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Partyka C, Asha S, Berry M, Ferguson I, Burns B, Tsacalos K, Gaetani D, Oliver M, Luscombe G, Delaney A, Curtis K. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. JAMA Surg 2024:2818238. [PMID: 38691350 PMCID: PMC11063926 DOI: 10.1001/jamasurg.2024.0969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 05/03/2024]
Abstract
Importance Rib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures. Objective To determine whether the addition of an SAPB to protocolized care bundles increases the likelihood of early favorable analgesic outcomes and reduces opioid requirements in patients with rib fractures. Design, Setting, and Participants This multicenter, open-label, pragmatic randomized clinical trial was conducted at 8 emergency departments across metropolitan and regional New South Wales, Australia, between April 12, 2021, and January 22, 2022. Patients aged 16 years or older with clinically suspected or radiologically proven rib fractures were included in the study. Participants were excluded if they were intubated, transferred for urgent surgical intervention, or had a major concomitant nonthoracic injury. Data were analyzed from September 2022 to July 2023. Interventions Patients were randomly assigned (1:1) to receive an SAPB in addition to usual rib fracture management or standard care alone. Main Outcomes and Measures The primary outcome was a composite pain score measured 4 hours after enrollment. Patients met the primary outcome if they had a pain score reduction of 2 or more points and an absolute pain score of less than 4 out of 10 points. Results A total of 588 patients were screened, of whom 210 patients (median [IQR] age, 71 [55-84] years; 131 [62%] male) were enrolled, with 105 patients randomized to receive an SAPB plus standard care and 105 patients randomized to standard care alone. In the complete-case intention-to-treat primary outcome analysis, the composite pain score outcome was reached in 38 of 92 patients (41%) in the SAPB group and 18 of 92 patients (19.6%) in the control group (relative risk [RR], 0.73; 95% CI, 0.60-0.89; P = .001). There was a clinically significant reduction in overall opioid consumption in the SAPB group compared with the control group (eg, median [IQR] total opioid requirement at 24 hours: 45 [19-118] vs 91 [34-155] milligram morphine equivalents). Rates of pneumonia (6 patients [10%] vs 7 patients [11%]), length of stay (eg, median [IQR] hospital stay, 4.2 [2.2-7.7] vs 5 [3-7.3] days), and 30-day mortality (1 patient [1%] vs 3 patients [4%]) were similar between the SAPB and control groups. Conclusions and Relevance This randomized clinical trial found that the addition of an SAPB to standard rib fracture care significantly increased the proportion of patients who experienced a meaningful reduction in their pain score while also reducing in-hospital opioid requirements. Trial Registration http://anzctr.org.au Identifier: ACTRN12621000040864.
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Affiliation(s)
- Christopher Partyka
- Emergency Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia
| | - Stephen Asha
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melanie Berry
- Emergency Department, Orange Base Hospital, Orange, New South Wales, Australia
- RPA Virtual Hospital, Sydney, New South Wales, Australia
- Orange Clinical School, University of Sydney, Orange, New South Wales, Australia
| | - Ian Ferguson
- Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia
- Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Burns
- Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia
- Emergency Department, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
- Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Katerina Tsacalos
- Emergency Department, The Sutherland Hospital, Caringbah, Sydney, New South Wales, Australia
| | - Daniel Gaetani
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Emergency Department, Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Matthew Oliver
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Trauma Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Greenlight Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Georgina Luscombe
- School of Rural Health, Sydney Medical School, University of Sydney, Orange, New South Wales, Australia
| | - Anthony Delaney
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Division of Critical Care, The George Institute of Global Health, University of New South Wales, Sydney, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Curtis
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sidney, New South Wales, Australia
- Critical Care Research, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Rushton TJ, Tian DH, Baron A, Hess JR, Burns B. Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02454-6. [PMID: 38319350 DOI: 10.1007/s00068-024-02454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Hypocalcaemia upon arrival (HUA) to hospital is associated with morbidity and mortality in the trauma patient. It has been hypothesised that there is an increased incidence of HUA in patients receiving prehospital transfusion as a result of citrated blood products. This research aimed to determine if there was a difference in arrival ionised calcium (iCa) levels in trauma patients who did and did not receive prehospital transfusion. METHODS We conducted a systematic review and meta-analysis of patients with an Injury Severity Score (ISS) > / = 15 and an iCa measured on hospital arrival. We then derived mean iCa levels and attempted to compare between-group variables across multiple study cohorts. RESULTS Nine studies reported iCa on arrival to ED, with a mean of 1.08 mmol/L (95% CI 1.02-1.13; I2 = 99%; 2087 patients). Subgroup analysis of patients who did not receive prehospital transfusion had a mean iCa of 1.07 mmol/L (95% CI 1.01-1.14; I2 = 99%, 1661 patients). Transfused patients in the 3 comparative studies had a slightly lower iCa on arrival compared to those who did not receive transfusion (mean difference - 0.03 mmol/L, 95% CI - 0.04 to - 0.03, I2 = 0%, p = 0.001, 561 patients). CONCLUSION HUA is common amongst trauma patients irrespective of transfusion. Transfused patients had a slightly lower initial iCa than those without transfusion, though the clinical impact of this remains to be clarified. These findings question the paradigm of citrate-induced hypocalcaemia alone in trauma. There is a need for consensus for the definition of hypocalcaemia to provide a basis for future research into the role of calcium supplementation in trauma.
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Affiliation(s)
- Timothy J Rushton
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
| | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, NSW, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Aidan Baron
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - John R Hess
- Transfusion Service, Harborview Medical Center, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Burns
- Trauma Service, Royal North Shore Hospital, Reserve Rd, St Leonards, Sydney, NSW, 2065, Australia.
- Aeromedical Operations, NSW Ambulance, Sydney, NSW, Australia.
- Sydney Medical School, Sydney University, Sydney, NSW, Australia.
- Faculty of Medicine, Macquarie University, Sydney, NSW, Australia.
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Burns B, Marschner I, Eggins R, Buscher H, Morton RL, Bendall J, Keech A, Dennis M. A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: Rationale and design of the EVIDENCE trial. Am Heart J 2024; 267:22-32. [PMID: 37871782 DOI: 10.1016/j.ahj.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Refractory Out of Hospital Cardiac Arrest (r-OHCA) is common and the benefit versus harm of intra-arrest transport of patients to hospital is not clear. OBJECTIVE To assess the rate of survival to hospital discharge in adult patients with r-OHCA, initial rhythm pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) or Pulseless Electrical Activity (PEA) treated with 1 of 2 locally accepted standards of care:1 expedited transport from scene; or2 ongoing advanced life support (ALS) resuscitation on-scene. HYPOTHESIS We hypothesize that expedited transport from scene in r-OHCA improves survival with favorable neurological status/outcome. METHODS/DESIGN Phase III, multi-center, partially blinded, prospective, intention-to-treat, safety and efficacy clinical trial with contemporaneous registry of patient ineligible for the clinical trial. Eligible patients for inclusion are adults with witnessed r-OHCA; estimated age 18 to 70, assumed medical cause with immediate bystander cardiopulmonary resuscitation (CPR); initial rhythm of VF/pulseless VT, or PEA; no return of spontaneous circulation following 3 shocks and/or 15 minutes of professional on-scene resuscitation; with mechanical CPR available. Two hundred patients will be randomized in a 1:1 ratio to either expedited transport from scene or ongoing ALS at the scene of cardiac arrest. SETTING Two urban regions in NSW Australia. OUTCOMES Primary: survival to hospital discharge with cerebral performance category (CPC) 1 or 2. Secondary: safety, survival, prognostic factors, use of ECMO supported CPR and functional assessment at hospital discharge and 4 weeks and 6 months, quality of life, healthcare use and cost-effectiveness. CONCLUSIONS The EVIDENCE trial will determine the potential risks and benefits of an expedited transport from scene of cardiac arrest.
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Affiliation(s)
- Brian Burns
- New South Wales Ambulance, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian Marschner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney Australia
| | - Renee Eggins
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney Australia
| | - Hergen Buscher
- St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Rachael L Morton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney Australia
| | | | - Anthony Keech
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
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Burns B, Hsu HR, Keech A, Huang Y, Tian DH, Coggins A, Dennis M. Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resusc Plus 2023; 16:100482. [PMID: 37822456 PMCID: PMC10563056 DOI: 10.1016/j.resplu.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
Background The benefit of rapid transport from the scene to definitive in-hospital care versus extended on-scene resuscitation in out-of-Hospital Cardiac Arrest (OHCA) is uncertain. Aim To assess the use of expedited transport from the scene of OHCA compared with more extended on-scene resuscitation of out-of-hospital cardiac arrest in adults. Methods A systematic search of the literature was conducted using MEDLINE, Embase, and SCOPUS. Randomised control trials (RCTs) and observational studies were included. Studies reporting transport timing for OHCA patients with outcome data on survival were identified and reviewed. Two investigators assessed studies identified by screening for relevance and assessed bias using the ROBINS-I tool. Studies with non-dichotomous timing data or an absence of comparator group(s) were excluded. Outcomes of interest included survival and favourable neurological outcome. Survival to discharge and favourable neurological outcome were meta-analysed using a random-effects model. Results Nine studies (eight cohort studies, one RCT) met eligibility criteria and were considered suitable for meta-analysis. On pooled analysis, expedited (or earlier) transfer was not predictive of survival to discharge (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.53 to 2.53, I2 = 99%, p = 0. 65) or favorable neurological outcome (OR 1.06, 95% CI 0.48 to 2.37, I2 = 99%, p = 0.85). The certainty of evidence across studies was assessed as very low with a moderate risk of bias. Region of publication was noted to be a major contributor to the significant heterogeneity observed amongst included studies. Conclusions There is inconclusive evidence to support or refute the use of expedited transport of refractory OHCA.
