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Thom O, Roberts K, Devine S, Leggat PA, Franklin RC. Feasibility study of the Utstein Style For Drowning to aid data collection on the resuscitation of drowning victims. Resusc Plus 2023; 16:100464. [PMID: 37693337 PMCID: PMC10483059 DOI: 10.1016/j.resplu.2023.100464] [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: 05/14/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
Aim The revised Utstein Style For Drowning (USFD) was published in 2015. Core data were considered feasible to be reported in most health systems worldwide. We aimed to determine the suitability of the USFD as a template for reporting data from drowning research. Method Clinical records of 437 consecutive drowning presentations to the Sunshine Coast Hospital and Health Service Emergency Departments (ED) between 1/1/2015 and 31/12/2021 were examined for data availability to complete the USFD. The proportions of patients with each variable documented is reported. Time taken to record core and supplementary variables was recorded for 120 consecutive patients with severity of drowning Grade 1 or higher. Results There were 437 patients, including 227 (51.9%) aged less than 16 years. There were 253 (57.9%) males and 184 (42.1%) females. Sixty-one patients (13.9%) received cardiopulmonary resuscitation (CPR). There were nine (2.1%) deaths after presentation to the ED. Median time for data entry was 17 minutes for core variables and 6 min for supplementary. This increased to 29 + 6 minutes for patients in cardiac arrest. Sixteen (32.7%) of 49 core variables and four (13.3%) of 30 supplementary variables were documented 100% of the time. One (2.0%) core and seven (23.3%) supplementary variables were never documented. Duration of submersion was documented in 100 (22.9%) patients. Conclusion USFD is time consuming to complete. Data availability to enable completion of the USFD varies widely, even in a resource rich health system. These results should be considered in future revisions of the USFD.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Peter A. Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Royal Life Saving Society – Australia, Sydney, NSW, Australia
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Bierens J, Bray J, Abelairas-Gomez C, Barcala-Furelos R, Beerman S, Claesson A, Dunne C, Fukuda T, Jayashree M, T Lagina A, Li L, Mecrow T, Morgan P, Schmidt A, Seesink J, Sempsrott J, Szpilman D, Thom O, Tobin J, Webber J, Johnson S, Perkins GD. A systematic review of interventions for resuscitation following drowning. Resusc Plus 2023; 14:100406. [PMID: 37424769 PMCID: PMC10323217 DOI: 10.1016/j.resplu.2023.100406] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.
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Affiliation(s)
- Joost Bierens
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group and Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo. Pontevedra, Spain
| | | | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Cody Dunne
- Department of Emergency Medicine, University of Calgary, Canada
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Toranomon Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Muralidharan Jayashree
- Department of Pediatrics. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anthony T Lagina
- School of Emergency Medicine, Wayne State University, Detroit, USA
| | - Lei Li
- School of Emergency Medicine, Wayne State University, Detroit, USA
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tom Mecrow
- Royal National Lifeboat Institution, West Quay Road, Poole, Dorset, UK
| | - Patrick Morgan
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Andrew Schmidt
- Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, USA
| | - Jeroen Seesink
- Erasmus MC University Medical Center, Department of Anaesthesiology, Rotterdam, the Netherlands
| | | | - David Szpilman
- Brazilian Lifesaving Society, SOBRASA, Rio de Janeiro, Brazil
| | - Ogilvie Thom
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Joshua Tobin
- UT Health San Antonio, Dept of Anesthesiology, San Antonio, USA
| | - Jonathon Webber
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin RC. Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration. BMJ Open 2023; 13:e068380. [PMID: 36759033 PMCID: PMC9923278 DOI: 10.1136/bmjopen-2022-068380] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender. METHODS AND ANALYSIS This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed. ETHICS AND DISSEMINATION This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- College of Medicine, Nursing & Health Sciences, University of Galway, Galway, UK
| | - Susan Devine
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Richard Charles Franklin
