Emergency medicine Australasia : EMA
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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
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.
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Emerg Med Australas · Feb 2025
The determinants for death in hospital following moderate to severe traumatic brain injury in Australia.
To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia. ⋯ Among people presenting to a major trauma hospital in Australia following moderate to severe TBI, there were multiple factors independently associated with death in hospital. The potentially modifiable determinants of in-hospital death included out-of-hours access to emergency care, mode of transfer from the scene of the injury, prior facility care and pre-definitive hospital endotracheal intubation.
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Emerg Med Australas · Feb 2025
Criteria for early discharge of drowning patients from the emergency department.
Clinical factors previously shown to independently predict safe discharge were applied at ED presentation to determine whether we could identify a group of drowning patients who do not require treatment and are thus safe for rapid discharge. ⋯ Drowning patients who meet rapid discharge criteria at ED presentation will not require treatment for their drowning and may be considered for discharge from the ED without further investigation or mandatory period of observation.