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Affiliation(s)
- Brian Burns
- Faculty of Medicine and Health, University of Sydney, Australia
- New South Wales Ambulance, Sydney, Australia
| | - Henry R. Hsu
- Faculty of Medicine and Health, University of Sydney, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Anthony Keech
- Faculty of Medicine and Health, University of Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - David H. Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Andrew Coggins
- Faculty of Medicine and Health, University of Sydney, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Mark Dennis
- Faculty of Medicine and Health, University of Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Genc O, Morrison MA, Villanueva-Meyer J, Burns B, Hess CP, Banerjee S, Lupo JM. DeepSWI: Using Deep Learning to Enhance Susceptibility Contrast on T2*-Weighted MRI. J Magn Reson Imaging 2023; 58:1200-1210. [PMID: 36733222 PMCID: PMC10443940 DOI: 10.1002/jmri.28622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although susceptibility-weighted imaging (SWI) is the gold standard for visualizing cerebral microbleeds (CMBs) in the brain, the required phase data are not always available clinically. Having a postprocessing tool for generating SWI contrast from T2*-weighted magnitude images is therefore advantageous. PURPOSE To create synthetic SWI images from clinical T2*-weighted magnitude images using deep learning and evaluate the resulting images in terms of similarity to conventional SWI images and ability to detect radiation-associated CMBs. STUDY TYPE Retrospective. POPULATION A total of 145 adults (87 males/58 females; 43.9 years old) with radiation-associated CMBs were used to train (16,093 patches/121 patients), validate (484 patches/4 patients), and test (2420 patches/20 patients) our networks. FIELD STRENGTH/SEQUENCE 3D T2*-weighted, gradient-echo acquired at 3 T. ASSESSMENT Structural similarity index (SSIM), peak signal-to-noise-ratio (PSNR), normalized mean-squared-error (nMSE), CMB counts, and line profiles were compared among magnitude, original SWI, and synthetic SWI images. Three blinded raters (J.E.V.M., M.A.M., B.B. with 8-, 6-, and 4-years of experience, respectively) independently rated and classified test-set images. STATISTICAL TESTS Kruskall-Wallis and Wilcoxon signed-rank tests were used to compare SSIM, PSNR, nMSE, and CMB counts among magnitude, original SWI, and predicted synthetic SWI images. Intraclass correlation assessed interrater variability. P values <0.005 were considered statistically significant. RESULTS SSIM values of the predicted vs. original SWI (0.972, 0.995, 0.9864) were statistically significantly higher than that of the magnitude vs. original SWI (0.970, 0.994, 0.9861) for whole brain, vascular structures, and brain tissue regions, respectively; 67% (19/28) CMBs detected on original SWI images were also detected on the predicted SWI, whereas only 10 (36%) were detected on magnitude images. Overall image quality was similar between the synthetic and original SWI images, with less artifacts on the former. CONCLUSIONS This study demonstrated that deep learning can increase the susceptibility contrast present in neurovasculature and CMBs on T2*-weighted magnitude images, without residual susceptibility-induced artifacts. This may be useful for more accurately estimating CMB burden from magnitude images alone. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ozan Genc
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Boğaziçi University, Istanbul, Turkey
| | - Melanie A. Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Javier Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, CA
| | | | - Christopher P. Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Neurology, University of California, San Francisco, CA
| | | | - Janine M. Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- UCSF/UC Berkeley Graduate Group of Bioengineering, University of California, Berkeley and San Francisco, CA
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Gruen RL, Mitra B, Bernard SA, McArthur CJ, Burns B, Gantner DC, Maegele M, Cameron PA, Dicker B, Forbes AB, Hurford S, Martin CA, Mazur SM, Medcalf RL, Murray LJ, Myles PS, Ng SJ, Pitt V, Rashford S, Reade MC, Swain AH, Trapani T, Young PJ. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med 2023; 389:127-136. [PMID: 37314244 DOI: 10.1056/nejmoa2215457] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain. METHODS We randomly assigned adults with major trauma who were at risk for trauma-induced coagulopathy to receive tranexamic acid (administered intravenously as a bolus dose of 1 g before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital) or matched placebo. The primary outcome was survival with a favorable functional outcome at 6 months after injury, as assessed with the use of the Glasgow Outcome Scale-Extended (GOS-E). Levels on the GOS-E range from 1 (death) to 8 ("upper good recovery" [no injury-related problems]). We defined survival with a favorable functional outcome as a GOS-E level of 5 ("lower moderate disability") or higher. Secondary outcomes included death from any cause within 28 days and within 6 months after injury. RESULTS A total of 1310 patients were recruited by 15 emergency medical services in Australia, New Zealand, and Germany. Of these patients, 661 were assigned to receive tranexamic acid, and 646 were assigned to receive placebo; the trial-group assignment was unknown for 3 patients. Survival with a favorable functional outcome at 6 months occurred in 307 of 572 patients (53.7%) in the tranexamic acid group and in 299 of 559 (53.5%) in the placebo group (risk ratio, 1.00; 95% confidence interval [CI], 0.90 to 1.12; P = 0.95). At 28 days after injury, 113 of 653 patients (17.3%) in the tranexamic acid group and 139 of 637 (21.8%) in the placebo group had died (risk ratio, 0.79; 95% CI, 0.63 to 0.99). By 6 months, 123 of 648 patients (19.0%) in the tranexamic acid group and 144 of 629 (22.9%) in the placebo group had died (risk ratio, 0.83; 95% CI, 0.67 to 1.03). The number of serious adverse events, including vascular occlusive events, did not differ meaningfully between the groups. CONCLUSIONS Among adults with major trauma and suspected trauma-induced coagulopathy who were being treated in advanced trauma systems, prehospital administration of tranexamic acid followed by an infusion over 8 hours did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. (Funded by the Australian National Health and Medical Research Council and others; PATCH-Trauma ClinicalTrials.gov number, NCT02187120.).
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Affiliation(s)
- Russell L Gruen
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Biswadev Mitra
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stephen A Bernard
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Colin J McArthur
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Brian Burns
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Dashiell C Gantner
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Marc Maegele
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Peter A Cameron
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Bridget Dicker
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Andrew B Forbes
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Sally Hurford
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Catherine A Martin
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stefan M Mazur
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Robert L Medcalf
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Lynnette J Murray
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Paul S Myles
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Sze J Ng
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Veronica Pitt
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Stephen Rashford
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Michael C Reade
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Andrew H Swain
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Tony Trapani
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
| | - Paul J Young
- From the College of Health and Medicine, Australian National University (R.L.G.), Canberra Health Services (R.L.G.), and Joint Health Command, Australian Defence Force (M.C.R.), Canberra, ACT, the Emergency and Trauma Centre (B.M., P.A.C.) and the Departments of Anaesthesiology and Perioperative Medicine (P.S.M.) and Intensive Care (S.A.B., D.C.G.), Alfred Hospital, the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine (D.C.G., L.J.M., S.J.N., T.T., P.J.Y.), the School of Public Health and Preventive Medicine (B.M., S.A.B., C.J.M., P.A.C., A.B.F., C.A.M., V.P.), the Australian Centre for Blood Diseases (R.L.M.), and the Central Clinical School (P.S.M.), Monash University, Ambulance Victoria (S.A.B.), and the Department of Critical Care, University of Melbourne (P.J.Y.), Melbourne, Aeromedical Operations, NSW Ambulance, Trauma Service, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney (B.B.), MedSTAR Emergency Medical Retrieval Services, South Australian Ambulance Service (S.M.M.), and the Emergency Department, Royal Adelaide Hospital (S.M.M.), Adelaide, SA, and Queensland Ambulance Service (S.R.) and the Faculty of Medicine, University of Queensland (M.C.R.), Brisbane - all in Australia; Te Toka Tumai Auckland City Hospital (C.J.M.), Hato Hone St. John, Mt. Wellington (B.D.), and the Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology (B.D., A.H.S.), Auckland, and Medical Research Institute of New Zealand (C.J.M., S.H., P.J.Y.), Wellington Free Ambulance (A.H.S.), and the Intensive Care Unit, Wellington Hospital (P.J.Y.), Wellington - all in New Zealand; Cologne-Merheim Medical Center, Department of Traumatology, Orthopedic Surgery, and Sports Medicine, and the Institute for Research in Operative Medicine, Witten-Herdecke University - both in Cologne, Germany (M.M.)
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Auerbach MA, Whitfill T, Montgomery E, Leung J, Kessler D, Gross IT, Walsh BM, Fiedor Hamilton M, Gawel M, Kant S, Janofsky S, Brown LL, Walls TA, Alletag M, Sessa A, Arteaga GM, Keilman A, Van Ittersum W, Rutman MS, Zaveri P, Good G, Schoen JC, Lavoie M, Mannenbach M, Bigham L, Dudas RA, Rutledge C, Okada PJ, Moegling M, Anderson I, Tay KY, Scherzer DJ, Vora S, Gaither S, Fenster D, Jones D, Aebersold M, Chatfield J, Knight L, Berg M, Makharashvili A, Katznelson J, Mathias E, Lutfi R, Abu-Sultaneh S, Burns B, Padlipsky P, Lee J, Butler L, Alander S, Thomas A, Bhatnagar A, Jafri FN, Crellin J, Abulebda K. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics 2023:e2022060790. [PMID: 37416979 DOI: 10.1542/peds.2022-060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.
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Affiliation(s)
| | | | - Erin Montgomery
- Indiana University School of Medicine, Indianapolis, Indiana
| | - James Leung
- McMaster University, Hamilton, Ontario, Canada
| | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Isabel T Gross
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Marcie Gawel
- Yale University School of Medicine, New Haven, Connecticut
| | - Shruti Kant
- University of California San Francisco, San Francisco, California
| | - Stephen Janofsky
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda L Brown
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Theresa A Walls
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Alletag
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Sessa
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Grace M Arteaga
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Ashley Keilman
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Maia S Rutman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Pavan Zaveri
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Grace Good
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Meghan Lavoie
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark Mannenbach
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | | | - Pamela J Okada
- University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Michelle Moegling
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Ingrid Anderson
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Khoon-Yen Tay
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Stacy Gaither
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel Fenster
- Columbia University Irving Medical Center, New York, New York
| | - Derick Jones
- Mayo Clinic Health System, Albert Lea and Austin, Minnesota
| | | | | | - Lynda Knight
- Stanford Medicine Children's Health, Palo Alto, California
| | - Marc Berg
- Stanford Medicine Children's Health, Palo Alto, California
| | | | | | | | - Riad Lutfi
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Brian Burns
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Jumie Lee
- The Lundquist Institute, Torrance, California
| | - Lucas Butler
- Virginia Mason Medical Center, Seattle, Washington
| | - Sarah Alander
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Anita Thomas
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | | | - Jason Crellin
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Kamal Abulebda
- Indiana University School of Medicine, Indianapolis, Indiana
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Thomas AA, Yoshida H, Keilman AE, Burns B, McDade J, Anderson T, Reid J. Gamification of a Low-Fidelity Paper Doll to Teach Primary Survey to Pediatric Residents. Cureus 2023; 15:e41996. [PMID: 37593309 PMCID: PMC10427884 DOI: 10.7759/cureus.41996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
When critically ill pediatric patients arrive in the emergency department (ED), a rapid physical evaluation is performed in order to systematically evaluate and address life-threatening conditions. This is commonly referred to as the primary survey. At our institution, pediatric residents are frequently tasked with this role, but they have limited training for or experience with this task. Quality improvement review of real resuscitation recordings at our institution revealed delays in initiation and incomplete primary surveys. We sought to utilize gamification to standardize and optimize reproducible training for the primary survey task for pediatric residents using a low-fidelity paper doll model simulation to improve primary survey performance in actual resuscitations.
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Affiliation(s)
- Anita A Thomas
- Pediatric Emergency Medicine, University of Washington, Seattle, USA
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Hiromi Yoshida
- Pediatric Emergency Medicine, University of Washington, Seattle, USA
| | - Ashley E Keilman
- Pediatric Emergency Medicine, Seattle Childrens Hospital, Seattle, USA
| | - Brian Burns
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Jessica McDade
- Pediatric Critical Care Medicine, University of Washington, Seattle, USA
| | - Tamar Anderson
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Jennifer Reid
- Pediatric Emergency Medicine, University of Washington Medical Center, Seattle, USA
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Hartford EA, Thomas AA, Kerwin O, Usoro E, Yoshida H, Burns B, Rutman LE, Migita R, Bradford M, Akhter S. Toward Improving Patient Equity in a Pediatric Emergency Department: A Framework for Implementation. Ann Emerg Med 2023; 81:385-392. [PMID: 36669917 DOI: 10.1016/j.annemergmed.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
Disparities in health care delivery and health outcomes for patients in the emergency department (ED) by race, ethnicity, and language for care (REaL) are common and well documented. Addressing inequities from structural racism, implicit bias, and language barriers can be challenging, and there is a lack of data on effective interventions. We describe the implementation of a multifaceted equity improvement strategy in a pediatric ED using Kotter's model for change as a framework to identify the key drivers. The main elements included a data dashboard with quality metrics stratified by patient self-reported REaL to visualize disparities, a staff workshop on implicit bias and microaggressions, and several clinical and operational tools that highlight equity. Our next steps include refining and repeating interventions and tracking important patient outcomes, including timely pain treatment, triage assessment, diagnostic evaluations, and interpreter use, with the overall goal of improving patient equity by REaL over time. This article presents a roadmap for a disparity reduction intervention, which can be part of a multifaceted approach to address health equity in EDs.