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin R. Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine. Emerg Med Australas 2023; 35:18-24. [PMID: 35878883 PMCID: PMC10087421 DOI: 10.1111/1742-6723.14036] [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: 01/27/2022] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor. METHODS Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition. RESULTS Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging. CONCLUSIONS The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Surf Life Saving Queensland, Brisbane, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin RC. Cervical spine injuries occurring at the beach: epidemiology, mechanism of injury and risk factors. BMC Public Health 2022; 22:1404. [PMID: 35869457 PMCID: PMC9306180 DOI: 10.1186/s12889-022-13810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Surf zone injuries include cervical spine injuries (CSI). Risk factors for CSI have not been extensively investigated. The objective was to examine risk factors associated with diagnosed CSI that occurred in a beach setting. Methods This retrospective case series used manually linked data from Sunshine Coast Hospital and Health Service Emergency Departments, Queensland Ambulance Service, Surf Life Saving Queensland (SLSQ), and Bureau of Meteorology data from 01/01/2015-21/04/2021. Variables included victim demographics, mechanism of injury, scene information, and patient course. Results Seventy-nine of the 574 (13.8%) confirmed CSI occurred at the beach. Local residents and visitors were injured equally. Females represented a minority (12.7%) of those diagnosed with CSI but were a higher proportion of suspected spinal incidents reported to SLSQ (45%). Surfers were more likely to be injured through shallow water diving than swimmers (27.6% vs 2.2%). Females were more likely to be injured by shallow water diving than males (30.0% vs 8.7%). Visitors were more likely to be injured swimming and local residents surfing (68.2% vs 77.8% respectively). CSI occurred most commonly (40.0%) with a below average ocean wave height (0.75-1.25 m) and were most likely (45.3%) to occur in the second half of the outgoing tide. One beach had a statistically significant greater incidence of spinal incidents (OR 3.9, 95% CI: 2.1-7.2) and of CSI (OR 10.7, 95% CI: 1.5-79.5). Conclusions Risk factors for CSI at the beach include male sex, smaller wave height and an outgoing tide. Shallow water diving among surfers and females should be addressed urgently. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13810-9.
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Roberts K, Thom O, Hocking J, Bernard A, Doyle T. Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study. BMJ Open Qual 2022. [PMCID: PMC9362791 DOI: 10.1136/bmjoq-2021-001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Clinical incident (CI) management within healthcare settings is a crucial component of patient safety and quality improvement. The complex environment in the emergency department (ED) and nursing work schedules are important aspects of human factor ergonomic (HFE) systems that requires closer examination. Nursing shifts are closely related to fatigue, including the late/early shift pattern and night shift. All nursing shifts were examined over a 1-year period when a CI occurred to a patient in the ED to identify if there was an association. Methods This was a retrospective observational study, conducted and reported using the Strengthening of the Reporting of Observational Studies in Epidemiology statement. All CIs reported in the ED over a 1-year period were reviewed by accessing the CI database, emergency department information system and patient health records. The nursing roster database was accessed to record nursing shifts and were de-identified. Results A total of n=244 CIs were eligible for inclusion into the study. ED nursing shift analysis included n=1095 nursing shifts. An analysis of early, late and night shifts, including days not worked by the ED nurse was conducted over a 48-hour and 96-hour period. There was no significant relationship identified between the CI and nursing shift patterns. ED length of stay (LOS) was significantly higher for a patient presentation when a CI occurred. Conclusion This study focused on the HFE system of nursing work schedules and CI events that occurred in the ED. This study found there was no relationship between emergency nursing shift patterns and an increased risk for the occurrence of a CI in the ED. Although a strong link was found between patients experiencing a CI in the ED and an extended LOS. This demonstrates the need for studies to investigate the interrelationships of multiple HFE systems in the ED, including the environment, patient, clinical team and organisational factors.
