Emergency Medicine Australasia最新文献_第7页

Non-Invasive Management of Blunt Traumatic Pneumothorax—a Meta-Analysis 钝性外伤性气胸的无创治疗——荟萃分析。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-30 DOI: 10.1111/1742-6723.70164

Mark Harrison

Background and Importance

Traumatic pneumothoraces occur in 25% of patients sustaining traumatic chest injury. Tube thoracostomy carries a risk of major complications leading to the necessity of tube thoracostomy insertion for traumatic pneumothoraces to be challenged.

Objectives

This meta-analysis analyses current evidence relating to the management of traumatic pneumothorax and synthesises the evidence to determine whether clinicians can safely omit tube thoracostomy in patients with traumatic pneumothorax presenting to the Emergency Department (ED).

Design

This meta-analysis was performed by searching electronic databases. Papers were included for analysis if they used patients sustaining blunt trauma and compared tube thoracostomy to conservative management. Comparisons were made for those undergoing tube thoracostomy and those undergoing conservative management.

Main Results

Fourteen studies comprising 1550 patients were included. There is a non-significant combined pneumothorax progression rate of 12% for those observed, and 7.6% for those with a tube thoracostomy (p = 0.8447) with an odds ratio of 1.33. There was an 11.9% rate for tube thoracostomy insertion among patients observed, and a 10.4% requirement for further tube thoracostomy placement in those already with a tube thoracostomy (p = 0.3436) with an odds ratio of 0.553. For patients receiving positive pressure ventilation, the rates were 18% in observed patients compared to 9% of those with a tube thoracostomy (p = 0.2848) with an odds ratio of 4.123.

Conclusions

Conservative management of traumatic pneumothorax without positive pressure ventilation is a reasonable initial safe approach in the ED. Only ~12% of these patients will eventually require a tube thoracostomy.

背景和重要性：25%的外伤性胸外伤患者发生外伤性气胸。导管开胸术存在严重并发症的风险，因此对于外伤性气胸是否需要插管开胸术提出了质疑。目的：本荟萃分析分析了目前与外伤性气胸处理相关的证据，并综合了证据，以确定临床医生是否可以安全地在急诊科（ED）的外伤性气胸患者中省略管式开胸术。设计：本meta分析通过检索电子数据库进行。论文被纳入分析，如果他们使用持续钝性创伤的患者，并比较管开胸术和保守治疗。进行了管式开胸术和保守治疗的比较。主要结果：纳入14项研究，1550例患者。观察组合并气胸进展率为12%，插管开胸组为7.6% (p = 0.8447)，优势比为1.33。在观察到的患者中，有11.9%的人需要插管，而在已经插管的患者中，有10.4%的人需要进一步插管（p = 0.3436），优势比为0.553。对于接受正压通气的患者，观察患者的发生率为18%，而插管开胸患者的发生率为9% (p = 0.2848)，优势比为4.123。结论：创伤性气胸不采用正压通气的保守治疗在急诊科是一种合理安全的初始治疗方法。只有约12%的患者最终需要气管开胸术。

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引用次数: 0

Low Clinical Value Pathology Tests in the Emergency Department: Audit of Urine Microbiology and Culture Use at a Large Regional Centre 急诊科低临床价值病理检查：大型区域中心尿液微生物学和培养使用的审计

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-29 DOI: 10.1111/1742-6723.70162

Daniel Brouillard, Sophie Pickavance, Walid Hammoud, Daniel van der Merwe, Geoffrey Melville, Chloe Story, Sandra Jones, Simon Binks, Kate Curtis

Objective

To assess the ordering practices of urine Microscopy Culture and Sensitivity (MCS) tests in a regional NSW emergency department. Our goal was to determine practices and alignment with diagnostic guidelines to inform future development of targeted interventions to reduce unnecessary testing.

