Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2025
The determinants for death in hospital following moderate to severe traumatic brain injury in Australia.
To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia. ⋯ Among people presenting to a major trauma hospital in Australia following moderate to severe TBI, there were multiple factors independently associated with death in hospital. The potentially modifiable determinants of in-hospital death included out-of-hours access to emergency care, mode of transfer from the scene of the injury, prior facility care and pre-definitive hospital endotracheal intubation.
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Emerg Med Australas · Feb 2025
Adverse events and paramedic interventions during extended ground transport in a rural pharmaco-invasive STEMI program.
Although guidelines recommend angiography and coronary intervention occur within 24 h of thrombolysis when percutaneous coronary intervention (PCI) is not available within 120 min, this target is difficult to achieve in rural and remote areas of New South Wales (NSW), Australia. ⋯ The primary study showed a significant reduction in time from first clinical contact to arrival at the PCI hospital. In this secondary analysis, we demonstrate that the rate of adverse events during long-distance road transport is low, the adverse events are mostly minor in nature and are within the scope of paramedic practice to manage.
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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.
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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.
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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.