifying MSS. The scoring system incorporated age, hypertension, mucosal bleeding, thrombocytopenia, and elevated ALT levels. D-SSS and MSS were evaluated for accuracy in predicting severe dengue according to the World Health Organisation 2009 classification using receiver operating characteristic (ROC) analysis.
Results
Of 507 eligible patients, 350 were analysed. D-SSS, with a cut-off value of 2.5, demonstrated 80.0% (95% CI: 51.91, 95.67) sensitivity and 75.5% (95% CI: 70.55, 80.03) specificity in predicting severe dengue. Its discriminative ability (AUC: 0.856) was numerically higher but not statistically different from MSS (AUC: 0.782; p = 0.335, DeLong's test).
Conclusions
D-SSS provides an accurate and more practical tool for predicting severe dengue in the ED. Its simplified design enhances applicability, facilitating earlier intervention and potentially improving patient outcomes.
{"title":"Development and Validation of the Dengue Simplified Severity Score Based on the Marois Severity Score for Predicting Severe Dengue in the Emergency Department","authors":"Kaur Dhesi Preetvinder, Khadijah Poh, Aida Bustam, Aliyah Zambri, Muhaimin Noor Azhar","doi":"10.1111/1742-6723.70158","DOIUrl":"10.1111/1742-6723.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To validate and simplify Marois Severity Score (MSS) for improved usability in the emergency department (ED) setting, and to compare its predictive accuracy with a newly developed Dengue Simplified Severity Score (D-SSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, observational study included adult patients presenting with laboratory-confirmed dengue to Universiti Malaya Medical Centre ED from January 2023 to December 2023. D-SSS was developed by modifying MSS. The scoring system incorporated age, hypertension, mucosal bleeding, thrombocytopenia, and elevated ALT levels. D-SSS and MSS were evaluated for accuracy in predicting severe dengue according to the World Health Organisation 2009 classification using receiver operating characteristic (ROC) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 507 eligible patients, 350 were analysed. D-SSS, with a cut-off value of 2.5, demonstrated 80.0% (95% CI: 51.91, 95.67) sensitivity and 75.5% (95% CI: 70.55, 80.03) specificity in predicting severe dengue. Its discriminative ability (AUC: 0.856) was numerically higher but not statistically different from MSS (AUC: 0.782; <i>p</i> = 0.335, DeLong's test).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>D-SSS provides an accurate and more practical tool for predicting severe dengue in the ED. Its simplified design enhances applicability, facilitating earlier intervention and potentially improving patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hatem Alkhouri, Isaac Arnold, Samantha Bennett, Sally McCarthy
Objective
Rapid sequence intubation (RSI) is critical for airway management in emergency departments (ED). This study investigates sex-based differences in RSI outcomes, exploring how biological, pharmacological and psychosocial factors may influence intubation success and complications.
Methods
Data from 5021 intubation episodes (January 2010–March 2017) across 42 EDs in Australia and New Zealand was analysed from the ANZEDAR study. Variables including intubation indications, patient factors and complications were stratified by sex. Multivariable logistic regression was used to identify factors associated with first-pass success (FPS) and complications.
Results
Males were more frequently intubated for trauma, while females had higher rates of medical indications such as overdose or stroke and had a higher shock index. Males had a higher predicted and observed difficult laryngoscopy and a lower FPS rate. Additionally, males had a higher overall complication rate, and more desaturation events. Females had a higher incidence of mainstem bronchus intubation. Despite a higher predicted difficulty in males, there were no significant differences in clinical practices such as positioning, use of video laryngoscopy or staff seniority.
Conclusions
Sex-related differences were observed in this registry, with males experiencing lower FPS and more complications. These findings are exploratory; prospective studies should test whether sex-aware assessment and preparation improve process measures and patient outcomes.