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Affiliation(s)
- Emily A Hartford
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA.
| | - Anita A Thomas
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Olivia Kerwin
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Etiowo Usoro
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Hiromi Yoshida
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Brian Burns
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Lori E Rutman
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Russell Migita
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | | | - Sabreen Akhter
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
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Sharwood LN, Martiniuk A, Sarrami Foroushani P, Seggie J, Wilson S, Hsu J, Burns B, Logan DB. Intentions and willingness to engage in risky driving behaviour among high school adolescents: evaluating the bstreetsmart road safety programme. Inj Prev 2023; 29:1-7. [PMID: 35961770 DOI: 10.1136/ip-2022-044571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/31/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the impact of a road safety programme on adolescents' willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest. METHOD The bstreetsmart is a road safety programme delivered to around 25 000 adolescent students annually in New South Wales. Using a smartphone-based app, student and teacher participation incentives, students were surveyed before and after programme attendance. Mixed-methods linear regression analysed pre/post-modified Behaviour of Young Novice Driver (BYNDS_M) scores. RESULTS 2360 and 1260 students completed pre-event and post-event surveys, respectively. Post-event BYNDS_M scores were around three points lower than pre-event scores (-2.99, 95% CI -3.418 to -2.466), indicating reduced intention to engage in risky driving behaviours. Covariates associated with higher stated intentions of risky driving were exposure to risky driving as a passenger (1.21, 95% CI 0.622 to 2.011) and identifying as non-binary gender (2.48, 95% CI 1.879 to 4.085), adjusting for other predictors. CONCLUSIONS Trauma-informed, reality-based injury prevention programmes can be effective in changing short-term stated intentions to engage in risky driving, among a pre-independent driving student population. The adolescent novice driver age group is historically challenging to engage, and injury prevention action must be multipronged to address the many factors influencing their behaviour.
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Affiliation(s)
- Lisa Nicole Sharwood
- John Walsh Centre for Rehabilitation Research, The University of Sydney-Camperdown and Darlington Campus, Sydney, New South Wales, Australia .,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - A Martiniuk
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pooria Sarrami Foroushani
- Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Warwick Farm, New South Wales, Australia
| | - Julie Seggie
- Trauma, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Jeremy Hsu
- Trauma, Westmead Hospital, Westmead, New South Wales, Australia
| | - Brian Burns
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,GSA-HEMS Research, Helicopter Emergency Medical Service, SWSLHD, Sydney, New South Wales, Australia
| | - David Bruce Logan
- Road Safety Programs, Monash University Accident Research Centre, Clayton, Victoria, Australia
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11
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Song C, Dennis M, Burns B, Dyson S, Forrest P, Ramanan M, Levinson D, Moylan E. Improving access to extracorporeal membrane oxygenation for out of hospital cardiac arrest: pre-hospital ECPR and alternate delivery strategies. Scand J Trauma Resusc Emerg Med 2022; 30:77. [PMID: 36566221 DOI: 10.1186/s13049-022-01064-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) patients is usually implemented in-hospital. As survival in ECPR patients is critically time-dependent, alternative models in ECPR delivery could improve equity of access. OBJECTIVES To identify the best strategy of ECPR delivery to provide optimal patient access, to examine the time-sensitivity of ECPR on predicted survival and to model potential survival benefits from different delivery strategies of ECPR. METHODS We used transport accessibility frameworks supported by comprehensive travel time data, population density data and empirical cardiac arrest time points to quantify the patient catchment areas of the existing in-hospital ECPR service and two alternative ECPR strategies: rendezvous strategy and pre-hospital ECPR in Sydney, Australia. Published survival rates at different time points to ECMO flow were applied to predict the potential survival benefit. RESULTS With an in-hospital ECPR strategy for refractory OHCA, five hospitals in Sydney (Australia) had an effective catchment of 811,091 potential patients. This increases to 2,175,096 under a rendezvous strategy and 3,851,727 under the optimal pre-hospital strategy. Assuming earlier provision of ECMO flow, expected survival for eligible arrests will increase by nearly 6% with the rendezvous strategy and approximately 26% with pre-hospital ECPR when compared to the existing in-hospital strategy. CONCLUSION In-hospital ECPR provides the least equitable access to ECPR. Rendezvous and pre-hospital ECPR models substantially increased the catchment of eligible OHCA patients. Traffic and spatial modelling may provide a mechanism to design appropriate ECPR service delivery strategies and should be tested through clinical trials.
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Affiliation(s)
- Changle Song
- School of Civil Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mark Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brian Burns
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NSW Ambulance, Sydney, Australia
| | | | - Paul Forrest
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mahesh Ramanan
- Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - David Levinson
- School of Civil Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Emily Moylan
- School of Civil Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.
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12
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Bluemke E, Bertrand A, Chu KY, Syed N, Murchison AG, Cooke R, Greenhalgh T, Burns B, Craig M, Taylor N, Shah K, Gleeson F, Bulte D. Oxygen-enhanced MRI and radiotherapy in patients with oropharyngeal squamous cell carcinoma. Clin Transl Radiat Oncol 2022; 39:100563. [PMID: 36655119 PMCID: PMC9841018 DOI: 10.1016/j.ctro.2022.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background and purpose This study aimed to assess the role of T1 mapping and oxygen-enhanced MRI in patients undergoing radical dose radiotherapy for HPV positive oropharyngeal cancer, which has not yet been examined in an OE-MRI study. Materials and methods Variable Flip Angle T1 maps were acquired on a 3T MRI scanner while patients (n = 12) breathed air and/or 100 % oxygen, before and after fraction 10 of the planned 30 fractions of chemoradiotherapy ('visit 1' and 'visit 2', respectively). The analysis aimed to assess to what extent (1) native R1 relates to patient outcome; (2) OE-MRI response relates to patient outcome; (3) changes in mean R1 before and after radiotherapy related to clinical outcome in patients with oropharyngeal squamous cell carcinoma. Results Due to the radiotherapy being largely successful, the sample sizes of non-responder groups were small, and therefore it was not possible to properly assess the predictive nature of OE-MRI. The tumour R1 increased in some patients while decreasing in others, in a pattern that was overall consistent with the underlying OE-MRI theory and previously reported tumour OE-MRI responses. In addition, we discuss some practical challenges faced when integrating this technique into a clinical trial, with the aim that sharing this is helpful to researchers planning to use OE-MRI in future clinical studies. Conclusion Altogether, these results suggest that further clinical OE-MRI studies to assess hypoxia and radiotherapy response are worth pursuing, and that there is important work to be done to improve the robustness of the OE-MRI technique in human applications in order for it to be useful as a widespread clinical technique.
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Affiliation(s)
- Emma Bluemke
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK,Corresponding author at: Old Road Campus Research Building, University of Oxford, Headington, Oxford OX3 7DQ, UK.
| | - Ambre Bertrand
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Kwun-Ye Chu
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Nigar Syed
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK
| | - Andrew G. Murchison
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Rosie Cooke
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Tessa Greenhalgh
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,University Hospital Southampton NHS Foundation Trust, UK
| | | | | | - Nia Taylor
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Ketan Shah
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Fergus Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Daniel Bulte
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
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13
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Barbosa AD, Long M, Lee W, Austen JM, Cunneen M, Ratchford A, Burns B, Kumarasinghe P, Ben-Othman R, Kollmann TR, Stewart CR, Beaman M, Parry R, Hall R, Tabor A, O’Donovan J, Faddy HM, Collins M, Cheng AC, Stenos J, Graves S, Oskam CL, Ryan UM, Irwin PJ. The Troublesome Ticks Research Protocol: Developing a Comprehensive, Multidiscipline Research Plan for Investigating Human Tick-Associated Disease in Australia. Pathogens 2022; 11:1290. [PMID: 36365042 PMCID: PMC9694322 DOI: 10.3390/pathogens11111290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/23/2022] [Accepted: 11/02/2022] [Indexed: 10/28/2023] Open
Abstract
In Australia, there is a paucity of data about the extent and impact of zoonotic tick-related illnesses. Even less is understood about a multifaceted illness referred to as Debilitating Symptom Complexes Attributed to Ticks (DSCATT). Here, we describe a research plan for investigating the aetiology, pathophysiology, and clinical outcomes of human tick-associated disease in Australia. Our approach focuses on the transmission of potential pathogens and the immunological responses of the patient after a tick bite. The protocol is strengthened by prospective data collection, the recruitment of two external matched control groups, and sophisticated integrative data analysis which, collectively, will allow the robust demonstration of associations between a tick bite and the development of clinical and pathological abnormalities. Various laboratory analyses are performed including metagenomics to investigate the potential transmission of bacteria, protozoa and/or viruses during tick bite. In addition, multi-omics technology is applied to investigate links between host immune responses and potential infectious and non-infectious disease causations. Psychometric profiling is also used to investigate whether psychological attributes influence symptom development. This research will fill important knowledge gaps about tick-borne diseases. Ultimately, we hope the results will promote improved diagnostic outcomes, and inform the safe management and treatment of patients bitten by ticks in Australia.
