Emergency medicine Australasia : EMA
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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.
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Emerg Med Australas · Apr 2019
Multicenter StudyKetamine use for rapid sequence intubation in Australian and New Zealand emergency departments from 2010 to 2015: A registry study.
This study aimed to quantify the proportion of patients undergoing rapid sequence intubation using ketamine in Australian and New Zealand EDs between 2010 and 2015. ⋯ Ketamine use increased between 2010 and 2015. Lower systolic blood pressure, the presence of an emergency medicine team leader, trauma and a higher Glasgow Coma Scale were associated with increased odds of ketamine use. Intubation occurring in a major referral centre was associated with lower odds of ketamine use.
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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 StudyImpact of the National Emergency Access Target policy on emergency departments' performance: A time-trend analysis for New South Wales, Australian Capital Territory and Queensland.
To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. ⋯ ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.
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Emerg Med Australas · Apr 2019
Multicenter StudyLonger time to transfer from the emergency department after bed request is associated with worse outcomes.
To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. ⋯ Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.