Methods

Retrospective review of NSW Pathology data on all urine samples sent for MCS testing from the Emergency Department between January 1 and December 31 of 2023. Data were merged with patient clinical data and 500 cases randomly selected for manual audit. Data extracted included patient characteristics, symptoms, urine analysis (UA) results, MCS results, treatment and whether results changed patient management.

Results

There were 7074 urine MCS requests, equating to 88 requests per 1000 ED presentations. In the audited sample of 500 cases, 22.4% yielded positive cultures, and 15% were mixed growth/contamination. Only 87% of patients (n = 433) had a UA before MCS. UA had a 93.2% (95% CI: 88.9–96.2) negative predictive value overall and 88.2% in asymptomatic patients. Nearly half (41.6%, n = 208) of patients were treated with antibiotics, 22.4% (n = 112) in the absence of a positive MCS. An estimated 27% of MCS tests could have been safely avoided based on the absence of clinical symptoms. When extrapolated to the whole sample, this could save approximately $39, 538 in pathology costs.

Conclusions

A significant proportion of urine MCS was ordered without a clear indication. Reinforcing guideline-based ordering and emphasizing UA screening could reduce unnecessary testing, decrease healthcare costs, and minimize potential harm from overtreatment.

目的评价新南威尔士州某地区急诊科尿液显微镜培养及敏感性（MCS）试验的排序做法。我们的目标是确定实践并与诊断指南保持一致，为未来有针对性的干预措施的发展提供信息，以减少不必要的检测。方法回顾性分析2023年1月1日至12月31日急诊科送往MCS检测的所有尿样的NSW病理学数据。数据与患者临床资料合并，随机抽取500例进行人工审核。提取的数据包括患者特征、症状、尿液分析（UA）结果、MCS结果、治疗以及结果是否改变了患者的管理。结果7074例尿MCS请求，相当于每1000例ED中有88例请求。在500个病例的审计样本中，22.4%产生阳性培养物，15%为混合生长/污染。只有87%的患者（n = 433）在MCS前有UA。UA总体阴性预测值为93.2% (95% CI: 88.9-96.2)，无症状患者阴性预测值为88.2%。近一半（41.6%,n = 208）的患者接受了抗生素治疗，22.4% （n = 112）的患者没有MCS阳性。根据没有临床症状，估计27%的MCS检测是可以安全避免的。当外推到整个样本时，这可以节省大约39,538美元的病理费用。结论：在没有明确适应症的情况下，有相当比例的尿MCS被订购。加强基于指南的排序和强调UA筛查可以减少不必要的检测，降低医疗保健成本，并最大限度地减少过度治疗的潜在危害。

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引用次数: 0

pH-Corrected Ionised Calcium Predicts Coagulopathy After Major Trauma: A Retrospective Cohort Study ph校正离子钙预测重大创伤后凝血功能障碍：一项回顾性队列研究。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-22 DOI: 10.1111/1742-6723.70161

Nicholas G. Chapman, Conor S. O'Flynn, James E. Moore

Objective

To evaluate the prognostic utility of pH-corrected ionised calcium (ciCa²⁺) as calculated by blood gas analysers in major trauma patients.

Methods

We conducted a retrospective cohort study of trauma patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 13 presenting to a New Zealand tertiary trauma centre from January 2021 to June 2022. Patients were excluded if they did not meet New Zealand Trauma Registry criteria, received blood products before ionised calcium (iCa²⁺) measurement, or had missing key laboratory data. Outcomes were in-hospital mortality, coagulopathy and transfusion. We compared prognostic performance of ciCa²⁺ versus iCa²⁺ using logistic regression and pairwise comparison of receiver operating characteristic curves.