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Affiliation(s)
- Amanda D. Barbosa
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
- CAPES Foundation, Ministry of Education of Brazil, Brasilia 70040-020, DF, Brazil
| | - Michelle Long
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC 3220, Australia
| | - Wenna Lee
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - Jill M. Austen
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - Mike Cunneen
- The App Workshop Pty Ltd., Perth, WA 6000, Australia
| | - Andrew Ratchford
- Emergency Department, Northern Beaches Hospital, Sydney, NSW 2086, Australia
- School of Medicine, Macquarie University, Sydney, NSW 2109, Australia
| | - Brian Burns
- Emergency Department, Northern Beaches Hospital, Sydney, NSW 2086, Australia
- Sydney Medical School, Sydney University, Camperdown, NSW 2006, Australia
| | - Prasad Kumarasinghe
- School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
- College of Science, Health, Education and Engineering, Murdoch University, Murdoch, WA 6150, Australia
- Western Dermatology, Hollywood Medical Centre, Nedlands, WA 6009, Australia
| | | | | | - Cameron R. Stewart
- CSIRO Health & Biosecurity, Australian Centre for Disease Preparedness, Geelong, VIC 3220, Australia
| | - Miles Beaman
- PathWest Laboratory Medicine, Murdoch, WA 6150, Australia
- Pathology and Laboratory Medicine, Medical School, University of Western Australia, Crawley, WA 6009, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Rhys Parry
- School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Roy Hall
- School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, QLD 4072, Australia
- Australian Infectious Diseases Research Centre, Global Virus Network Centre of Excellence, Brisbane, QLD 4072, Australia
| | - Ala Tabor
- Queensland Alliance for Agriculture and Food Innovation, Centre of Animal Science, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Justine O’Donovan
- Clinical Services and Research, Australian Red Cross Lifeblood, Sydney, NSW 2015, Australia
| | - Helen M. Faddy
- Clinical Services and Research, Australian Red Cross Lifeblood, Sydney, NSW 2015, Australia
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD 4502, Australia
| | - Marjorie Collins
- School of Psychology, Murdoch University, Murdoch, WA 6150, Australia
| | - Allen C. Cheng
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC 3004, Australia
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC 3220, Australia
| | - Stephen Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC 3220, Australia
| | - Charlotte L. Oskam
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - Una M. Ryan
- Health Futures Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - Peter J. Irwin
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
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14
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Ferguson I, Buttfield A, Burns B, Reid C, Shepherd S, Milligan J, Harris IA, Aneman A. Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study-A randomized clinical trial. Acad Emerg Med 2022; 29:719-728. [PMID: 35064992 PMCID: PMC9314707 DOI: 10.1111/acem.14446] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/30/2021] [Accepted: 01/10/2022] [Indexed: 01/21/2023]
Abstract
Objective The objective was to determine whether the use of fentanyl with ketamine for emergency department (ED) rapid sequence intubation (RSI) results in fewer patients with systolic blood pressure (SBP) measurements outside the pre‐specified target range of 100–150 mm Hg following the induction of anesthesia. Methods This study was conducted in the ED of five Australian hospitals. A total of 290 participants were randomized to receive either fentanyl or 0.9% saline (placebo) in combination with ketamine and rocuronium, according to a weight‐based dosing schedule. The primary outcome was the proportion of patients in each group with at least one SBP measurement outside the prespecified range of 100–150 mm Hg (with adjustment for baseline abnormality). Secondary outcomes included first‐pass intubation success, hypotension, hypertension and hypoxia, mortality, and ventilator‐free days 30 days following enrollment. Results A total of 142 in the fentanyl group and 148 in the placebo group commenced the protocol. A total of 66% of patients receiving fentanyl and 65% of patients receiving placebo met the primary outcome (difference = 1%, 95% CI = −10 to 12). Hypotension (SBP ≤ 99 mm Hg) was more common with fentanyl (29% vs. 16%; difference = 13%, 95% CI = 3% to 23%), while hypertension (≥150 mm Hg) occurred more with placebo (69% vs. 55%; difference = 14%, 95% CI = 3 to 24). First‐pass success rate, 30 day mortality, and ventilator‐free days were similar. Conclusions and Relevance There was no difference in the primary outcome between groups, although lower blood pressures were more common with fentanyl. Clinicians should consider baseline hemodynamics and postinduction targets when deciding whether to use fentanyl as a coinduction agent with ketamine.
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Affiliation(s)
- Ian Ferguson
- South West Clinical School University of New South Wales Sydney New South Wales Australia
- Emergency Department Liverpool Hospital Sydney New South Wales Australia
- GSA‐HEMS, NSW Ambulance Bankstown Aerodrome Sydney New South Wales Australia
| | - Alexander Buttfield
- University of Western Sydney Sydney New South Wales Australia
- Campbelltown Hospital Sydney New South Wales Australia
| | - Brian Burns
- GSA‐HEMS, NSW Ambulance Bankstown Aerodrome Sydney New South Wales Australia
- University of Sydney, Discipline of Emergency Medicine Sydney New South Wales Australia
- Northern Beaches Hospital Sydney New South Wales Australia
| | - Cliff Reid
- GSA‐HEMS, NSW Ambulance Bankstown Aerodrome Sydney New South Wales Australia
- University of Sydney, Discipline of Emergency Medicine Sydney New South Wales Australia
- Northern Beaches Hospital Sydney New South Wales Australia
| | - Shamus Shepherd
- Orange Health Service Orange New South Wales Australia
- University of New South Wales Rural Clinical School Orange New South Wales Australia
| | - James Milligan
- Royal North Shore Hospital, St Leonards Sydney New South Wales Australia
- CareFlight Ltd Sydney New South Wales Australia
| | - Ian A. Harris
- South West Clinical School University of New South Wales Sydney New South Wales Australia
- Ingham Institute for Applied Medical Research Liverpool New South Wales Australia
| | - Anders Aneman
- South West Clinical School University of New South Wales Sydney New South Wales Australia
- Intensive Care Unit, Liverpool Hospital Liverpool New South Wales Australia
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15
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Burns B, Dinh M, Holland AJ. Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia. Injury 2022; 53:61-68. [PMID: 33632604 DOI: 10.1016/j.injury.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. METHODS This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry. RESULTS There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ2(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)]. CONCLUSION Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; George Institute for Global Health, King St, Newtown, NSW, Australia.
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Mary K Lam
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia; The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Michael Dinh
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia
| | - Andrew Ja Holland
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
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16
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Tunc EM, Burns B, Brennan K, Yoshida H, Burns R. Nitrous Oxide Sedation Asynchronous Curriculum for Pediatric Emergency Medicine Providers. Cureus 2021; 13:e18949. [PMID: 34853733 PMCID: PMC8607845 DOI: 10.7759/cureus.18949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
This technical report describes a nitrous oxide sedation training curriculum for pediatric emergency medicine providers. This curriculum was used during the novel coronavirus disease 2019 (COVID-19) pandemic where in-person classroom training was significantly limited. We demonstrate a model for concept and equipment learning with video-guided self-practice in place of in-person training with a facilitator. A similar model can be utilized for other equipment or concept training.
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Affiliation(s)
- Emine M Tunc
- Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, USA
| | - Brian Burns
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Kelly Brennan
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Hiromi Yoshida
- Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rebekah Burns
- Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, USA
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17
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Partyka C, Coggins A, Bliss J, Burns B, Fiorentino M, Goorkiz P, Miller M. A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service. Emerg Radiol 2021; 29:299-306. [PMID: 34817706 DOI: 10.1007/s10140-021-02002-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians. METHODS Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician's interpretations of these ultrasounds were compared to gold standard references of CT imaging or operating room findings. The outcomes measured include the calculated accuracy of eFAST for detecting intraperitoneal free fluid (IPFF), pneumothorax, hemothorax, and pericardial fluid compared to available gold standard results. RESULTS Of the 411 patients with adequate data for comparison, the median age was 39.5 years with 73% male and 98% sustaining blunt force trauma. For the detection of IPFF, eFAST had a sensitivity of 25% (95% CI 16-36%) and specificity of 96% (95% CI 93-98%). Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), hemothorax (17% and 97% respectively), and pericardial effusion (17% and 100% respectively). These results did not change significantly when reassessed with several sensitivity analyses. CONCLUSION Prehospital eFAST is reliable for detecting the presence of intraperitoneal free fluid. This finding should inform receiving trauma teams to prepare for early definitive care in these patients. The low sensitivities across all components of the eFAST highlight the importance of cautiously interpreting negative studies while prompting the need for further studies. TRIAL REGISTRATION ACTRN12618001973202 (Registered on 06/12/2018).
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Affiliation(s)
- Christopher Partyka
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia. .,Emergency Department, Liverpool Hospital, Liverpool, NSW, Australia. .,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.
| | - Andrew Coggins
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Jimmy Bliss
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia.,Emergency Department, Liverpool Hospital, Liverpool, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Burns
- Sydney Medical School, University of Sydney, Sydney, Australia.,GSA-HEMS, NSW Ambulance, Blacktown, NSW, Australia
| | | | - Pierre Goorkiz
- Intensive Care Unit, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Matthew Miller
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia.,UNSW St George and Sutherland Clinical Schools, Kogarah, Australia
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18
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Mitchell RJ, Harris IA, Balogh ZJ, Curtis K, Burns B, Seppelt I, Brown J, Sarrami P, Singh H, Levesque JF, Dinh M. Determinants of long-term unplanned readmission and mortality following self-inflicted and non-self-inflicted major injury: a retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:2145-2156. [PMID: 34792610 DOI: 10.1007/s00068-021-01837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the characteristics of major injury and identify determinants of long-term unplanned readmission and mortality after self-inflicted and non-self-inflicted injury to inform potential readmission screening. METHOD A retrospective cohort study of 11,269 individuals aged ≥ 15 years hospitalised for a major injury during 2013-2017 in New South Wales, Australia. Unplanned readmission and mortality up to 27-month post-injury were examined. Logistic regression was used to examine predictors of unplanned readmission. RESULTS During the 27-month follow-up, 2700 (24.8%) individuals with non-self-inflicted and 98 (26.1%) with self-inflicted injuries had an unplanned readmission. Individuals with an anxiety-related disorder and a non-self-inflicted injury who were discharged home were three times more likely (OR: 3.27; 95%CI 2.28-4.69) or if they were discharged to a psychiatric facility were four times more likely (OR: 4.11; 95%CI 1.07-15.80) to be readmitted. Compared to individuals aged 15-24 years, individuals aged ≥ 65 years were 3 times more likely to be readmitted (OR 3.12; 95%CI 2.62-3.70). Individuals with one (OR 1.60; 95%CI 1.39-1.84) or ≥ 2 (OR 1.88; 95%CI 1.52-2.32) comorbidities, or who had a drug-related dependence (OR 1.88; 95%CI 1.52-2.31) were more likely to be readmitted. The post-discharge age-adjusted mortality rate following a self-inflicted injury (35.6%; 95%CI 29.9-41.8) was higher than for individuals with a non-self-inflicted injury (11.0%; 95%CI 10.4-11.8). CONCLUSIONS Unplanned readmission after injury is associated with injury intent, age, and comorbid health. Screening for anxiety and drug-related dependence after major injury, accompanied by service referrals and post-discharge follow-up, has potential to prevent readmission.
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Affiliation(s)
- Rebecca J Mitchell
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Ian A Harris
- South Western Sydney Clinical School, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales, Kensington, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Callaghan, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | - Brian Burns
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian Seppelt
- Nepean Hospital and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Brown
- The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | - Pooria Sarrami
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), St Leonards, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Hardeep Singh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), St Leonards, Australia
| | - Jean-Frederic Levesque
- NSW Agency for Clinical Innovation (ACI), St Leonards, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Kensington, Australia
| | - Michael Dinh
- NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), St Leonards, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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19
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Curtis K, Holland AJ, Black D, Burns B, Mitchell RJ, Dinh M, Kennedy B, Lam MK. Response to Letter to the Editor from Carmo et al. re Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia. Injury 2021; 52:2486-2487. [PMID: 33865605 DOI: 10.1016/j.injury.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; George Institute for Global Health, King St, Newtown, NSW, Australia.