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Affiliation(s)
- Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Julia Hocking
- R&D Lab, Stryker Australia Pty Ltd, Brisbane, Queensland, Australia
| | - Anne Bernard
- QCIF Bioinformatics, QCIF, Saint Lucia, Queensland, Australia
| | - Tammy Doyle
- Women's and Children's Service, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Simon GI, Craswell A, Thom O, Fung YL. Unplanned blood use within 24 hours of emergency department presentation: A cohort study in an ageing population. Emerg Med Australas 2021; 34:244-251. [PMID: 34569137 DOI: 10.1111/1742-6723.13873] [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: 05/24/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This research aims to elucidate drivers of blood use in an older population, with a focus on unplanned transfusions following ED presentation. METHODS In a retrospective cohort study we examined 2015 data for ED presentations and blood use in two hospitals serving a population containing a high proportion (21%) of adults aged ≥65 years. Unplanned blood use was defined as any transfusion ≤24 h of presentation. Data were analysed by age, sex, Major Diagnostic Category, triage category and time to transfusion. RESULTS A total of 5294 blood components were transfused, comprising red cells (n = 3784), fresh frozen plasma (n = 657), platelets (n = 563) and cryoprecipitate (n = 290). Men aged ≥65 years were the highest users (40%, 2107 components). Unplanned transfusions accounted for 28% (n = 1057) of annual red cell use. Of 85 014 ED presentations, 494 (0.6%) were associated with unplanned red cell transfusion. Four Major Diagnostic Categories accounted for 81% (n = 853) of unplanned red cell use: gastrointestinal (n = 375), haematology (n = 267), trauma (n = 144) and cardiovascular (n = 67). Over one-fifth of unplanned transfusions (21%, n = 222 of 1057) were associated with ICD-10 codes for anaemia as a reason for presentation within the Haematology Major Diagnostic Category. Adults aged ≥65 years accounted for 62% of overall red cell use and 61% of transfusions ≤24 h of presentation. Odds of unplanned red cell transfusion increased with age, peaking at odds ratio 28.5 (95% confidence interval 14.2-57.4) in those aged 85 years and above. CONCLUSIONS Unplanned blood use accounted for 28% of annual hospital blood consumption. Blood component use increased with age and was greatest in older men. A significant burden of anaemia treatment was identified by the ED.
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Affiliation(s)
- Geoff I Simon
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Yoke Lin Fung
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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Thom O, Roberts K, Devine S, Leggat PA, Franklin RC. Treatment of the lung injury of drowning: a systematic review. Crit Care 2021; 25:253. [PMID: 34281609 PMCID: PMC8287554 DOI: 10.1186/s13054-021-03687-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022]
Abstract
Background Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? Methods The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. Results Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. Conclusions Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03687-2.
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Affiliation(s)
- Ogilvie Thom
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia. .,Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia.
| | - Kym Roberts
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Royal Life Saving - Australia, National Office, Broadway, Sydney, Australia
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Roberts K, Thom O, Devine S, Leggat PA, Peden AE, Franklin RC. A scoping review of female drowning: an underexplored issue in five high-income countries. BMC Public Health 2021; 21:1072. [PMID: 34090385 PMCID: PMC8178917 DOI: 10.1186/s12889-021-10920-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. METHODS A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. RESULTS The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). CONCLUSION Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.
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Affiliation(s)
- Kym Roberts
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Ogilvie Thom
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Peter A. Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Amy E. Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
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Roberts K, Thom O, Eley R, Cabilan CJ, Vallmuur K. Long term impact of ladder-related injuries as measured by the AQoL instrument. PLoS One 2020; 15:e0235092. [PMID: 32574183 PMCID: PMC7310734 DOI: 10.1371/journal.pone.0235092] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. Materials and methods This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months. Results There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001). Conclusions Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury. Prevention Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.