{"title":"Assessing Sex Disparities in Rapid Sequence Intubation Procedures in the Emergency Department: Registry Study","authors":"Hatem Alkhouri, Isaac Arnold, Samantha Bennett, Sally McCarthy","doi":"10.1111/1742-6723.70169","DOIUrl":"10.1111/1742-6723.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Rapid sequence intubation (RSI) is critical for airway management in emergency departments (ED). This study investigates sex-based differences in RSI outcomes, exploring how biological, pharmacological and psychosocial factors may influence intubation success and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 5021 intubation episodes (January 2010–March 2017) across 42 EDs in Australia and New Zealand was analysed from the ANZEDAR study. Variables including intubation indications, patient factors and complications were stratified by sex. Multivariable logistic regression was used to identify factors associated with first-pass success (FPS) and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Males were more frequently intubated for trauma, while females had higher rates of medical indications such as overdose or stroke and had a higher shock index. Males had a higher predicted and observed difficult laryngoscopy and a lower FPS rate. Additionally, males had a higher overall complication rate, and more desaturation events. Females had a higher incidence of mainstem bronchus intubation. Despite a higher predicted difficulty in males, there were no significant differences in clinical practices such as positioning, use of video laryngoscopy or staff seniority.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sex-related differences were observed in this registry, with males experiencing lower FPS and more complications. These findings are exploratory; prospective studies should test whether sex-aware assessment and preparation improve process measures and patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anastasia Mutic, Rui Zhi Tan, Eunicia Tan, Michael C. Fahey, Emily Callander, Libby Haskell, Shane George, Meredith L. Borland, Naomi Loftus, Jeremy Furyk, Natalie Phillips, Jane Bourke, Stuart R. Dalziel, Simon Craig, the PREDICT Network
Objectives
To examine variation in practice and adherence to international clinical guidelines for the management of fever among Australian Emergency Department (ED) clinicians.
Methods
Cross-sectional survey across 22 Australian EDs. Clinical vignettes were used to determine compliance with international best practice guidelines (use of antipyretic monotherapy to alleviate fever-associated child distress) for paediatric fever treatment. Comparisons were made between specialist paediatric EDs and general (non-specialist paediatric) EDs, and between medical and nursing staff.
Results
Of 539 survey respondents (300 doctors, 239 nurses; overall response rate 65.9%), only 9.3% (50/539, 95% confidence interval [CI] 7.1%–12.0%) adhered to evidence-based practice guidelines. Specialist paediatric ED clinicians demonstrated less than half the adherence of those from general EDs (5.4% [11/204] vs. 12.4% [38/307], difference −7.0%, 95% CI −11.7% to −1.9%). In a febrile settled child with normal hydration, the proportion of respondents who opted for antipyretics more than doubled in the context of elevated vital signs (40.4% [218/539] vs. 83.1% [44/539], difference −42.7%, 95% CI −46.8% to −38.2%). Nearly half of respondents (239/539, 46.8%, 95% CI 42.4%–51.2%) endorsed giving combined antipyretic therapy. In a febrile settled child, most participants would give antipyretics for temperature reduction (453/539, 84.0%, 95% CI 80.7%–86.9%) and for decreased fluid intake (468/539, 87.5%, 95% CI 84.4%–90.0%). Over one-third (192/539, 36.0%, 95% CI 32.1%–40.2%) recommended using antipyretics for febrile convulsion prevention during the current illness.
Conclusions
Fewer than 10% of Australian ED clinicians self-report practice consistent with international consensus recommendations for paediatric fever management.
目的：研究澳大利亚急诊科（ED）临床医生在发烧管理方面的实践差异和对国际临床指南的遵守情况。方法：横断面调查22个澳大利亚急诊科。使用临床小片段来确定是否遵守国际最佳实践指南（使用退热单药来减轻与发烧相关的儿童痛苦）的儿科发烧治疗。对专科儿科急诊科和普通儿科（非专科儿科）急诊科以及医护人员和护理人员进行了比较。结果：539名调查对象（300名医生，239名护士，总体回复率65.9%）中，只有9.3%（50/539,95%可信区间[CI] 7.1%-12.0%）遵守循证实践指南。专科儿科急诊科临床医生的依从性低于普通急诊科临床医生的一半（5.4%[11/204]对12.4%[38/307]，差异为-7.0%，95% CI为-11.7%至-1.9%）。在正常水合作用的发热安定儿童中，在生命体征升高的情况下选择退烧药的受访者比例增加了一倍以上（40.4%[218/539]对83.1%[44/539]，差异为-42.7%，95% CI为-46.8%至-38.2%）。近一半的应答者（239/539,46.8%,95% CI 42.4%-51.2%）赞同给予联合退热治疗。在发热稳定的儿童中，大多数参与者会给予退烧药以降低体温（453/539,84.0%,95% CI 80.7%-86.9%）和减少液体摄入量（468/539,87.5%,95% CI 84.4%-90.0%）。超过三分之一（192/539,36.0%,95% CI 32.1%-40.2%）的患者建议在当前疾病期间使用退烧药预防热惊厥。结论：不到10%的澳大利亚急诊科医生自我报告的做法与国际共识的儿科发烧管理建议一致。