Results

Among 232 patients, 110 (47.4%) had an initial ciCa²⁺ ≤ 1.1 mmol/L. In unadjusted analysis, ciCa²⁺ ≤ 1.1 mmol/L was not associated with mortality (OR 2.18, 95% CI 0.99–4.79; p = 0.08). After adjusting for age and ISS, lower ciCa²⁺ was independently associated with mortality (aOR per 0.1 mmol/L increase 0.58, 95% CI 0.35–0.97; p = 0.04), but this was attenuated after adjusting for lactate (aOR 1.30, 95% CI 0.74–2.28; p = 0.37). ciCa²⁺ was strongly associated with coagulopathy (OR 23.0, 95% CI 1.32–395; p < 0.01) and transfusion (OR 2.54, 95% CI 1.41–4.58; p < 0.01), with superior discrimination over iCa²⁺ for both (AUROC 0.95 vs. 0.56 and 0.69 vs. 0.54, respectively; p < 0.01).

Conclusions

ciCa²⁺ outperformed uncorrected iCa²⁺. As a routine blood gas parameter incorporating key elements of trauma pathophysiology—hypocalcaemia and acidaemia—it may offer a practical tool for early risk stratification in trauma.

目的：评价血气分析仪计算的ph校正离子钙（ciCa2+）在重大创伤患者中的预后价值。方法：我们对2021年1月至2022年6月在新西兰三级创伤中心就诊的年龄≥16岁、损伤严重程度评分(ISS)≥13的创伤患者进行了回顾性队列研究。如果患者不符合新西兰创伤登记处的标准，在离子钙（iCa2+）测量之前接受了血液制品，或者缺少关键的实验室数据，则排除患者。结果是住院死亡率、凝血功能障碍和输血。我们使用logistic回归和受试者工作特征曲线两两比较来比较ciCa2+和iCa2+的预后表现。结果：232例患者中，110例（47.4%）患者初始ciCa2+≤1.1 mmol/L。在未校正分析中，ciCa2+≤1.1 mmol/L与死亡率无关（OR 2.18, 95% CI 0.99-4.79; p = 0.08）。在调整年龄和ISS后，较低的ciCa2+与死亡率独立相关（每0.1 mmol/L的aOR增加0.58,95% CI 0.35-0.97; p = 0.04），但在调整乳酸水平后，这种相关性减弱（aOR 1.30, 95% CI 0.74-2.28; p = 0.37）。ciCa2+与凝血功能障碍密切相关(OR为23.0,95% CI为1.32-395；两者的p均为2+ (AUROC分别为0.95对0.56和0.69对0.54)；p结论：ciCa2+优于未校正的iCa2+。作为一种常规血气参数，它结合了创伤病理生理的关键因素-低钙血症和酸血症-可能为创伤早期风险分层提供实用的工具。

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引用次数: 0

The Use of Mobile Health and Wearable Technologies for the Follow-Up of Patients With Acute Episodes of Atrial Fibrillation: A Scoping Review 使用移动健康和可穿戴技术对急性心房颤动患者进行随访：范围综述

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-22 DOI: 10.1111/1742-6723.70157

Alex Stothart, Ibrahim Al-Busaidi, Laura Joyce

As mobile health (mHealth) technologies evolve, their role in Atrial Fibrillation (AF) care is still emerging. This scoping review explored the current use of mHealth and wearable technologies for the follow-up of patients with acute, uncomplicated AF. The review followed the Arksey and O'Malley framework. Five databases were searched for studies published from January 2010 to April 2024. Two authors independently screened, selected and extracted data. Ten publications from seven countries were included: nine observational studies and one randomised controlled trial. Devices were used across three models of mHealth integration (community-based telehealth care programs, virtual wards and post-acute episode rhythm monitoring). Reporting on clinical outcomes, adverse events, costs, barriers and patient experience was inconsistent. The review highlights heterogeneity in mHealth use for AF follow-up and limited reporting of patient-centred outcomes. Further research is needed to understand patient experience, adherence and the impact of mHealth on long-term outcomes.