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Affiliation(s)
- Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- * E-mail:
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Rob Eley
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- The University of Queensland, St Lucia, Queensland, Australia
| | - CJ. Cabilan
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kirsten Vallmuur
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Hospital and Health Service Royal, Brisbane and Women’s Hospital, Herston, Queensland, Australia
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11
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Greenslade JH, Wallis MC, Johnston A, Carlström E, Wilhelms D, Thom O, Abraham L, Crilly J. Development of a revised Jalowiec Coping Scale for use by emergency clinicians: a cross-sectional scale development study. BMJ Open 2019; 9:e033053. [PMID: 31796493 PMCID: PMC7003388 DOI: 10.1136/bmjopen-2019-033053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop and validate a scale to measure the coping strategies used by emergency staff in response to workplace stress. To achieve this aim, we developed a refined Jalowiec Coping Scale (JCS), termed the Jalowiec Coping Scale-Emergency Department (JCS-ED) and validated this scale on a sample of emergency clinicians. DESIGN A cross-sectional survey incorporating the JCS, the working environment scale-10 and a measure of workplace stressors was administered between July 2016 and June 2017. The JCS-ED was developed in three stages: 1) item reduction through content matter experts, 2) exploratory factor analysis for further item reduction and to identify the factor structure of the revised scale and 3) confirmatory factor analyses to confirm the factors identified within the exploratory factor analysis. SETTING Six Emergency Departments (EDs) in Australia and four in Sweden. There were three tertiary hospitals, five large urban hospitals and two small urban hospitals. PARTICIPANTS Participants were eligible for inclusion if they worked full-time or part-time as medical or nursing staff in the study EDs. The median age of participants was 35 years (IQR: 28-45 years) and they had been working in the ED for a median of 5 years (IQR: 2-10 years). 79% were females and 76% were nurses. RESULTS A total of 875 ED staff completed the survey (response rate 51%). The content matter experts reduced the 60-item scale to 32 items. Exploratory factor analyses then further reduced the scale to 18 items assessing three categories of coping: problem-focussed coping, positive emotion-focussed coping and negative emotion-focussed coping. Confirmatory factor analysis supported this three-factor structure. Negative coping strategies were associated with poor perceptions of the work environment and higher ratings of stress. CONCLUSIONS The JCS-ED assesses maladaptive coping strategies along with problem-focussed and emotion-focussed coping styles. It is a short instrument that is likely to be useful in measuring the types of coping strategies employed by staff.
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Affiliation(s)
- Jaimi H Greenslade
- Institute of Health and Biomedical Innovation, School of Public Health annd Social Work, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marianne C Wallis
- School of Nursing & Midwifery, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Amy Johnston
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Nursing, Midwifery, and Social Work, University of Queensland-St Lucia Campus, Brisbane, Queensland, Australia
| | - Eric Carlström
- Health and Crisis Management and Policy, Sahlgrenska Akademin, Goteborgs Universitet, Goteborg, Sweden
| | - Daniel Wilhelms
- Department of Health and Medical Sciences, Linköping University, Linkoping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Linkoping, Sweden
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Louisa Abraham
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Julia Crilly
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Health Service District, Southport, Queensland, Australia
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Yap CYL, Taylor DM, Kong DCM, Knott JC, Taylor SE, Graudins A, Keijzers G, Kulawickrama S, Thom O, Lawton L, Furyk J, Finucci D, Holdgate A, Watkins G, Jordan P. Management of behavioural emergencies: a prospective observational study in Australian emergency departments. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Celene Y. L. Yap
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Emergency Department The Royal Melbourne Hospital Melbourne Australia
- Centre for Medicine Use and Safety Monash University Melbourne Australia
| | - David McD. Taylor
