Emergency Medicine Australasia

Fatovich, Daniel M

doi: 10.1111/1742-6723.12044pmid: 23379445

Haji, Darsim L; Royse, Alistair; Royse, Colin F

doi: 10.1111/1742-6723.12033pmid: 23379446

There is increased realisation of the emerging role of point‐of‐care transthoracic echocardiography (TTE) as ‘ultrasound‐assisted examination’, given the low sensitivity of clinical examination for cardiovascular pathologies and the time‐critical nature of these pathologies. There is evidence that point‐of‐care TTE provides higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point‐of‐care TTE is increasingly used by non‐cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaesthesia. The diagnostic capability of new portable devices is improving rapidly and outdating its predecessors, thereby improving confidence in echocardiography findings.

Donath, Susan; Davidson, Andrew; Babl, Franz E

doi: 10.1111/1742-6723.12018pmid: 23379447

In this series we address key topics for clinicians who conduct research as part of their work in the ED. In this section we will address important statistical concepts for clinical researchers and readers of clinical research publications. We use practical clinical examples of how to describe clinical data for presentation and publication, and explain key statistical concepts and tests clinical researchers will likely use for the majority of ED datasets.

Wattimena, Jeany; Pelosi, Marilena; Cheney, Kate; Green, Timothy; Black, Kirsten I

doi: 10.1111/1742-6723.12023pmid: 23379448

Objective This study aimed to determine factors associated with length of stay (LOS) for women presenting with early pregnancy complications to a public hospital ED. In particular, we sought to investigate the impact the involvement of the Clinical Midwife Consultant (CMC), specialising in early pregnancy care, had on the ED LOS. Methods We undertook a retrospective cohort study of women less than 20 weeks pregnant who presented between August 2008 and December 2010 with early pregnancy complications to the ED of the Royal Prince Alfred Hospital in Sydney, Australia and who were then discharged. The main outcome measured was LOS. We performed logistic regression analysis to identify factors significantly associated with this outcome. Results Data were available for 1739 women. Involvement of the CMC reduced LOS and patients were significantly more likely to be discharged within 4 h or less (OR = 0.47, 95% CI = 0.37–0.60). The factors that increased LOS to over 4 h were arrival after hours (OR = 2.09, 95% CI = 1.66–2.63), being triaged as category 1 to 3 (OR = 1.36, 95% CI = 1.11–1.67) and requiring an ultrasound assessment (OR = 2.44, 95% CI = 1.81–3.28). Conclusions This study was able to show factors significantly associated with ED LOS, many of which are not modifiable. The involvement of the CMC reduced LOS, whereas requiring an ultrasound assessment increased LOS. Thus, improvement could be achieved by greater access to a CMC and more rapid access to ultrasound services.

McIntyre, Shona; McD Taylor, David; Greene, Shaun

doi: 10.1111/1742-6723.12020pmid: 23379449

Objective Under‐ or overdosing of N‐acetylcysteine (NAC), when used to treat paracetamol toxicity, is associated with significant morbidity and mortality. This study evaluated the effect of a weight‐based dosing chart (WBDC) introduced to decrease NAC prescription errors. Methods We undertook a pre‐ and post‐intervention trial in a single ED. The intervention (the NAC WBDC) was introduced in January 2011 and publicised by posters and presentations at medical handovers and education sessions. ED staff were not aware that use of the WBDC was to be evaluated. Data were collected using a retrospective explicit medical record review by a single investigator. The study end‐point was the proportion of NAC prescriptions with errors. Results The 81 and 42 patients enrolled in the pre‐ and post‐intervention periods, respectively, did not differ in age, sex or weight (P > 0.05). Post‐intervention, there were significant reductions in prescription errors of fluid type/volume (50.6% vs 4.8%, P < 0.001), NAC dosage (13.6% vs 0.0%, P = 0.01) and infusion rate (11.1% vs 0.0%, P = 0.03). The proportion of prescriptions with any errors also decreased (56.8% vs 14.3%, P < 0.001). However, there were no improvements in the documentation of patient weight (65.4% vs 64.3%, respectively, P = 0.90) or the proportion of incomplete prescriptions (4.9% vs 11.9%, P = 0.16). Conclusion The introduction of a WBDC did not produce a clinically significant reduction in major NAC prescription error rates (as pre‐defined in this study); however, there was a clear trend towards a reduction. The WBDC significantly reduced total and minor NAC prescription error rates.

Jones, Ian SC; O'Connor, Alan

doi: 10.1111/1742-6723.12016pmid: 23379450

Objective To describe the mechanism, injury pattern and management of women who present to the ED with non‐obstetric vulval trauma. Methods A retrospective, single‐institution case series was carried out. Data were sourced from medical records of women who presented to the ED and Royal Brisbane and Women's Hospital between 2007 and 2011. Records of possible injuries to the vulva were assessed to determine incidence, age, site, type of injury, mechanism of injury and whether urinary retention required treatment. This information was analysed using the computer software Statistical Package for the Social Sciences 11.0. Results Vulval non‐obstetric trauma was found in 19 of 519 cases, resulting in haematoma formation, lacerations, tears or a combination of the three in 16 of the 19 cases. Injuries were due to falling astride a firm object, consensual coitus, sexual assault, cold waxing and tight clothing. Urinary retention occurred in three cases. Site of injury, whether anterior or posterior, was evenly distributed irrespective of the mechanism of injury. Haematomas were treated conservatively and bleeding lacerations sutured. None required resuscitation. Conclusions Non‐obstetric vulval injuries are uncommon (incidence 3.7%). All cases require assessment for vaginal, urethral, anal and bony pelvis injuries. This might require examination under anaesthesia. Conservative management of haematomas in the absence of acute haematoma expansion is favoured. The need to screen for sexually transmissible infections and pregnancy is important. Social worker and psychological support is important to reduce the incidence of long‐term psychological problems.