| | - Andrew Ja Holland
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Brian Burns
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Michael Dinh
- The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia
| | - Mary K Lam
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, The University of Sydney, NSW 2006, Australia
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20
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Burns B, Dinh M, Smith H, Holland AJ. Emergency department management of severely injured children in New South Wales. Emerg Med Australas 2021; 33:1066-1073. [PMID: 34105264 DOI: 10.1111/1742-6723.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.6% in children with major injury. Little is known about the care and interventions received by children presenting to Australian EDs with major injury. METHODS The ED care of injured children <16 years who ultimately received definitive care at a New South Wales Paediatric Trauma Centre between July 2015 and September 2016, and had an Injury Severity Score ≥9, required intensive care admission or died were included. RESULTS There were 491 injured children who received treatment at 64 EDs, half (49.4%, n = 243) were treated initially in a Paediatric Trauma Centre. One third (32.8%) sustained an Injury Severity Score >12, more than half (n = 251, 51.1%) of children were classified as a triage category 1 or 2, and 38.3% received trauma team activation. Critical intervention was infrequent. Intubation was documented in 9.2% (n = 45), needle thoracostomy and activation of massive transfusion protocol in two (0.4%) and eight (1.6%) had intraosseous access established. Only a small proportion (14.7%, n = 63) had two or more observations outside the normal range. CONCLUSION A small proportion of children arriving in the ED post-major trauma have deranged clinical observations and receive critical interventions. The limited exposure in the management of trauma in paediatric patients requires measures to ensure clinicians have adequate training, skills and confidence to manage these clinical presentations in all EDs.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary K Lam
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brian Burns
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Greater Sydney Area HEMS, NSW Ambulance, Sydney, New South Wales, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Holly Smith
- Paediatric Emergency, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew Ja Holland
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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21
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Keilman AE, Umoren R, Lo M, Roberts J, Yoshida H, Hartford E, Patrao F, Burns B, Fenstermacher S, Masse E, Reid J. Virtual protective equipment: paediatric resuscitation in the COVID-19
era. BMJ Simul Technol Enhanc Learn 2021; 7:169-170. [PMID: 35518557 PMCID: PMC8936725 DOI: 10.1136/bmjstel-2020-000658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ashley Elizabeth Keilman
- Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel Umoren
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark Lo
- Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Roberts
- Pediatrics, Division of Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hiromi Yoshida
- Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Emily Hartford
- Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Fiona Patrao
- Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brian Burns
- Emergency Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sara Fenstermacher
- Emergency Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elizabeth Masse
- Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jennifer Reid
- Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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22
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Mitra B, Bernard S, Gantner D, Burns B, Reade MC, Murray L, Trapani T, Pitt V, McArthur C, Forbes A, Maegele M, Gruen RL. Protocol for a multicentre prehospital randomised controlled trial investigating tranexamic acid in severe trauma: the PATCH-Trauma trial. BMJ Open 2021; 11:e046522. [PMID: 33722875 PMCID: PMC7970250 DOI: 10.1136/bmjopen-2020-046522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ineffective or harmful. The effectiveness of prehospital TXA, incidence of thrombotic complications, benefit versus risk in advanced trauma systems and the mechanism of benefit remain uncertain. METHODS AND ANALYSIS The Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (The PATCH-Trauma study) is comparing TXA, initiated prehospital and continued in hospital over 8 hours, with placebo in patients with severe trauma at risk of acute traumatic coagulopathy. We present the trial protocol and an overview of the statistical analysis plan. There will be 1316 patients recruited by prehospital clinicians in Australia, New Zealand and Germany. The primary outcome will be the eight-level Glasgow Outcome Scale Extended (GOSE) at 6 months after injury, dichotomised to favourable (GOSE 5-8) and unfavourable (GOSE 1-4) outcomes, analysed using an intention-to-treat (ITT) approach. Secondary outcomes will include mortality at hospital discharge and at 6 months, blood product usage, quality of life and the incidence of predefined adverse events. ETHICS AND DISSEMINATION The study was approved by The Alfred Hospital Research and Ethics Committee in Victoria and also approved in New South Wales, Queensland, South Australia, Tasmania and the Northern Territory. In New Zealand, Northern A Health and Disability Ethics Committee provided approval. In Germany, Witten/Herdecke University has provided ethics approval. The PATCH-Trauma study aims to provide definitive evidence of the effectiveness of prehospital TXA, when used in conjunction with current advanced trauma care, in improving outcomes after severe injury. TRIAL REGISTRATION NUMBER NCT02187120.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Dashiell Gantner
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney University, Sydney, New South Wales, Australia
| | - Michael C Reade
- Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lynnette Murray
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Tony Trapani
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Veronica Pitt
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Colin McArthur
- Critical Care Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Marc Maegele
- Cologne Merheim Medical Center, Department of Traumatology, Othopedic Surgery and Sportsmedicine, University of Witten/Herdecke, Cologne, Germany
- Institute for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Peden AE, Sarrami P, Dinh M, Lassen C, Hall B, Alkhouri H, Daniel L, Burns B. Description and prediction of outcome of drowning patients in New South Wales, Australia: protocol for a data linkage study. BMJ Open 2021; 11:e042489. [PMID: 33452197 PMCID: PMC7813289 DOI: 10.1136/bmjopen-2020-042489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Despite being a preventable cause of death, drowning is a global public health threat. Australia records an average of 288 unintentional drowning deaths per year; an estimated annual economic burden of $1.24 billion AUD ($2017). On average, a further 712 hospitalisations occur due to non-fatal drowning annually. The Australian state of New South Wales (NSW) is the most populous and accounts for 34% of the average fatal drowning burden. This study aims to explore the demographics and outcome of patients who are admitted to hospitals for drowning in NSW and also investigates prediction of patients' outcome based on accessible data. METHODS AND ANALYSIS This protocol describes a retrospective, cross-sectional data linkage study across secondary data sources for any person (adult or paediatric) who was transferred by NSW Ambulance services and/or admitted to a NSW hospital for fatal or non-fatal drowning between 1/1/2010 and 31/12/2019. The NSW Admitted Patient Data Collection will provide data on admitted patients' characteristics and provided care in NSW hospitals. In order to map patients' pathways of care, data will be linked with NSW Ambulance Data Collection and the NSW Emergency Department Data Collection. Finally patient's mortality will be assessed via linkage with NSW Mortality data, which is made up of the NSW Register of Births, Deaths and Marriages and a Cause of Death Unit Record File. Regression analyses will be used to identify predicting values of independent variables with study outcomes. ETHICS AND DISSEMINATION This study has been approved by the NSW Population & Health Services Research Ethics Committee. Results will be disseminated through peer-reviewed publications, mass media releases and at academic conferences. The study will provide outcome data for drowning patients across NSW and study results will provide data to deliver evidence-informed recommendations for improving patient care, including updating relevant guidelines.
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Affiliation(s)
- Amy E Peden
- School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Pooria Sarrami
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Christine Lassen
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Benjamin Hall
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lovana Daniel
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Burns
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- Greater Sydney Area Helicopter, Emergency Medical Service, NSW Ambulance, Sydney, New South Wales, Australia
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Shand S, Curtis K, Dinh M, Burns B. Retrieval transfusion protocol in New South Wales, Australia: A retrospective review of the first 5 years. Transfusion 2020; 61:730-737. [PMID: 33615494 DOI: 10.1111/trf.16217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ambulance service blood transfusion is an area of rapid development. In New South Wales, Australia, the blood products carried by ambulance medical teams are often the first available to patients with critical bleeding. In addition to the blood products routinely carried by these teams, the Service created and implemented a method of initiating large-volume, mixed-product transfusions using existing blood banks: the Retrieval Transfusion Procedure (RTP). This article describes the trends and characteristics of New South Wales Ambulance RTP activations. MATERIALS AND METHODS This retrospective database review examines the patient records for all RTP activations. Key areas of investigation include logistics, product requests, population demographics, etiologies, physiology, mission timings, and transfusions. RESULTS Ambulance medical teams attended 27 531 missions in the reviewed period, 1573 patients received transfusion, and there were 138 RTP activations. Blood products were sourced from 40 banks and transported by police (46.7%), ambulance (27.1%), and helicopter (13.0%) to refueling stops (39.2%), prehospital scenes (24.2%) and hospitals (15.8%). The median time engaged on each mission was 189 minutes for metropolitan and 222 minutes for rural locations. Seventy-eight patients were transfused with RTP blood products; 83.3% were traumas, of which 63.1% were motor vehicle collisions. Up to 18 units of blood products were administered before hospital arrival. There was significant (P < .001) improvement in the mean shock index of transfused patients between the first and final observations recorded. CONCLUSIONS Ambulance service extended blood product transfusion is logistically achievable and facilitates emergency transfusions throughout the state with minimal additional infrastructure.
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Affiliation(s)
- Sophie Shand
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Ambulance Centre, NSW Ambulance, Eveleigh, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Illawara Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Michael Dinh
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Institute of Trauma and Injury Management, Chatswood, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Brian Burns
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Greater Sydney Area HEMS, NSW Ambulance, Rozelle, New South Wales, Australia
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25
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Burns B, Loudfoot A, Tall G, Dinh M, Beech C, Holland AJA. Prehospital care and transport costs of severely injured children in NSW Australia. Injury 2020; 51:2581-2587. [PMID: 32843148 DOI: 10.1016/j.injury.2020.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injury is the leading cause of childhood death and disability in Australia. Prehospital emergency services in New South Wales (NSW) are provided by NSW Ambulance. The incidence, pre-hospital care provided and outcomes of children suffering major injury in NSW has not previously been described. METHODS This retrospective study was conducted between July 2015 and September 2016 and included children <16 years with an injury severity score (ISS) >9, or requiring intensive care admission, or deceased following injury and treated in NSW. Children were identified through the three NSW Paediatric Trauma Centres, the NSW Trauma Registry, NSW Medical Retrieval Registry (AirMaestro, Avinet, Australia). RESULTS There were 359 majorly injured children treated by NSW-based emergency service providers, the majority were male (73.3%) with a mean (SD) age of 8.0 (5.2) years. The median (IQR) injury severity score (ISS) for those transported via NSW emergency medical services was 10 (9-17), with almost half (44.1%) treated prehospital having an ISS >12. The most common documented interventions were intravenous access (44.1%) and oxygen therapy (39.6%). Intubation and chest decompression were recorded in 15.3% and 3.1% of cases respectively. The calculated median (IQR) transport charges for NSW Emergency Services was AUD $942 ($841.3-$1184.6). CONCLUSION Critical interventions are performed infrequently in children with major injuries in the pre-hospital environment. The monitoring of the incidence and success rates for staff performing these interventions is not readily available from all prehospital emergency medical services operating in NSW. The capacity and processes to monitor and audit all critical interventions in the paediatric population should be resourced and clearly defined.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia.
| | - Mary K Lam
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia
| | - Allan Loudfoot
- NSW Ambulance, Locked bag 105, Rozelle NSW 2039, Australia
| | - Gary Tall
- Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management (ITIM), Agency for Clinical Innovation, Level 4/67 Albert Ave, Chatswood NSW 2067, Australia
| | - Clare Beech
- NSW Ambulance, Locked bag 105, Rozelle NSW 2039, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
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Curtis K, Kennedy B, Lam MK, Mitchell RJ, Black D, Burns B, White L, Loudfoot A, D'Amato A, Dinh M, Holland AJA. Cause, treatment costs and 12-month functional outcomes of children with major injury in NSW, Australia. Injury 2020; 51:2066-2075. [PMID: 32471685 DOI: 10.1016/j.injury.2020.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW. METHODS A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y. RESULTS There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p=<0.001) and polytrauma (p=<0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. CONCLUSION Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, MO2 88 Mallett St, NSW 2006, Australia.
| | - Mary K Lam
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Deborah Black
- Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia
| | - Leslie White
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia
| | - Allan Loudfoot
- NSW Ambulance, Locked bag 105, Rozelle NSW 2039, Australia
| | - Alfa D'Amato
- System Financial Performance and Deputy CFO, NSW Ministry of Health; UTS Business School, Sydney, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management (ITIM), Agency for Clinical Innovation, Level 4/67 Albert Ave, Chatswood NSW 2067, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
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27
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Varma G, Munsch F, Burns B, Duhamel G, Girard OM, Guidon A, Lebel RM, Alsop DC. Three-dimensional inhomogeneous magnetization transfer with rapid gradient-echo (3D ihMTRAGE) imaging. Magn Reson Med 2020; 84:2964-2980. [PMID: 32602958 DOI: 10.1002/mrm.28324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To demonstrate the feasibility of integrating the magnetization transfer (MT) preparations required for inhomogeneous MT (ihMT) within an MPRAGE-style acquisition. Such a sequence allows for reduced power deposition and easy inclusion of other modules. METHODS An ihMT MPRAGE-style sequence (ihMTRAGE) was initially simulated to investigate acquisition of the 3D ihMT data sequentially, or in an interleaved manner. The ihMTRAGE sequence was implemented on a 3T clinical scanner to acquire ihMT data from the brain and spine. RESULTS Both simulations and in vivo data provided an ihMT signal that was significantly greater using a sequential ihMTRAGE acquisition, compared with an interleaved implementation. Comparison with a steady-state ihMT acquisition (defined as having one MT RF pulse between successive acquisition modules) demonstrated how ihMTRAGE allows for a reduction in average power deposition, or greater ihMT signal at equal average power deposition. Inclusion of a prospective motion-correction module did not significantly affect the ihMT signal obtained from regions of interest in the brain. The ihMTRAGE acquisition allowed combination with a spatial saturation module to reduce phase wrap artifacts in a cervical spinal cord acquisition. CONCLUSIONS Use of preparations necessary for ihMT experiments within an MPRAGE-style sequence provides a useful alternative for acquiring 3D ihMT data. Compared with our steady-state implementation, ihMTRAGE provided reduced power deposition, while allowing use of the maximum intensity from off-resonance RF pulses. The 3D ihMTRAGE acquisition allowed combination of other modules with the preparation necessary for ihMT experiments, specifically motion compensation and spatial saturation modules.
