Emergency medicine Australasia : EMA
-
Emerg Med Australas · Feb 2025
De-implementing low-value care in emergency medicine: A framework for sustainable improvement.
The continued use of low-value care interventions is a persisting challenge across the healthcare system despite targeted international efforts to reduce their use. These practices result in considerable economic and carbon costs. ⋯ We outline the interventions and the proportions by which they were reduced. We provide a step-by-step framework that provides a model for other hospital departments or primary care centres to initiate their own de-implementation process for low-value care practices within their setting.
-
Emerg Med Australas · Feb 2025
ReviewReview article: Primer for clinical researchers on innovative trial designs for emergency medicine.
Randomised trials have long been recognised as the gold standard research tool for evidence-based medicine. The past decade has seen the emergence of several innovative trial designs that are revolutionising how trials are conducted. ⋯ We describe the main features of each design, outline their pros and cons, and describe when they may or may not be useful. We also provide examples of these innovative designs in contexts that are relevant to emergency medicine.
-
Emerg Med Australas · Feb 2025
ReviewReview article: Efficacy of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning - A systematic review.
Serotonin toxicity is a potentially fatal condition caused by increased serotonergic activity in the central nervous system. Cyproheptadine, a serotonergic antagonist, is recommended for treatment; however, there is a lack of evidence to support its use. The present study aimed to evaluate the evidence for the use of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning. ⋯ Few reports commented on clinical resolution and therefore efficacy was not established. All studies were graded as being of very low evidence and at high risk of bias. There is a lack of evidence to support the efficacy of cyproheptadine or its recommendation in clinical guidelines pertaining to the management of serotonin toxicity.
-
Emerg Med Australas · Feb 2025
Prehospital use of spinal precautions by emergency medical services in children and adolescents.
Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia. ⋯ Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric-specific evidence into prehospital guidelines to risk stratify children.