随着移动医疗（mHealth）技术的发展，它们在房颤（AF）治疗中的作用仍在不断显现。本综述探讨了移动健康和可穿戴技术在急性无并发症房颤患者随访中的应用。该综述遵循Arksey和O'Malley框架。检索了2010年1月至2024年4月期间发表的五个数据库。两位作者独立筛选、选择和提取数据。纳入了来自7个国家的10份出版物：9项观察性研究和1项随机对照试验。设备被用于移动健康整合的三种模式（基于社区的远程医疗保健计划、虚拟病房和急性发作后心律监测）。关于临床结果、不良事件、费用、障碍和患者经历的报告不一致。该综述强调了移动医疗用于房颤随访的异质性和以患者为中心的结果的有限报告。需要进一步的研究来了解患者的体验、依从性以及移动健康对长期结果的影响。

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引用次数: 0

Response to: Reconsidering Evidence Gaps in Antibiotic Therapy for Acute Pyelonephritis 回应：重新考虑抗生素治疗急性肾盂肾炎的证据差距。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-21 DOI: 10.1111/1742-6723.70160

Biswadev Mitra, Jessica Yu, Christine Koolstra, De Villiers Smit

引用次数: 0

Reflections From the Edge: Emergency Medicine and Completing a PhD 从边缘反思：急诊医学和完成博士学位。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-20 DOI: 10.1111/1742-6723.70163

Siegfried R. S. Perez

引用次数: 0

Variable Adherence to Australian Clinical Care Standard: An Audit of Patients With Acute Low Back Pain Attending a Tertiary Emergency Department 对澳大利亚临床护理标准的不同依从性：三级急诊科急性腰痛患者的审计。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-14 DOI: 10.1111/1742-6723.70156

Jane Males, Leigh Hobday, Michelle Hobday, Carly Fitzgerald, Janice Power, Maeve Kiely, Brittney Wicksteed, Kandy Connell, Gareth Humphreys, Carol Watson, Dale W. Edgar

Background

Low back pain (LBP) has the second highest burden of disease in Australia and is the 5th most common reason for attending an Emergency Department (ED). Variation in clinical care is linked to poorer outcomes and higher health care costs. In 2022, the Australian Commission for Safety and Quality in Healthcare (ACSQHC) released the LBP Clinical Care Standard (LBP CCS). An audit was completed at a tertiary metropolitan hospital ED to benchmark the care of patients attending with LBP against the LBP CCS.

Methods

The medical notes of all adult patients with a diagnosis of LBP, attending Royal Perth Hospital (RPH) ED between 1 January and 31 March 2023 were reviewed. A total of 170 records met the inclusion criteria and were audited against the LBP CCS. A groupwise threshold of 80% was set a priori to confirm acceptable adherence of recorded practice with each item of the LBP CCS.

Results

Screening for serious spinal pathologies and appropriate patient review demonstrated the highest adherence, with imaging rates close to meeting the pre-determined threshold. No patients were screened for psychosocial factors and compliance with the remaining LBP CCS items was low.

Conclusion

This audit demonstrated that care for people with LBP in a tertiary ED did not meet the recommendations set out by the LBP CCS. A multifaceted approach incorporating a pathway within ED, with ongoing clinician education to implement contemporary LBP management, is warranted to reduce this variation and facilitate higher value care for patients with LBP.

背景：腰痛（LBP）是澳大利亚第二大疾病负担，也是第五大就诊急诊科（ED）的常见原因。临床护理的差异与较差的结果和较高的医疗保健费用有关。2022年，澳大利亚医疗安全与质量委员会（ACSQHC）发布了LBP临床护理标准（LBP CCS）。一项审计是在一个三级城市医院ED完成的，以基准护理患者参加LBP与LBP CCS。方法：回顾2023年1月1日至3月31日在皇家珀斯医院（RPH）急诊科就诊的所有诊断为LBP的成年患者的医疗记录。共有170条记录符合纳入标准，并根据LBP CCS进行了审计。先验设置80%的分组阈值，以确认记录实践对LBP CCS每个项目的可接受依从性。结果：对严重脊柱病变的筛查和适当的患者复查显示了最高的依从性，成像率接近预定的阈值。没有患者进行心理社会因素筛查，其余LBP CCS项目的依从性很低。结论：这次审计表明，在高等教育ED对LBP患者的护理不符合LBP CCS提出的建议。采用多方面的方法，结合ED内的途径，以及正在进行的临床医生教育来实施当代LBP管理，有必要减少这种差异，并为LBP患者提供更高价值的护理。