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Affiliation(s)
- Gopal Varma
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Fanny Munsch
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | - David C Alsop
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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28
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Shand S, Curtis K, Dinh M, Burns B. Prehospital Blood Transfusion in New South Wales, Australia: A Retrospective Cohort Study. PREHOSP EMERG CARE 2020; 25:404-411. [DOI: 10.1080/10903127.2020.1769781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Curtis K, Kennedy B, Holland AJ, Mitchell RJ, Tall G, Smith H, Soundappan SS, Loudfoot A, Burns B, Dinh M. Determining the priorities for change in paediatric trauma care delivery in NSW, Australia. Australas Emerg Care 2020; 23:97-104. [DOI: 10.1016/j.auec.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022]
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Abstract
Disasters such as earthquakes can interrupt healthcare delivery by forcing the evacuation of intensive care patients. Critically ill neonates are particularly vulnerable due to their complexity and thus can be difficult to safely and efficiently evacuate in a disaster. In general, most education surrounding this is based on lectures. This technical report describes the creation and use of a simulation-based curriculum focusing on the evacuation of a critically ill, septic neonate by a single nurse participant in the setting of an earthquake. This simulation provides learners the experience of expediently assessing safety in the setting of a disaster and prioritizing equipment when evacuating a critically ill neonate, which may provide a more realistic training environment than traditional lectures.
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Affiliation(s)
- Anita Thomas
- Pediatrics, Seattle Children's Hospital, Seattle, USA
| | - Megan M Gray
- Neonatology, Seattle Children's Hospital, Seattle, USA
| | - Brian Burns
- Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, USA
| | - Rachel Umoren
- Pediatrics, University of Washington School of Medicine, Seattle, USA
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Keilman A, Reid J, Thomas A, Uspal N, Stone K, Beardsley E, Burns B, Burns R. Enhancing paediatric resuscitation team performance: targeted simulation-based team leader training. BMJ Simul Technol Enhanc Learn 2020; 7:44-46. [DOI: 10.1136/bmjstel-2019-000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022]
Abstract
Effective team leadership is linked to improved resuscitation outcomes. Previous studies have focused primarily on trainee performance and simulation-based outcomes. We hypothesised that a targeted simulation-based educational intervention for experienced physicians focusing on specific process and communication goals would result in improved performance during actual resuscitations. We conducted an observational pilot study evaluating specific process metrics during clinical resuscitations before and after a 1-hour training intervention for paediatric emergency medicine (PEM) supervising physicians using rapid cycle deliberate practice simulation-based training. Videos of clinical resuscitations from before and after the intervention were retrospectively reviewed to assess time to patient transfer to emergency department stretcher, time to primary assessment and time to team leader summary statement. Between March and July 2018, 21/38 of PEM supervising physicians participated in a training session. After the intervention period, clinical resuscitation teams showed significant improvements in targeted process metrics: transfer of patient within 1 min (79% vs 100%, p=0.03), assessment completed within 3 min (28% vs 75%, p=0.01) and summary statement within 5 min (50% to 85%, p=0.03). Brief, focused simulation-based team leader training can improve the teamwork and communication performance of experienced clinicians during clinical resuscitations.
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Abstract
The use of extracorporeal cardiopulmonary resuscitation (E‐CPR) for the treatment of patients with out‐of‐hospital cardiac arrest who do not respond to conventional cardiopulmonary resuscitation CPR) has increased significantly in the past 10 years, in response to case reports and observational studies reporting encouraging results. However, no randomized controlled trials comparing E‐CPR with conventional CPR have been published to date. The evidence from systematic reviews of the available observational studies is conflicting. The inclusion criteria for published E‐CPR studies are variable, but most commonly include witnessed arrest, immediate bystander CPR, an initial shockable rhythm, and an estimated time from CPR start to establishment of E‐CPR (low‐flow time) of <60 minutes. A shorter low‐flow time has been consistently associated with improved survival. In an effort to reduce low‐flow times, commencement of E‐CPR in the prehospital setting has been reported and is currently under investigation. The provision of an E‐CPR service, whether hospital based or prehospital, carries considerable cost and technical challenges. Despite increased adoption, many questions remain as to which patients will derive the most benefit from E‐CPR, when and where to implement E‐CPR, optimal post‐arrest E‐CPR care, and whether this complex invasive intervention is cost‐effective. Results of ongoing trials are awaited to determine whether E‐CPR improves survival when compared with conventional CPR.
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Affiliation(s)
- Mark Dennis
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Sean Lal
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Paul Forrest
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of AnaesthesiaRoyal Prince Alfred HospitalSydneyAustralia
| | - Alistair Nichol
- University College Dublin‐Clinical Research CentreSt Vincent’s University HospitalDublinIreland
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Intensive CareThe Alfred HospitalMelbourneAustralia
| | - Lionel Lamhaut
- INSERM U970 Team 4 “Sudden Death Expertise Center”ParisFrance
- Paris Descartes UniversityParisFrance
- SAMU de Paris‐DAR Necker University Hospital‐Assistance Public Hopitaux de ParisParisFrance
| | - Richard J. Totaro
- Department of Intensive CareRoyal Prince Alfred HospitalSydneyAustralia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical ServiceNew South Wales, Ambulance Service???Australia
| | - Claudio Sandroni
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore – Policlinico Universitario Agostino Gemelli – IRCCSRomeItaly
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Dennis M, Buscher H, Gattas D, Burns B, Habig K, Bannon P, Patel S, Buhr H, Reynolds C, Scott S, Nair P, Hayman J, Granger E, Lovett R, Forrest P, Coles J, Lowe DA. Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study. CRIT CARE RESUSC 2020. [DOI: 10.51893/2020.1.oa3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39–65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38–73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24–108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.
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Dennis M, Buscher H, Gattas D, Burns B, Habig K, Bannon P, Patel S, Buhr H, Reynolds C, Scott S, Nair P, Hayman J, Granger E, Lovett R, Forrest P, Coles J, Lowe DA. Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study. CRIT CARE RESUSC 2020; 22:26-34. [PMID: 32102640 PMCID: PMC10692455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Hergen Buscher
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - David Gattas
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Brian Burns
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Karel Habig
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance Service, Sydney, NSW, Australia
| | - Paul Bannon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Heidi Buhr
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Claire Reynolds
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Sean Scott
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Priya Nair
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jon Hayman
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Emily Granger
- Department of Cardiothoracic Surgery St Vincent's Hospital, Sydney, NSW, Australia
| | - Ryan Lovett
- New South Wales Ambulance Service, Sydney, NSW, Australia
| | - Paul Forrest
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jennifer Coles
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David A Lowe
- Department of Intensive Care, St Vincent's Hospital, Sydney, NSW, Australia
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DiGiacomo P, Maclaren J, Aksoy M, Tong E, Carlson M, Lanzman B, Hashmi S, Watkins R, Rosenberg J, Burns B, Skloss TW, Rettmann D, Rutt B, Bammer R, Zeineh M. A within-coil optical prospective motion-correction system for brain imaging at 7T. Magn Reson Med 2020; 84:1661-1671. [PMID: 32077521 DOI: 10.1002/mrm.28211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Motion artifact limits the clinical translation of high-field MR. We present an optical prospective motion correction system for 7 Tesla MRI using a custom-built, within-coil camera to track an optical marker mounted on a subject. METHODS The camera was constructed to fit between the transmit-receive coils with direct line of sight to a forehead-mounted marker, improving upon prior mouthpiece work at 7 Tesla MRI. We validated the system by acquiring a 3D-IR-FSPGR on a phantom with deliberate motion applied. The same 3D-IR-FSPGR and a 2D gradient echo were then acquired on 7 volunteers, with/without deliberate motion and with/without motion correction. Three neuroradiologists blindly assessed image quality. In 1 subject, an ultrahigh-resolution 2D gradient echo with 4 averages was acquired with motion correction. Four single-average acquisitions were then acquired serially, with the subject allowed to move between acquisitions. A fifth single-average 2D gradient echo was acquired following subject removal and reentry. RESULTS In both the phantom and human subjects, deliberate and involuntary motion were well corrected. Despite marked levels of motion, high-quality images were produced without spurious artifacts. The quantitative ratings confirmed significant improvements in image quality in the absence and presence of deliberate motion across both acquisitions (P < .001). The system enabled ultrahigh-resolution visualization of the hippocampus during a long scan and robust alignment of serially acquired scans with interspersed movement. CONCLUSION We demonstrate the use of a within-coil camera to perform optical prospective motion correction and ultrahigh-resolution imaging at 7 Tesla MRI. The setup does not require a mouthpiece, which could improve accessibility of motion correction during 7 Tesla MRI exams.