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Emergency Department Austin Health Melbourne Australia
| | - David C. M. Kong
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Centre for Medicine Use and Safety Monash University Melbourne Australia
- Pharmacy Department Ballarat Health Services Ballarat Australia
| | - Jonathan C. Knott
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Emergency Department The Royal Melbourne Hospital Melbourne Australia
| | | | - Andis Graudins
- Emergency Department Monash Health Melbourne Australia
- Department of Medicine, Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Gerben Keijzers
- Emergency Department Gold Coast University Hospital Gold Coast Australia
- School of Medicine Bond University Gold Coast Australia
- School of Medicine Griffith University Gold Coast Australia
| | | | - Ogilvie Thom
- Emergency Department Nambour General Hospital Nambour Australia
| | - Luke Lawton
- Emergency Department The Townsville Hospital Townsville Australia
| | - Jeremy Furyk
- Emergency Department The Townsville Hospital Townsville Australia
| | - Daniel Finucci
- Emergency Department Liverpool Hospital Sydney Australia
| | - Anna Holdgate
- Emergency Department Liverpool Hospital Sydney Australia
| | - Gina Watkins
- Emergency Department Sutherland Hospital Sydney Australia
| | - Peter Jordan
- Emergency Department The Northern Hospital Melbourne Australia
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13
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Crilly J, Greenslade JH, Johnston A, Carlström E, Thom O, Abraham L, Mills D, Wallis M. Staff perceptions of the emergency department working environment: An international cross‐sectional survey. Emerg Med Australas 2019; 31:1082-1091. [DOI: 10.1111/1742-6723.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/03/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health Service Gold Coast Queensland Australia
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
| | - Jaimi H Greenslade
- Emergency and Trauma CentreRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
- Queensland University of Technology Brisbane Queensland Australia
| | - Amy Johnston
- The University of Queensland Brisbane Queensland Australia
| | - Eric Carlström
- Health and Crisis Management and PolicySahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Ogilvie Thom
- Sunshine Coast Hospital and Health Service Sunshine Coast Queensland Australia
| | - Louisa Abraham
- Emergency and Trauma CentreRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Donna Mills
- Sunshine Coast Hospital and Health Service Sunshine Coast Queensland Australia
| | - Marianne Wallis
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
- School of Nursing and MidwiferyUniversity of the Sunshine Coast Sunshine Coast Queensland Australia
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14
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Xu HG, Johnston ANB, Greenslade JH, Wallis M, Elder E, Abraham L, Thom O, Carlström E, Crilly J. Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study. Australas Emerg Care 2019; 22:180-186. [PMID: 31151793 DOI: 10.1016/j.auec.2018.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 06/29/2018] [Revised: 10/19/2018] [Accepted: 10/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emergency departments (EDs) are stressful workplaces. Limited research explores components ED staff find stressful and how they cope. The aim of this study is to describe ED staff perceptions of their working environment. METHODS A cross-sectional study was undertaken in 2017 in a public, teaching hospital ED situated in an outer-metropolitan low socio-economic area. ED doctors and nurses completed surveys exploring workplace stressors (the ED stressors tool), coping strategies (Jalowiec Coping Scale), and perceptions of the working environment (Working Environment Scale-10). Descriptive and comparative analyses were undertaken. RESULTS A 40% response rate (161/400) was achieved. Staff reported high workload, moderate self-realisation, and low levels of conflict and nervousness. Heavy workload, poor skill-mix and overcrowding were ranked as high-stress, high-exposure (daily) events. The death or sexual abuse of a child and inability to provide optimal care were ranked highly stressful but infrequent. Coping strategies most often used included: trying to keep life as normal as possible (90%) and considering different ways to handle the situation (89%). CONCLUSIONS Impacts of varying degrees of exposure of this young cohort of staff, with limited experience, to modifiable and non-modifiable stressors highlight site-specific opportunities to enhance staff perceptions of their working environment.