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引用次数: 0

Fractured Neck of Femur Clinical Pathway Use in Tasmanian Emergency Departments: A Retrospective Study 股骨颈骨折临床路径在塔斯马尼亚急诊科的应用：回顾性研究。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-14 DOI: 10.1111/1742-6723.70155

Innocent Tawanda Mudzingwa, Sarah Jane Prior, Phoebe Griffin, Emma Tavender, Viet Tran

Introduction

The emergency department (ED) has a critical role in initiating early treatment for fractured neck of femur (fractured NOF). Delayed treatment is associated with adverse outcomes. The primary objective of this study was to retrospectively examine the use of a fractured NOF formal pathway document. Secondary outcomes assessed pathway compliance, impact on waiting times, and differences across Tasmanian EDs to guide local quality improvement.

Study Design

Descriptive retrospective study with random sampling of 200 fractured NOF cases across three regional hospital EDs.

Results

Of the 195 fractured neck of femur (NOF) ED presentations across three sites, 155 (79.5%) used the pathway. Nerve block administration showed a statistically significant association with pathway use, with a relative increase of +44.9% (95% CI: +15.0% to +83.0%, p < 0.000001). MiniCog screening showed a notable relative increase of +93.5% (95% CI: +1.0% to +271.0%) but did not meet the significance threshold. MiniCog assessment differed significantly between hospitals H1 versus H2 and H1 versus H3 (p < 0.00001). Goals of care completion showed some variation (p = 0.0033) but was not statistically significant. Pathway use did not significantly affect waiting times, length of stay, or representation rates. Hospital comparisons revealed significant differences in waiting times and length of stay.

Conclusions

This study suggests that pathway use was associated with significant increases in the administration of nerve blocks. Significant differences in pathway use, element completion, and associated waiting times were reported between hospitals. Findings support the pathway's role in standardising care and guiding targeted quality improvement efforts.

简介：在股骨颈骨折的早期治疗中，急诊科（ED）起着至关重要的作用。延迟治疗与不良后果有关。本研究的主要目的是回顾性检查骨折非of正式通路的使用情况。次要结果评估了途径依从性、等待时间的影响以及塔斯马尼亚州急诊室的差异，以指导当地的质量改进。研究设计：描述性回顾性研究，随机抽取三家地区医院急诊科200例非of骨折病例。结果：在三个部位的195例股骨颈骨折（NOF） ED中，155例（79.5%）使用了该途径。神经阻滞给药与通路使用有统计学意义的关联，相对增加+44.9% （95% CI: +15.0% ~ +83.0%, p）。结论：本研究提示通路使用与神经阻滞给药的显著增加相关。据报道，不同医院在途径使用、要素完成和相关等待时间方面存在显著差异。研究结果支持该途径在标准化护理和指导有针对性的质量改进工作中的作用。

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引用次数: 0

Point-of-Care High-Sensitivity Troponin Use in an ESC-Type Pathway for Assessment of Possible Acute Myocardial Infarction in the Emergency Department 急诊部即时高灵敏度肌钙蛋白在esc型途径中用于评估可能的急性心肌梗死

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-12 DOI: 10.1111/1742-6723.70147

Logan Fann, Laura R. Joyce, John W. Pickering, Andrew Munro, Nick Fisher, Martin Than

This prospective observational study aimed to assess the diagnostic utility of point-of-care (POC) high-sensitivity troponin (hs-cTn) within an ED chest pain pathway. Patients had paired laboratory hs-cTnT and POC hs-cTnI on arrival. Clinical care utilised the hs-cTnT result. Allocation to risk classes was compared between hs-cTnT and POC hs-cTnI. AMI was adjudicated blinded to the POC result. Of 184 patients, 14 (7.6%) had AMI. Twenty-one (11.4%) had AMI ruled out by hs-cTnT and 59 (32.1%) by POC, both with 100% sensitivity. The POC test returned invalid results in 17 patients (8.5%). A POC hs-cTnI assay within a clinical pathway may effectively risk stratify for AMI.