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Affiliation(s)
- Phillip DiGiacomo
- Department of Bioengineering, Stanford University, Stanford, California
| | - Julian Maclaren
- Department of Radiology, Stanford University, Stanford, California
| | - Murat Aksoy
- Department of Radiology, Stanford University, Stanford, California
| | - Elizabeth Tong
- Department of Radiology, Stanford University, Stanford, California
| | - Mackenzie Carlson
- Department of Bioengineering, Stanford University, Stanford, California
| | - Bryan Lanzman
- Department of Radiology, Stanford University, Stanford, California
| | - Syed Hashmi
- Department of Radiology, Stanford University, Stanford, California
| | - Ronald Watkins
- Department of Radiology, Stanford University, Stanford, California
| | | | - Brian Burns
- Applied Sciences Lab West, GE Healthcare, Menlo Park, California
| | | | - Dan Rettmann
- MR Applications and Workflow, GE Healthcare, Rochester, Minnesota
| | - Brian Rutt
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Radiology, Stanford University, Stanford, California
| | - Roland Bammer
- Department of Radiology, University of Melbourne, Melbourne, Australia
| | - Michael Zeineh
- Department of Radiology, Stanford University, Stanford, California
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McLean J, Cooke S, Burns B, Reid C. First Reported Helicopter In-flight Serratus Plane Block for Rib Fractures. Air Med J 2019; 38:374-376. [PMID: 31578977 DOI: 10.1016/j.amj.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/02/2019] [Accepted: 06/13/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Justin McLean
- Greater Sydney Area Helicopter Emergency Medical Service, Ambulance Service New South Wales, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Sean Cooke
- Greater Sydney Area Helicopter Emergency Medical Service, Ambulance Service New South Wales, Sydney, New South Wales, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Ambulance Service New South Wales, Sydney, New South Wales, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cliff Reid
- Greater Sydney Area Helicopter Emergency Medical Service, Ambulance Service New South Wales, Sydney, New South Wales, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Curtis K, Kennedy B, Holland AJA, Tall G, Smith H, Soundappan SSV, Burns B, Mitchell RJ, Wilson K, Loudfoot A, Dinh M, Lyons T, Gillen T, Dickinson S. Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. Injury 2019; 50:1089-1096. [PMID: 30683570 DOI: 10.1016/j.injury.2019.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. METHODS Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016. Records were peer-reviewed by nurse surveyors who identified cases that might not meet the expected standard of care or where the child died following the injury. A multidisciplinary panel conducted the peer-review using a major trauma peer-review tool. Records were reviewed independently, then discussed to establish consensus. RESULTS A total 535 records were reviewed and 41 cases were peer-reviewed. The median (IQR) age was 7 (2-12) years, the median ISS was 25 (IQR 16-30). The peer-review identified a combination of clinical (85%), systems (51%) and communication (12%) problems that contributed to difficulties in care delivery. In 85% of records, staff actions were identified to contribute to events; with medical task failure the most frequently identified cause (89%). CONCLUSION The peer-review of paediatric trauma cases assisted in the identification of contributing factors to clinical incidents in trauma care resulting in 26 recommendations for change. The prioritisation and implementation of these recommendations, alongside a uniform State-wide trauma case review process with consistent criteria (definitions), performance indicators, monitoring and reporting would facilitate improvement in health service delivery to children sustaining severe injury.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia; The George Institute for Global Health, Sydney, Australia; Illawarra Health and Medical Research Institute, NSW, Australia
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, NSW, Australia.
| | - Andrew J A Holland
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | | | - Soundappan S V Soundappan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Brian Burns
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; NSW Ambulance, Sydney, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | | | - Michael Dinh
- NSW Institute of Trauma and Injury Management (ITIM), Australia; Sydney Local Health District, NSW, Australia
| | - Timothy Lyons
- Department of Forensic Medicine Newcastle, NSW, Australia
| | - Tona Gillen
- Lady Cilento Children's Hospital, Brisbane, Australia
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Ferguson I, Milligan J, Buttfield A, Shepherd S, Burns B, Reid C, Aneman A, Harris I. FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol. Acta Anaesthesiol Scand 2019; 63:693-699. [PMID: 30656637 DOI: 10.1111/aas.13309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/09/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co-induction agent may lead to a smoother haemodynamic profile post-induction, which may lead to reduced mortality in this critically ill cohort. This randomised controlled trial aims to compare the effect of administering fentanyl vs placebo in a standardised induction regimen with ketamine and rocuronium on (a) the percentage of patients in each group with a systolic blood pressure outside the range of 100-150 mm Hg within 10 minutes of induction, (b) the laryngoscopic view, and (c) 30-day mortality. METHODS/DESIGN Three hundred patients requiring rapid sequence intubation in participating emergency departments will be randomised to receive either fentanyl or placebo (0.9% saline) in addition to ketamine and rocuronium according to a standardised, weight-based induction regimen. The primary outcome measure is the percentage of patients in each group with a systolic blood pressure outside the range of 100-150 mm Hg within 10 minutes of induction. Secondary outcome measures include the laryngoscopic view, percentage of first pass success, 30-day mortality and number of ventilator-free days at 30 days. DISCUSSION The effect of adding fentanyl to an induction regimen of ketamine and rocuronium will be evaluated, both in terms of post-intubation physiology, the effect on intubating conditions, and 30-day mortality.
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Affiliation(s)
- Ian Ferguson
- Liverpool Hospital Liverpool BC New South Wales Australia
| | - James Milligan
- Royal North Shore Hospital St Leonards New South Wales Australia
| | - Alex Buttfield
- Campbelltown Hospital Campbelltown New South Wales Australia
| | | | - Brian Burns
- The Northern Beaches Hospital Frenchs Forest New South Wales Australia
| | - Cliff Reid
- The Northern Beaches Hospital Frenchs Forest New South Wales Australia
| | - Anders Aneman
- Liverpool Hospital Liverpool BC New South Wales Australia
| | - Ian Harris
- Liverpool Hospital Liverpool BC New South Wales Australia
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Taylor BWP, Ratchford A, van Nunen S, Burns B. Tick killing in situ before removal to prevent allergic and anaphylactic reactions in humans: a cross-sectional study. Asia Pac Allergy 2019; 9:e15. [PMID: 31089457 PMCID: PMC6494660 DOI: 10.5415/apallergy.2019.9.e15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/17/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management. OBJECTIVE To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts could reduce this risk. METHODS This was a prospective study at Mona Vale Hospital Emergency Department (ED) in Sydney, New South Wales, over a 6-month period during the peak tick season of 2016. Tick removal methods, allergic/anaphylactic reactions were recorded for patients presenting with ticks in situ or having already removed the ticks themselves. Primary endpoint was allergic/anaphylactic reaction after tick killing/removal. RESULTS One hundred twenty-one patients met study inclusion criteria. Sixty-one patients (28 known tick-hypersensitive) had ticks killed with Wart-Off Freeze or Lyclear Scabies Cream (5% w/w permethrin) before removal with fine-tipped forceps or Tick Twister. Three patients (2 known tick-hypersensitive) had allergic reactions (5%), none anaphylactic. The 2 known hypersensitive patients suffered reactions during the killing process and the third patient had a particularly embedded tick meaning it could not be removed solely by mouthparts. Fifty patients presented to the ED posttick removal by various methods, none using either fine-tipped forceps or Tick Twister, of which 43 (86%) experienced allergic reactions - 2 anaphylactic. Five patients suffered allergic reactions before presentation despite no attempt at kill or removal, but ticks had likely been disturbed by some other method. Five patients had live ticks removed in ED - 3 refused killing and had no reaction despite 1 having known hypersensitivity; 2 had ticks on eyelids contraindicating killing, 1 with known hypersensitivity but both had allergic reactions post removal. CONCLUSION Results support killing ticks in-situ before careful removal by mouthparts to reduce allergic/anaphylactic reactions although further research is still required.
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Affiliation(s)
| | - Andrew Ratchford
- Department of Emergency Medicine, Northern Beaches Hospital, Sydney, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sheryl van Nunen
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Brian Burns
- Department of Emergency Medicine, Northern Beaches Hospital, Sydney, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia
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Dennis M, Zmudzki F, Burns B, Scott S, Gattas D, Reynolds C, Buscher H, Forrest P. Cost effectiveness and quality of life analysis of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Resuscitation 2019; 139:49-56. [PMID: 30922936 DOI: 10.1016/j.resuscitation.2019.03.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/20/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest (ECPR) has increased exponentially. ECPR is a resource intensive service and its cost effectiveness has yet to be demonstrated. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes of patients who have undergone ECPR. METHODS Using data on all extracorporeal cardiopulmonary resuscitation (ECPR) patients at two ECMO centres in Sydney, Australia; we completed a costing analysis of ECPR patients. A Markov model of cost, quality of life and survival outcomes was developed to examine cost per QALY estimates and incremental cost effectiveness ratios (ICERs). Probabilistic sensitivity analysis (PSA) was completed to assess the probability of cost effectiveness for base case and variations. RESULTS Sixty-two consecutive ECPR patients were analysed; mean age of 51.9 ± 13.6 years, 38 (61%) were in hospital cardiac arrests (IHCA). Twenty-five patients (40%) survived to hospital discharge; all with a cerebral performance category (CPC) of 1 or 2. The mean cost per ECPR patient was AUD 75,165 (€50,535; ±AUD 75,737). Over 10 years ECPR was estimated to add a mean gain of 3.0 Quality Adjusted Life Years (QALYs) per patient with an incremental cost effectiveness ratio (ICER) of AUD 25,212 (€16,890) per QALY, increasing to 4.0 QALYs and an ICER of AUD 18,829 (€12,614) over a 15-year survival scenario. Mean cost per QALY did not differ significantly by OHCA or IHCA. CONCLUSIONS ECMO support for refractory cardiac arrests is cost effective and compares favourably to accepted cost effectiveness thresholds.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Fredrick Zmudzki
- Époque Consulting, Sydney, Australia; Social Policy Research Centre, University of New South Wales, Sydney, Australia.
| | - Brian Burns
- Sydney Medical School, University of Sydney, Sydney, Australia; Greater Sydney Area HEMS, NSW Ambulance Service, Australia.
| | - Sean Scott
- Department of Emergency Medicine, St. Vincent's Hospital, Sydney, Australia.
| | - David Gattas
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Claire Reynolds
- Department of Intensive Care, Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia.
| | - Hergen Buscher
- Department of Intensive Care, Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
| | - Paul Forrest
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia.
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Austin DE, Burns B, Lowe D, Cartwright B, Clarke A, Dennis M, D'Souza M, Nathan R, Bannon PG, Gattas D, Connellan M, Forrest P. Retrieval of critically ill adults using extracorporeal membrane oxygenation: the nine-year experience in New South Wales. Anaesth Intensive Care 2019; 46:579-588. [PMID: 30447667 DOI: 10.1177/0310057x1804600608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients. Of these, 118 patients (74%) were treated with veno-venous (VV) ECMO and 42 patients (26%) were treated with veno-arterial ECMO. The mean (standard deviation, SD) age was 40.4 (15.0) years. Seventy-seven transports (47%) occurred within metropolitan Sydney, 52 (32%) were from rural or regional areas within NSW, 17 (10%) were interstate transfers and 18 (11%) were international transfers. Transfers were by road (58%), fixed wing aircraft (27%) or helicopter (15%). No deaths occurred during transport. The median (interquartile range) duration of ECMO treatment was 8.9 (5.2-15.3) days. One hundred and nineteen patients (74%) were successfully weaned from ECMO and 109 (68%) survived to hospital discharge or transfer. In patients treated with VV ECMO, age, sequential organ failure assessment score, pre-existing immunosuppressive disease, pre-existing diabetes, renal failure requiring dialysis and failed prone positioning prior to ECMO were independently associated with increased mortality. ECMO-facilitated patient transport is feasible, safe, and results in acceptable short-term outcomes. The NSW ECMO Retrieval Service provides specialised support to patients with severe respiratory and cardiovascular illness, who may otherwise be too unstable to undergo inter-hospital transfer to access advanced cardiovascular and critical care services.