{"title":"Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments","authors":"Anastasia Mutic, Rui Zhi Tan, Eunicia Tan, Michael C. Fahey, Emily Callander, Libby Haskell, Shane George, Meredith L. Borland, Naomi Loftus, Jeremy Furyk, Natalie Phillips, Jane Bourke, Stuart R. Dalziel, Simon Craig, the PREDICT Network","doi":"10.1111/1742-6723.70165","DOIUrl":"10.1111/1742-6723.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine variation in practice and adherence to international clinical guidelines for the management of fever among Australian Emergency Department (ED) clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional survey across 22 Australian EDs. Clinical vignettes were used to determine compliance with international best practice guidelines (use of antipyretic monotherapy to alleviate fever-associated child distress) for paediatric fever treatment. Comparisons were made between specialist paediatric EDs and general (non-specialist paediatric) EDs, and between medical and nursing staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 539 survey respondents (300 doctors, 239 nurses; overall response rate 65.9%), only 9.3% (50/539, 95% confidence interval [CI] 7.1%–12.0%) adhered to evidence-based practice guidelines. Specialist paediatric ED clinicians demonstrated less than half the adherence of those from general EDs (5.4% [11/204] vs. 12.4% [38/307], difference −7.0%, 95% CI −11.7% to −1.9%). In a febrile settled child with normal hydration, the proportion of respondents who opted for antipyretics more than doubled in the context of elevated vital signs (40.4% [218/539] vs. 83.1% [44/539], difference −42.7%, 95% CI −46.8% to −38.2%). Nearly half of respondents (239/539, 46.8%, 95% CI 42.4%–51.2%) endorsed giving combined antipyretic therapy. In a febrile settled child, most participants would give antipyretics for temperature reduction (453/539, 84.0%, 95% CI 80.7%–86.9%) and for decreased fluid intake (468/539, 87.5%, 95% CI 84.4%–90.0%). Over one-third (192/539, 36.0%, 95% CI 32.1%–40.2%) recommended using antipyretics for febrile convulsion prevention during the current illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fewer than 10% of Australian ED clinicians self-report practice consistent with international consensus recommendations for paediatric fever management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12580986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine Allen, Ben Aston, Anja Dehn, Jacob O'Gorman, Katherine Isoardi
Objective
Paracetamol is commonly taken in overdose. Australian and New Zealand guidelines include specific recommendations on transferring patients with paracetamol poisoning, supporting local treatment of ingestions < 30 g in rural facilities, limiting need for transfer. We aim to investigate paracetamol overdose presentations attended by aeromedical retrieval services and the appropriateness of transfer.
Methods
This is a retrospective observational series of paracetamol overdose retrievals in Queensland, performed by LifeFlight Retrieval Medicine, Retrieval Services Queensland, and Royal Flying Doctors Service from January 2017 to December 2023. Cases were identified through each services' databases. Data extracted included details of ingestion, investigations, management, and the reason for patient transfer.
Results
There were 272 cases retrieved during the study period. Retrieval data were available for 174, for inclusion. Paracetamol was taken in isolation in 65 (37%) cases. The median ingestion was 15.0 g (IQR: 10.0–25.0 g). An overdose of ≤ 30 g of paracetamol was taken in 100 (57%) presentations. The most commonly assigned primary reason for transfer was lack of pathology services (87, 50%); insufficient stocks of acetylcysteine occurred in 13 (8%) cases. Over the seven-year period, there were 60 (35%) potentially avoidable transfers, according to the ANZ guideline. Of these, 52 (30%) were retrieved due to unavailable pathology services and eight (5%) for insufficient acetylcysteine.
Conclusion
Increased availability of acetylcysteine in rural facilities paired with better alignment of treatment with ANZ toxicology guidelines may reduce the rate of transfer for paracetamol overdoses in Queensland.
