Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2018
The Sydney Triage to Admission Risk Tool (START): A prospective validation study.
The present study aims to prospectively validate the Sydney Triage to Admission Risk Tool (START) to predict ED disposition. ⋯ The overall performance of the START tool with respect to model discrimination and accuracy has been prospectively validated. Further clinical trials are required to test the clinical effectiveness of the tool in improving patient flow and overall ED performance.
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Emerg Med Australas · Aug 2018
ReviewReview article: NEXUS criteria to rule out cervical spine injury among older patients: A systematic review.
The National Emergency X-Radiography Utilization Study (NEXUS) criteria were derived from a heterogeneous group of adult blunt trauma patients, with the outcome measure assessed most commonly using plain X-ray radiographs. Recent observations have suggested inadequacy of these criteria for excluding injury in population subgroups such as the elderly. The aim of this systematic review was to determine the sensitivity of the NEXUS criteria in excluding cervical spine injury among older patients aged ≥65 years. ⋯ Sensitivity of the NEXUS criteria among older patients ranged from 66% to 100%. Variable sensitivity was demonstrated when the NEXUS criteria were applied to older blunt trauma patients. This questions the applicability of the NEXUS criteria in this subgroup.
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Emerg Med Australas · Aug 2018
Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data.
To describe patterns for potentially avoidable general practice (PAGP)-type and non-PAGP-type ED presentations by older patients during 2008 and 2012. ⋯ The rate of repeat and frequent PAGP-type presentations by older people decreased in 2012 compared with 2008, suggesting that initiatives implemented to reduce avoidable presentations may have had an effect. However, an increase in the rate of frequent non-PAGP-type presentations, predominately for acute exacerbation of cardiovascular and respiratory conditions, has important implications for planning future healthcare delivery; hence, the importance of initiatives such as the Health Care Home.
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Emerg Med Australas · Aug 2018
Perhaps quality of life should not be used as a trigger for discussing resuscitation and advance care plans.
As a subjective measure, quality of life should not be used as a trigger for discussing resuscitation, goals of care or advanced care plans. Limitations and challenges in measurement and assessment of quality of life have been recognised. ⋯ Surrogate quality of life estimations may misrepresent individual worth and self-perceived quality of life. Disagreement over quality of life statements may cause harm.