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Shand S, Curtis K, Dinh M, Burns B. What is the impact of prehospital blood product administration for patients with catastrophic haemorrhage: an integrative review. Injury 2019; 50:226-234. [PMID: 30578085 DOI: 10.1016/j.injury.2018.11.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Catastrophic haemorrhage is recognised as the leading cause of preventable death in trauma and is also prevalent in medical and other surgical aetiology. Prehospital blood product transfusion is increasingly available for both military and civilian emergency teams. Hospitals have well-established massive transfusion protocols for the resuscitation of this patient group, however the use and impact in the prehospital field is less understood. AIM To identify and evaluate the current knowledge surrounding prehospital blood product administration for patients with catastrophic haemorrhage. METHODS The integrative review method included systematic searching of online databases Medline, EMBASE, SCOPUS and CINAHL alongside hand-searching for primary research articles published prior to 19 November 2018. Papers were included if the population studied patients with catastrophic haemorrhage who received prehospital transfusion of blood products. The level of evidence and quality was evaluated using the NHMRC hierarchy of evidence. All identified full text articles were reviewed by all authors. RESULTS Twenty-two papers were included in the final analysis, including both civilian (16) and military (6) practice. The earliest publication for prehospital transfusion was 1999, with increasing prevalence in recent years. Findings were extracted and into two main categories; (1) transfusion processes included team staffing, product selection, and criteria for transfusion and (2) transfusion outcomes; transfusion safety, haemoglobin, hospital intervention and mortality. DISCUSSION The level of evidence specific to prehospital blood product transfusion is low, with predominantly retrospective methods and rarely sufficient sample sizes to reach statistical significance. Prehospital research is challenged by clinical and logistical variability preventing accurate cohort matching, sample sizes and inconsistent data collection. Evaluation of prehospital transfusion in isolation is also particularly problematic as multiple factors and developments in clinical practice affect patient outcomes and all samples were subject to survival bias. Conclusion The volume and strength of the available evidence prevents accurate evaluation of the intervention and definitive practice recommendations however prehospital transfusion is shown to be logistically achievable and without serious incident. The reviewed evidence broadly supports the translation of recent in-hospital studies, such as PROMTT and PROPPR. Further research specific to prehospital practice is required to guide the development of evidence-based protocols.
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Affiliation(s)
- Sophie Shand
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; NSW Ambulance, Sydney Ambulance Centre, Eveleigh, NSW, Australia.
| | - Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia
| | - Michael Dinh
- Royal Prince Alfred Hospital, NSW, Australia; Institute of Trauma and Injury Management, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Burns B, Reid C, Habig K, Miller M, Healy G. Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: Beneficial or detrimental? Acta Anaesthesiol Scand 2019; 63:137. [PMID: 30426479 DOI: 10.1111/aas.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brian Burns
- Greater Sydney Area HEMS; NSW Ambulance; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney University; Sydney New South Wales Australia
| | - Cliff Reid
- Greater Sydney Area HEMS; NSW Ambulance; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney University; Sydney New South Wales Australia
| | - Karel Habig
- Greater Sydney Area HEMS; NSW Ambulance; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney University; Sydney New South Wales Australia
| | - Matt Miller
- Greater Sydney Area HEMS; NSW Ambulance; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney University; Sydney New South Wales Australia
| | - Geoff Healy
- Greater Sydney Area HEMS; NSW Ambulance; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney University; Sydney New South Wales Australia
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Dennis M, Forrest P, Bannon P, Scott S, Lowe D, Reynolds C, Burns B, Habig K, Nair P, Gattas D, Buscher H. The 2CHEER Study: (Mechanical CPR, Hypothermia, ECMO and Early Re-Perfusion) for Refractory Cardiac arrest. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharwood LN, Dhaliwal S, Ball J, Burns B, Flower O, Joseph A, Stanford R, Middleton J. Emergency and acute care management of traumatic spinal cord injury: a survey of current practice among senior clinicians across Australia. BMC Emerg Med 2018; 18:57. [PMID: 30567501 PMCID: PMC6300889 DOI: 10.1186/s12873-018-0207-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background To describe pre-hospital, emergency department and acute care assessment and management practices of senior clinicians for patients with acute traumatic spinal cord injury (TSCI) across Australia; and to describe clinical practice variation. Methods We used a descriptive, cross-sectional study design to survey senior clinicians (greater than 10 years practice in this field) caring for patients with acute TSCI. The assessment, management and referral practices of prehospital, emergency department/trauma and surgical expert clinicians, across prehospital, early hospital care, diagnostic imaging and haemodynamic management were surveyed. Results We invited 95 eligible senior clinicians; the response rate was 75%. Survey findings demonstrated overall lack of awareness or consistent use of evidence based published guidelines; many clinicians following ‘locally written’ or ‘no particular’ guideline. Practitioners were conflicted across multiple areas including patient assessment and diagnosis, treatment and transport decisions. Reported spinal immobilisation practices differed substantially, as did target setting for blood pressure; the majority of clinicians actively monitored risk of respiratory deterioration. Specialist care consult and specialist service bed availability was reported as problematic by more than one third of clinicians. Conclusions Unwarranted clinical practice variation is known to contribute to different health outcomes for patients with similar etiologies. Clinical practice guidelines offer evidence based, best practice standards, however are only effective if adopted throughout the healthcare system. Wide variability in acute care practices, pathways and timing to specialist centres for TSCI was evidenced by this survey despite seniority among clinicians. This devastating injury requires prompt, consistent, evidence based care from the moment of first responder. Improved outcomes for patients with TSCI would be more likely with standardised care across pre-hospital, emergency and acute care phases of care. Keywords Spinal Cord Injuries, Multiple Trauma, Practice Guideline, Treatment Outcome, Surveys and Questionnaires, Expert Testimony
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Affiliation(s)
- Lisa N Sharwood
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
| | - Shelly Dhaliwal
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Jonathon Ball
- Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Bankstown, NSW, 2200, Australia
| | - Oliver Flower
- Intensive Care Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Anthony Joseph
- Department of Trauma, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Ralph Stanford
- Department of Orthopaedics, Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
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Engle B, Corbet N, Allen J, Laing A, Fordyce G, McGowan M, Burns B, Hayes B. 282 Accuracy of multi-trait genomic predictions for age at puberty in Northern Australian beef heifers. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Engle
- Texas A&M University, Department of Animal Science,College Station, TX, United States
| | - N Corbet
- Central Queensland University, School of Health, Medical and Applied Sciences,Rockhampton, Australia
| | - J Allen
- Agricultural Business Research Institute, University of New England,Armidale, Australia
| | - A Laing
- Department of Agriculture and Fisheries,Rockhampton, Queensland, Australia
| | - G Fordyce
- Queensland Alliance for Agriculture and Food Innovation, Centre for Animal Science, University of Queensland, St Lucia, Queensland, Australia
| | - M McGowan
- University of Queensland, School of Veterinary Science,St Lucia, Queensland, Australia
| | - B Burns
- Department of Agriculture and Fisheries,Rockhampton, Queensland, Australia
| | - B Hayes
- Queensland Alliance for Agriculture and Food Innovation, Centre for Animal Science, University of Queensland, St Lucia, Queensland, Australia
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Hutin A, Abu-Habsa M, Burns B, Bernard S, Bellezzo J, Shinar Z, Torres EC, Gueugniaud PY, Carli P, Lamhaut L. Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation 2018; 130:44-48. [DOI: 10.1016/j.resuscitation.2018.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/26/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022]
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Scott R, Burns B, Ware S, Oud F, Miller M. The reliability of thromboelastography in a simulated rotary wing environment. Emerg Med J 2018; 35:739-742. [PMID: 30158145 DOI: 10.1136/emermed-2017-207418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND With the increasing role of point-of-care coagulation testing in trauma, we sought to test the reliability of the thromboelastography (TEG)6s machine in a simulated rotary wing environment. METHOD A two-arm study was conducted, running TEG6s quality control cartridges in a helicopter flight simulator with realistic vibration and in stable ground conditions. The flight conditions during testing included take-offs, landings and inflight emergencies such as engine failures. TEG values for R time, K time, α-angle and maximum amplitude (MA) were collected and compared with manufacturers' normal ranges. RESULTS 148 TEG samples were included for analysis (72 simulator arm, 76 ground arm). In the simulator arm, four of our K time values fell below the normal range and four MA values were above the normal range. All other values in both simulator and ground arms were in the normal range. CONCLUSION The TEG6s is a viable technology in the simulated rotary wing environment, and it is feasible to conduct further studies using human blood in live rotary wing conditions. Extreme flight conditions should be avoided during further testing.
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Affiliation(s)
- Robert Scott
- Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia
| | - Sandra Ware
- Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia
| | - Floris Oud
- Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia
| | - Matthew Miller
- Greater Sydney Area HEMS, NSW Ambulance, Bankstown Airport, New South Wales, Australia.,St George & Sutherland Clinical Schools, UNSW, Sydney, NSW
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Chiew M, Jiang W, Burns B, Larson P, Steel A, Jezzard P, Albert Thomas M, Emir UE. Density-weighted concentric rings k-space trajectory for 1 H magnetic resonance spectroscopic imaging at 7 T. NMR Biomed 2018; 31:e3838. [PMID: 29044762 PMCID: PMC5969060 DOI: 10.1002/nbm.3838] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 05/21/2023]
Abstract
It has been shown that density-weighted (DW) k-space sampling with spiral and conventional phase encoding trajectories reduces spatial side lobes in magnetic resonance spectroscopic imaging (MRSI). In this study, we propose a new concentric ring trajectory (CRT) for DW-MRSI that samples k-space with a density that is proportional to a spatial, isotropic Hanning window. The properties of two different DW-CRTs were compared against a radially equidistant (RE) CRT and an echo-planar spectroscopic imaging (EPSI) trajectory in simulations, phantoms and in vivo experiments. These experiments, conducted at 7 T with a fixed nominal voxel size and matched acquisition times, revealed that the two DW-CRT designs improved the shape of the spatial response function by suppressing side lobes, also resulting in improved signal-to-noise ratio (SNR). High-quality spectra were acquired for all trajectories from a specific region of interest in the motor cortex with an in-plane resolution of 7.5 × 7.5 mm2 in 8 min 3 s. Due to hardware limitations, high-spatial-resolution spectra with an in-plane resolution of 5 × 5 mm2 and an acquisition time of 12 min 48 s were acquired only for the RE and one of the DW-CRT trajectories and not for EPSI. For all phantom and in vivo experiments, DW-CRTs resulted in the highest SNR. The achieved in vivo spectral quality of the DW-CRT method allowed for reliable metabolic mapping of eight metabolites including N-acetylaspartylglutamate, γ-aminobutyric acid and glutathione with Cramér-Rao lower bounds below 50%, using an LCModel analysis. Finally, high-quality metabolic mapping of a whole brain slice using DW-CRT was achieved with a high in-plane resolution of 5 × 5 mm2 in a healthy subject. These findings demonstrate that our DW-CRT MRSI technique can perform robustly on MRI systems and within a clinically feasible acquisition time.
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Affiliation(s)
- Mark Chiew
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - Wenwen Jiang
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCAUSA
| | - Brian Burns
- Department of OncologyUniversity of OxfordOxfordUK
| | - Peder Larson
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCAUSA
| | - Adam Steel
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalOxfordUK
- Laboratory of Brain and Cognition, National Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - M. Albert Thomas
- Department of Radiological SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - Uzay E. Emir
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalOxfordUK
- School of Health SciencesPurdue UniversityWest LafayetteINUSA
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Fedor PJ, Burns B, Lauria M, Richmond C. Major Trauma Outside a Trauma Center: Prehospital, Emergency Department, and Retrieval Considerations. Emerg Med Clin North Am 2017; 36:203-218. [PMID: 29132578 DOI: 10.1016/j.emc.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward.
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Affiliation(s)
- Preston J Fedor
- Department of Emergency Medicine, Division of Prehospital, Austere and Disaster Medicine, University of New Mexico, 1 University of New Mexico, MSC11 6025, Albuquerque, NM 87131-0001, USA.
| | - Brian Burns
- Greater Sydney Area HEMS, NSW Ambulance, NSW 2200, Australia; Sydney University, Sydney, NSW, Australia
| | - Michael Lauria
- Dartmouth-Hitchcock Advanced Response Team (DHART), Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Clare Richmond
- Greater Sydney Area HEMS, NSW Ambulance, NSW 2200, Australia; Royal Prince Alfred Hospital, Sydney, Australia
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