Mahmoud, Ibrahim; Hou, Xiang‐Yu; Chu, Kevin; Clark, Michele

doi: 10.1111/1742-6723.12017pmid: 23379451

Objective To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home. Methods A retrospective analysis of a Queensland statewide hospital ED dataset (ED Information System) from 1 January 2008 to 31 December 2010 was conducted. Access to ED care was measured by the proportion of the state's population attending EDs. Logistic regression analyses were performed to determine the relationships between ambulance use and language, and between hospital admission and language, both after adjusting for age, sex and triage category. Results The ED utilisation rate was highest in English only speakers (290 per 1000 population), followed by Arabic speakers (105), and lowest among German speakers (30). Compared with English speakers, there were lower rates of ambulance use in Chinese (odds ratio 0.50, 95% confidence interval, 0.47–0.54), Vietnamese (0.87, 0.79–0.95), Arabic (0.87, 0.78–0.97), Spanish (0.56, 0.50–0.62), Italian (0.88, 0.80–0.96), Hindi (0.61, 0.53–0.70) and German (0.87, 0.79–0.90) speakers. Compared with English speakers, German speakers had higher admission rates (odds ratio 1.17, 95% confidence interval, 1.02–1.34), whereas there were lower admission rates in Chinese (0.90, 0.86–0.99), Arabic (0.76, 0.67–0.85) and Spanish (0.83, 0.75–0.93) speakers. Conclusion This study showed that there was a significant association between lower utilisation of emergency care and speaking languages other than English at home. Further researches are needed using in‐depth methodology to investigate if there are language barriers in accessing emergency care in Queensland.

Flabouris, Arthas; Jeyadoss, Jellsingh; Field, John; Soulsby, Tom

doi: 10.1111/1742-6723.12021pmid: 23379452

Objective To evaluate the association of ED length of stay (EDLOS) and outcome of patients admitted to a ward, intensive care (ICU) or stepdown (high dependency) unit (SDU). Methods Design: Retrospective cohort study using linked administrative and clinical data. Setting: 650‐bed, university‐affiliated, tertiary referral hospital, whose ED has approximately 60 000 patient presentations per annum. Participants: Adult patients admitted via the ED, to a ward (ED to ward), ICU (ED to ICU) or SDU (ED to SDU), and whose EDLOS was <24 h. Outcome measures: Hospital outcome and LOS. Results A total of 43 484 patients over 4 years. Median EDLOS was 2:36 h for ICU, 5:07 h for SDU and 7:19 h for ward (P < 0.01) patients. EDLOS differed significantly, based on hospital outcome, for ward (alive, 7:18 h vs died, 7:44 h, P < 0.001), but not SDU or ICU patients. At an EDLOS of 4 and 8 h, 19.4% and 5.2% of ICU, 52.1% and 15.5% of SDU and 77.9% and 32.6% of ward patients remained in the ED. EDLOS was not a significant predictor of death, in comparison with increasing age and admitting unit across all three groups, and higher triage acuity for ED to ward and ED to ICU. Conclusions EDLOS was greater for ED to ward patients, and of the ED to ward patients who died. At an EDLOS of 4 h there were fewer ICU, in comparison with ward, patients remaining in the ED. Future studies that report on EDLOS should differentiate for patients admitted from the ED to the ward, ICU or SDU.

Ong, Marcus EH; Cho, Jungheum; Ma, Matthew Huei‐Ming; Tanaka, Hideharu; Nishiuchi, Tatsuya; Al Sakaf, Omer; Abdul Karim, Sarah; Khunkhlai, Nalinas; Atilla, Ridvan; Lin, Chih‐Hao; Shahidah, Nur; Lie, Desiree; Shin, Sang Do; Shin, Sang Do

O'Connor, Alan E; Lukin, William; Eriksson, Lars; O'Connor, Colm

doi: 10.1111/1742-6723.12030pmid: 23379454

Objective To study any change in reference accuracy in the Australasian emergency medicine journal (now known as Emergency Medicine Australasia), in the 10 years since a previous analysis was undertaken. Method A sample of 100 randomly selected references was compared with the results from the previous analysis. Results There was a significant reduction in the number of citations with errors and in the total number of errors. Conclusion This paper demonstrates a significant improvement in the accuracy of references in the journal Emergency Medicine Australasia over the past decade. This paper did not identify the reasons for this improvement, but potential causes might include the introduction of a web‐based peer review and manuscript submission process, as well as improved reference bibliography systems by authors. In addition, an increase in the overall standard of paper submitted to the journal might have contributed to this improvement.