Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2021
Introduction of point-of-care ROTEM testing in the emergency department of an Australian level 1 trauma centre and its effect on blood product use.
To assess whether the introduction of point-of-care rotational thromboelastometry (ROTEM) analysis influences blood product transfusion and coagulation management in a modern Australian level 1 trauma centre. ⋯ Point-of-care ROTEM was performed in a small proportion of patients, mainly those with a higher ISS. ROTEM introduction in the ED altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products.
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Emerg Med Australas · Oct 2021
Evaluation of an augmented emergency department electronic medical record-based sepsis alert.
Electronic medical records-based alerts have shown mixed results in identifying ED sepsis. Augmenting clinical patient-flagging with automated alert systems may improve sepsis screening. We evaluate the performance of a hybrid alert to identify patients in ED with sepsis or in-hospital secondary outcomes from infection. ⋯ The hybrid alert performed modestly in identifying ED sepsis and secondary outcomes from infection. Not all infected patients with a secondary outcome were identified by the alert or mSOFA score ≥2 threshold. Augmenting clinical practice with auto-alerts rather than pure automation should be considered as a potential for sepsis alerting until more reliable algorithms are available for safe use in clinical practice.
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Emerg Med Australas · Oct 2021
Clinical utility of the Glasgow Blatchford Score in patients presenting to the emergency department with upper gastrointestinal bleeding: A retrospective cohort study.
Upper gastrointestinal bleeding (UGIB) is a common presentation to EDs. Limited Australian data are available. Study aims were to assess mortality and re-bleeding rates in patients presenting with UGIB as risk-stratified by the Glasgow Blatchford Score (GBS). ⋯ Mortality and re-bleeding outcomes are similar to other international UGIB cohorts. Patients with a low-risk bleed were appropriately identified and discharged home. Those at higher risk were correctly identified and accessed timely endoscopy. The GBS demonstrated clinical utility in an Australian ED cohort of UGIB bleeding patients.
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Emerg Med Australas · Oct 2021
Acute traumatic coagulopathy and the relationship to prehospital care and on-scene red blood cell transfusion.
To identify the incidence of acute traumatic coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital, analyse prehospital contributors, including red blood cell transfusion and assess the clinical significance of ATC. ⋯ Prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma.
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Emerg Med Australas · Oct 2021
Impact of the modifiable areal unit problem in assessing determinants of emergency department demand.
To examine the impact of the modifiable areal unit problem (MAUP) in an investigation of factors associated with ED demand in Perth, Western Australia, in 2016. Furthermore, to advocate a means of avoiding this impact. ⋯ When formulating interventions targeting reduced ED utilisation, policy planners should be guided by evidence based on analysis of appropriate spatial units. This ideal is undermined by the widespread lack of acknowledgement of the MAUP in studies examining drivers of ED demand using spatially aggregated data. To avoid the MAUP, only estimates obtained through examining a minimal geographic unit should be relied upon.