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Affiliation(s)
- Hui Grace Xu
- Department of Emergency Medicine, Logan Hospital, Armstrong Rd & Loganlea Rd, Meadowbrook, Logan, Qld 4131, Australia; Menzies Health Institute Queensland, Griffith University, Qld, Australia; School of Nursing and Midwifery, Griffith University, Qld, Australia.
| | - Amy N B Johnston
- Menzies Health Institute Queensland, Griffith University, Qld, Australia; Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, Qld 4215, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia; School of Nursing, Midwifery and Social Work, the University of Queensland, Woolloongabba, Qld 4102, Australia
| | - Jaimi H Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Bowen Bridge Rd, Herston, Qld 4029, Australia; Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia
| | - Marianne Wallis
- Menzies Health Institute Queensland, Griffith University, Qld, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, Qld 4558, Australia
| | - Elizabeth Elder
- Menzies Health Institute Queensland, Griffith University, Qld, Australia; School of Nursing and Midwifery, Griffith University, Qld, Australia
| | - Louisa Abraham
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Bowen Bridge Rd, Herston, Qld 4029, Australia
| | - Ogilvie Thom
- Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia; Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Qld 4560, Australia
| | - Eric Carlström
- Sahlgrenska Academy, University of Gothenburg, Box 457, SE 405 30 Gothenburg, Sweden
| | - Julia Crilly
- Menzies Health Institute Queensland, Griffith University, Qld, Australia; Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, Qld 4215, Australia
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15
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Simon GI, Craswell A, Thom O, Chew MS, Anstey CM, Fung YL. Impacts of Aging on Anemia Tolerance, Transfusion Thresholds, and Patient Blood Management. Transfus Med Rev 2019; 33:154-161. [PMID: 31129009 DOI: 10.1016/j.tmrv.2019.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/12/2019] [Accepted: 03/28/2019] [Indexed: 01/28/2023]
Abstract
Evidence-based patient blood management guidelines commonly recommend restrictive hemoglobin thresholds of 70 to 80 g/L for asymptomatic adults. However, most transfusion trials have enrolled adults across a broad age span, with few exclusive to older adults. Our recent meta-analysis of transfusion trials that focused on older adults paradoxically found lower mortality and fewer cardiac complications when these patients were managed using higher hemoglobin thresholds. We postulate that declining cardiac output with age contributes to deteriorating oxygen delivery capacity which impacts anemia-associated outcomes in older adults and propose a model to explain this age-related difference. We reviewed evidence concerning the pathophysiology of aging to explore the disparity in transfusion trial outcomes related to hemoglobin thresholds in different age groups. The literature was searched for normative cardiac output values at different ages in healthy adults. Using normative peak cardiac output data, we modeled oxygen delivery capacity in young, middle-aged, and older adults at a range of hemoglobin levels. Cardiovascular and pulmonary systems are impacted by age-related pathophysiological changes. Diminishing peak cardiac output associated with aging reduces the maximal oxygen delivery achievable under metabolic stress. Hence, at low hemoglobin levels, older adults are more susceptible to tissue hypoxia than younger adults. Our model predicts that an older adult with a hemoglobin of 100 g/L has a similar peak oxygen delivery capacity to a young adult with a hemoglobin of 70 g/L. Age-related pathophysiological changes provide some explanation as to why older adults have a lower tolerance for anemia than younger adults. This indicates the need for patient blood management hemoglobin thresholds specific to older as distinct from younger adults. The primary application of this model is in the consideration of patients rehabilitating to life outside hospital. It is important to note that pathophysiological changes associated with critical illness and major surgery are more complex than can be described in a simple model based on cardiac output and hemoglobin concentration. However, our review of oxygen transport and delivery in health and disease states allows the model to be considered in the context of treatment decisions for anemic adults in a range of hospital and community settings.
