Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2025
Observational StudyEvaluation of older patients with minor blunt head trauma to identify those who do not have clinically important traumatic brain injury and can be safely managed without cranial computed tomography.
Our primary aim was to identify a low-risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT). ⋯ Alert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs.
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Emerg Med Australas · Feb 2025
Triage gap? Analysis of admission rates, service utilisation and mortality for First Nations patients compared to non-First Nations patients, stratified by ED triage category.
First Nations patients often experience poorer health outcomes than non-First Nations patients. Despite emergency triage primarily focusing on severity, implying comparable outcomes for patients in the same triage group regardless of demographics, the precision of triage for First-Nations Australians may be undermined by multiple factors, although research in this area is scarce. ⋯ First Nations patients appear to have worse outcomes than non-First Nations patients in the same triage category. Socio-economic factors and high discharge against advice rates from wards may explain the significantly higher admission rate. Under-recognition of serious illness at triage could be attributed to communication issues or a 'well bias'. The results raise many questions and further investigation is required.
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Emerg Med Australas · Feb 2025
Impact of socioeconomic status on utilisation of a Virtual Emergency Department: An exploratory analysis.
To explore whether utilisation of a Virtual Emergency Department (VVED) differs according to socioeconomic status (SES). ⋯ The present study demonstrated a relatively even utilisation of the VVED service across SES population groups. The use of healthcare provider pathways, such as ambulance paramedics, may increase equitable access to telehealth. Clinical attention should be directed toward specific social groups in the emergency care setting.
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Emerg Med Australas · Feb 2025
ReviewReview article: Evaluating the effectiveness of arterial pressure point techniques as a first aid method for external haemorrhage control: A systematic review.
The current ANZCOR guidelines for first aid management of life-threatening bleeding from a limb, where bleeding cannot be controlled with direct pressure, recommends the use of an arterial tourniquet. However, tourniquets required specialised training and equipment, which may not be accessible in all emergencies. This systematic review evaluated the effectiveness of arterial pressure point techniques (APPT) as a first aid measure for controlling life-threatening, non-compressible bleeding from limbs and anatomical junctions. ⋯ Additional research with higher levels of evidence, standardised protocols and larger sample sizes is needed. Investigation in real-world scenarios is crucial to compare methods like tourniquets. Future research will determine APPT's effectiveness and its potential role as a bridging technique before tourniquet application or medical assistance.
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Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care. ⋯ The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.