目的：扑热息痛常被过量服用。澳大利亚和新西兰的指南包括关于转移扑热息痛中毒患者的具体建议，支持局部摄入治疗方法：这是一项回顾性观察系列，由LifeFlight检索医学、昆士兰检索服务和皇家飞行医生服务于2017年1月至2023年12月在昆士兰州进行的扑热息痛过量检索。案例是通过每个服务的数据库确定的。提取的数据包括摄入、调查、管理和患者转移原因的详细信息。结果：研究期间共检索病例272例。检索资料有174份。65例（37%）患者单独服用扑热息痛。中位摄食量为15.0 g （IQR: 10.0-25.0 g）。100例（57%）患者服用过量≤30g扑热息痛。转院最常见的主要原因是缺乏病理服务（87,50%）；13例（8%）发生乙酰半胱氨酸库存不足。根据澳新银行的指导方针，在7年的时间里，有60起（35%）是可以避免的转移。其中，52例（30%）因无法获得病理服务而被检索，8例（5%）因乙酰半胱氨酸不足而被检索。结论：在昆士兰州，农村设施中乙酰半胱氨酸的可用性增加，加上更好地符合ANZ毒理学指南的治疗，可能会降低对乙酰氨基酚过量的转移率。
{"title":"Retrieval of Rural and Remote Paracetamol Poisoning in Queensland","authors":"Katherine Allen, Ben Aston, Anja Dehn, Jacob O'Gorman, Katherine Isoardi","doi":"10.1111/1742-6723.70166","DOIUrl":"10.1111/1742-6723.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Paracetamol is commonly taken in overdose. Australian and New Zealand guidelines include specific recommendations on transferring patients with paracetamol poisoning, supporting local treatment of ingestions < 30 g in rural facilities, limiting need for transfer. We aim to investigate paracetamol overdose presentations attended by aeromedical retrieval services and the appropriateness of transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective observational series of paracetamol overdose retrievals in Queensland, performed by LifeFlight Retrieval Medicine, Retrieval Services Queensland, and Royal Flying Doctors Service from January 2017 to December 2023. Cases were identified through each services' databases. Data extracted included details of ingestion, investigations, management, and the reason for patient transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 272 cases retrieved during the study period. Retrieval data were available for 174, for inclusion. Paracetamol was taken in isolation in 65 (37%) cases. The median ingestion was 15.0 g (IQR: 10.0–25.0 g). An overdose of ≤ 30 g of paracetamol was taken in 100 (57%) presentations. The most commonly assigned primary reason for transfer was lack of pathology services (87, 50%); insufficient stocks of acetylcysteine occurred in 13 (8%) cases. Over the seven-year period, there were 60 (35%) potentially avoidable transfers, according to the ANZ guideline. Of these, 52 (30%) were retrieved due to unavailable pathology services and eight (5%) for insufficient acetylcysteine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Increased availability of acetylcysteine in rural facilities paired with better alignment of treatment with ANZ toxicology guidelines may reduce the rate of transfer for paracetamol overdoses in Queensland.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bart J. Currie, Chris Peberdy, Celeste Woerle, Claire Peberdy, Kelly McCrory, Adrian Nightingale, Didier Palmer
We have evaluated the impact of using mobile phone images of snakes to guide aeromedical retrieval and hospital management of snakebite in the tropical Top End of the Northern Territory of Australia, including many rural and remote locations. We retrospectively analysed data from 14 years of using the Top End snakebite management guideline, which incorporates assessment of mobile phone images of snakes implicated in snakebites. The implicated snake was identified for 192 patients with suspected or definite snakebite, with 74 (38.5%) being venomous snakes. Aeromedical retrieval was able to be safely avoided for 25 patients from remote locations, mostly bites at nighttime and some over 700 km from the hospital. Hospitalised patients bitten by confirmed non-venomous snakes were able to be safely discharged without further observation time and blood tests. In conclusion, with guidance on images required, access to expert identification of local snake fauna and strict confirmation of attribution of the bite to the photographed snake, pathways can be safely implemented that avoid aeromedical retrieval and prolonged hospitalisation for snakebites from confirmed non-venomous snakes.
{"title":"Tele-Toxinology: Using Mobile Phone Images to Safely Avoid Aeromedical Evacuation for Snakebite in Northern Australia","authors":"Bart J. Currie, Chris Peberdy, Celeste Woerle, Claire Peberdy, Kelly McCrory, Adrian Nightingale, Didier Palmer","doi":"10.1111/1742-6723.70159","DOIUrl":"10.1111/1742-6723.70159","url":null,"abstract":"<div>\u0000 \u0000 <p>We have evaluated the impact of using mobile phone images of snakes to guide aeromedical retrieval and hospital management of snakebite in the tropical Top End of the Northern Territory of Australia, including many rural and remote locations. We retrospectively analysed data from 14 years of using the Top End snakebite management guideline, which incorporates assessment of mobile phone images of snakes implicated in snakebites. The implicated snake was identified for 192 patients with suspected or definite snakebite, with 74 (38.5%) being venomous snakes. Aeromedical retrieval was able to be safely avoided for 25 patients from remote locations, mostly bites at nighttime and some over 700 km from the hospital. Hospitalised patients bitten by confirmed non-venomous snakes were able to be safely discharged without further observation time and blood tests. In conclusion, with guidance on images required, access to expert identification of local snake fauna and strict confirmation of attribution of the bite to the photographed snake, pathways can be safely implemented that avoid aeromedical retrieval and prolonged hospitalisation for snakebites from confirmed non-venomous snakes.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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