Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2019
Multicenter Study Observational StudyTreatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study.
Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. ⋯ The data suggests that compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is sub-optimal. It also suggests over-use of antibiotics.
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Emerg Med Australas · Aug 2019
Multicenter StudyPaediatric intentional head injuries in the emergency department: A multicentre prospective cohort study.
Although there is a large body of research on head injury (HI) inflicted by caregivers in young children, little is known about intentional HI in older children and inflicted HI by perpetrators other than carers. Therefore, we set out to describe epidemiology, demographics and severity of intentional HIs in childhood. ⋯ Intentional HI is infrequent in children. The most frequently identified perpetrators are caregivers and peers. Caregiver injuries are particularly severe.
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Emerg Med Australas · Aug 2019
Multicenter Study Observational StudyAccuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department.
Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. ⋯ The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.
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Emerg Med Australas · Apr 2019
Multicenter StudyValue of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries.
To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps. ⋯ Bicycle injuries carry a considerable burden to the ED and the incidence of presentations appears to be rising. The current triage data, designed to provide a rapid assessment for medical urgency, are limited to describing broad demographics, trends and causes.
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Emerg Med Australas · Apr 2019
Multicenter Study Comparative StudyEffect of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer on pulmonary embolism diagnosis, scan rates and diagnostic yield.
To assess the association between the use of a flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer and subsequent imaging and yield rates of computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion scans being ordered in the ED for the assessment of pulmonary embolism. ⋯ The introduction of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer was associated with an increase in ED computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion yield rate from 9.9% to 16.5% across the three enrolment hospitals when investigating possible pulmonary embolism. This corresponded to a 40% relative reduction in pulmonary embolism imaging. Diagnosis rates remained unchanged and no cases of missed pulmonary embolism attributable to the flowchart were identified.