Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2025
Comparative StudyRethinking the pan scan in stable trauma: A comparison of whole-body computed tomography and selective imaging in clinically stable blunt force trauma.
To compare the frequency of clinically significant missed injuries in clinically stable trauma patients undergoing initial whole-body computed tomography (WBCT) versus selective imaging. Secondary objectives include comparisons of radiation exposure, incidental findings, ED length of stay (LOS), hospital LOS and mortality. ⋯ Missed injuries were rare and without major complications in this clinically stable cohort. The liberal use of WBCT, despite low rates of missed injuries, morbidity and mortality, suggests over-utilisation of WBCT for 'mechanism only' traumas.
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Emerg Med Australas · Feb 2025
Rate and yield of imaging for acute pyelonephritis in the emergency department: A retrospective cohort study.
The role of imaging in acute pyelonephritis (APN) in the ED is poorly understood, with variability among clinical guidelines for when patients should be imaged, and the modality of imaging. The objective of this study was to identify the proportion of patients with APN being imaged, the proportion abnormal findings, and the association between abnormal imaging and discharge disposition. ⋯ Among patients with APN, abnormalities on imaging were common and both imaging and abnormalities on imaging were associated with hospital ward admission. This suggests that there is possible utility of early and routine imaging for patients with APN to allow clinicians to efficiently make decisions about patient disposition.
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Emerg Med Australas · Feb 2025
Children exposed to family and domestic violence perpetrated against their mother are at an increased risk of emergency department attendance in childhood.
To determine the association between family and domestic violence (FDV) exposure and ED attendance in Australian children. ⋯ Exposure to FDV is associated with an increased risk of ED attendance in childhood. The findings add to the limited literature providing further support that FDV exposure impacts children's health service utilisation and further supports that children's exposure to FDV as an area of public health concern. Attendance at the ED presents an opportunity for intervention.
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Emerg Med Australas · Feb 2025
Somatic symptom and related disorders in a tertiary paediatric hospital: Characteristics of ED use prior to admission.
Somatic symptom and related disorders (SSRDs) are complex disorders that are commonly encountered in tertiary paediatric settings. Despite this, little is known about ED use prior to hospital admission. We aimed to describe the pattern of ED use in a cohort of children and adolescents who were subsequently admitted to hospital with SSRD and to identify factors associated with ED presentations. ⋯ Children and adolescents with SSRD who go on to have a hospital admission present frequently to EDs, especially in the setting of pain symptoms. Training of ED clinicians in diagnosing SSRD appears indicated, as is the development of local care pathways that may obviate the need for hospital admission in at least some patients.
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Emerg Med Australas · Feb 2025
Renal colic: Streamlining investigations to improve patient outcomes in emergency medicine.
In Australian EDs, patients experience long waits for imaging, particularly for presentations such as renal colic. Computed tomography (CT) imaging is the gold-standard for renal stones, although ultrasonography is recommended for young patients and those susceptible to radiation, an approach supported by The Canberra Hospital (TCH) ED guidelines for renal colic. This audit aims to not only assess how well these guidelines are adhered to, but also to discuss possible methods of improving flow through ED and thus patient outcomes. ⋯ We propose that patients with significant clinical and biochemical features of renal stones could be referred to urology earlier to await CT as an inpatient and those without be referred to their general practitioner for outpatient imaging and medical management. This could improve flow through the department and improve patient outcomes through reduced waiting times and radiation burden.