这项前瞻性观察性研究旨在评估即时护理（POC）高灵敏度肌钙蛋白（hs-cTn）在ED胸痛途径中的诊断效用。患者在到达时进行了实验室hs-cTnT和POC hs-cTnI配对。临床护理采用hs-cTnT结果。比较hs-cTnT和POC hs-cTnI对风险等级的分配。AMI被判定对POC结果不知情。184例患者中，14例（7.6%）发生AMI。hs-cTnT排除AMI 21例（11.4%），POC排除AMI 59例（32.1%），敏感性均为100%。17例（8.5%）患者的POC检测结果无效。临床途径中的POC hs-cTnI检测可以有效地对AMI进行风险分层。

引用次数: 0

Effect of Optimised Single Role Versus Multirole Physician Response Model on Time to Contact in Patients Requiring Advanced Interventions in Greater Sydney, Australia 优化的单一角色与多角色医生反应模型对澳大利亚大悉尼地区需要高级干预的患者接触时间的影响。

IF 1.4 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia

Pub Date : 2025-10-12 DOI: 10.1111/1742-6723.70151

Alan A. Garner, Russell Hoore, Sviatlana Kamarova

Objective

This study aimed to compare the timeliness of single role versus multirole physician-staffed prehospital models and construct an optimised capability-based case allocation map for Sydney, Australia.

Methods

We retrospectively compared response, scene, and total prehospital intervals over an 11-year period. Generalized linear regression models with log function were used to control for confounders. An optimized case allocation map was derived from response time data.

Results

For the single role service 672 helicopter responses were compared with 289 road and 208 helicopter multirole responses. Multirole patients were typically closer to their base (median 18.2 km vs. 23.4 km, p = 0.004). Response interval was shorter for the single role service (median 18 min vs. 24 min, p < 0.001). Scene and total prehospital intervals were shorter for the single role service (24 min vs. 32 min, p < 0.001 and 70 min vs. 80 min, p < 0.001, respectively). On multivariate analysis, multirole allocation was significantly associated with longer scene intervals (IRR = 1.176, [95% CI 1.133, 1.221], p < 0.001) and longer total prehospital intervals (IRR = 1.402 [95% CI 1.315, 1.495], p < 0.001). The optimised case allocation map indicates multirole road response is faster for a 9 km radius circle eccentrically centred on their base. All other locations are more rapidly served by the single role helicopter model.

Conclusions

A single role model is associated with a shorter response, scene, and total prehospital intervals compared with a multirole model. Real-world response time data rather than distance can be used to optimise case allocation when response capabilities are not equivalent.

目的：本研究旨在比较单一角色与多角色医生配备的院前模型的及时性，并为澳大利亚悉尼构建一个优化的基于能力的病例分配图。方法：我们回顾性比较了11年期间的反应、现场和总院前间隔。采用对数函数广义线性回归模型控制混杂因素。根据响应时间数据得到优化的病例分配图。结果：对于单一角色服务，672架直升机响应与289架公路和208架直升机多角色响应进行了比较。多角色患者通常更接近其基础（中位数18.2公里对23.4公里，p = 0.004）。单角色服务的反应间隔更短（中位数为18分钟vs. 24分钟，p）。结论：与多角色服务相比，单角色服务的反应、场景和总院前间隔更短。当响应能力不相等时，可以使用实际响应时间数据而不是距离数据来优化病例分配。

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引用次数: 0