Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2021
Establishing the protocols for the South Australian Emergency Department Admission Blood Psychoactive Testing (EDABPT) programme for drug surveillance.
ED presentations because of illicit use of psychotropic drugs and pharmaceuticals result in significant medical harm and resource consumption. Patient assessment is complicated by the regular emergence of new psychoactive substances, difficulties associated with their identification and a lack of information about their effects. Here we report the protocol for the Emergency Department Admission Blood Psychoactive Testing (EDABPT) programme, an observational study utilising clinical data capture and definitive drug identification to assess the medical impact and patterns of illicit drug use in the community, and their geographic and temporal fluctuations. The study provides data to an early warning system targeting an improved public health response to emerging drugs of concern. ⋯ The study pairs city-wide patient enrolment with analytically confirmed toxicology results to allow broad sampling and identification of illicit drugs causing medical harm. It provides a mechanism for the identification of new agents as they emerge in the community, delivers a relevant and reliable source of information for public health agencies and clinicians and supplements existing local early warning mechanisms.
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Emerg Med Australas · Oct 2021
Observational StudyRetrospective validation of a risk stratification tool developed for the management of patients with blunt chest trauma (the STUMBL score).
To assess validity of the STUMBL score in New Zealand for complications of blunt chest trauma without multi-trauma and immediate life-threatening injuries. ⋯ The STUMBL score at a cut-off of <12 did not predict all complications sufficiently well to recommend for general use in our population. However, a score >15 predicted prolonged LOS and a score >18 predicted mortality sufficiently to be clinically useful for these outcomes. The score is more accurate in New Zealand Pākehā and needs to be used with caution in Māori and Pasifika populations. A larger prospective validation is required to further assess the score.
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Emerg Med Australas · Oct 2021
Low back pain presentations to New South Wales emergency departments: Trends over time and geographical variation.
To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales. ⋯ The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20-fold variation in presentation rates across different regions.
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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.