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Affiliation(s)
- Geoff I Simon
- School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Medical and Health Sciences, Linköping University Hospital, Linköping, Sweden
| | - Chris M Anstey
- Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service; School of Medicine, University of Queensland; School of Medicine, Griffith University, Birtinya, Australia
| | - Yoke Lin Fung
- School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Australia
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16
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Chu K, Windsor C, Fox J, Howell T, Keijzers G, Eley R, Kinnear F, Furyk J, Thom O, Brown NJ, Brown AFT. Factors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study. Emerg Med J 2018; 36:72-77. [PMID: 30573523 DOI: 10.1136/emermed-2018-207876] [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: 06/13/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians' decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. METHODS We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent individual face-to-face or telephone interviews. Content analysis was performed whereby transcripts were examined and coded independently by two co-investigators, who then jointly agreed on the influencing factors. RESULTS Six categories of influencing factors were identified. Patient interaction was at the forefront of the identified factors. This shared decision-making process incorporated 'what the patient wants' but may be biased by how the clinician communicates the benefits and harms of the diagnostic options to the patient. Patient risk profile, practice evidence and guidelines were also important. Other influencing factors included experiential factors of the clinician, consultation with colleagues and external influences where practice location and work processes impose constraints on test ordering external to the preferences of the clinician or patient. The six categories were organised within a conceptual framework comprising four components: the context, the evidence, the experience and the decision. CONCLUSIONS When clinicians are faced with a diagnostic challenge, such as the workup of a patient with suspected SAH, there are a number of influencing factors that can result in a variation in approach. These need to be considered in approaches to improve the appropriateness and consistency of medical care.
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Affiliation(s)
- Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Carol Windsor
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jennifer Fox
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Tegwen Howell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Robert Eley
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Emergency Medicine, The Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Frances Kinnear
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Emergency and Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Jeremy Furyk
- Department of Emergency Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ogilvie Thom
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Anthony F T Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
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17
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Abraham LJ, Thom O, Greenslade JH, Wallis M, Johnston ANB, Carlström E, Mills D, Crilly J. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments. Emerg Med Australas 2018; 30:375-381. [DOI: 10.1111/1742-6723.12895] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Louisa J Abraham
- Emergency and Trauma Centre; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Ogilvie Thom
- Department of Emergency Medicine; Sunshine Coast Hospital and Health Service; Brisbane Queensland Australia
| | - Jaimi H Greenslade
- Emergency and Trauma Centre; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine; University of the Sunshine Coast; Sippy Downs Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
| | - Amy NB Johnston
- Department of Emergency Medicine; Gold Coast Health; Gold Coast Queensland Australia
| | - Eric Carlström
- Health and Crisis Management and Policy; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Donna Mills
- Department of Emergency Medicine; Sunshine Coast Hospital and Health Service; Brisbane Queensland Australia
| | - Julia Crilly
- Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
- Department of Emergency Medicine; Gold Coast Health; Gold Coast Queensland Australia
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Simon GI, Craswell A, Thom O, Fung YL. Authors' reply to comment Blood transfusion strategies in elderly patients. Lancet Haematol 2017; 4:e508. [PMID: 28919086 DOI: 10.1016/s2352-3026(17)30172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Geoff I Simon
- School of Health and Sports Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4558, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Yoke Lin Fung
- School of Health and Sports Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4558, Australia
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19
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Simon GI, Craswell A, Thom O, Fung YL. Outcomes of restrictive versus liberal transfusion strategies in older adults from nine randomised controlled trials: a systematic review and meta-analysis. The Lancet Haematology 2017; 4:e465-e474. [DOI: 10.1016/s2352-3026(17)30141-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 01/28/2023]
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20
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Cabilan CJ, Vallmuur K, Eley R, Judge C, Cochrane S, Reed C, Riordan J, Roberts K, Thom O, Wood G. Impact of ladder-related falls on the emergency department and recommendations for ladder safety. Emerg Med Australas 2017; 30:95-102. [DOI: 10.1111/1742-6723.12854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/22/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- CJ Cabilan
- Department of Emergency Medicine; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Kirsten Vallmuur
- Centre for Accident Research and Road Safety; Queensland University of Technology; Brisbane Queensland Australia
| | - Rob Eley
- Department of Emergency Medicine; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Chantelle Judge
- Department of Emergency Medicine; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Sarah Cochrane
- Department of Emergency Medicine; Nambour Hospital; Sunshine Coast Queensland Australia
| | - Connie Reed
- Centre for Accident Research and Road Safety; Queensland University of Technology; Brisbane Queensland Australia
| | - Jessica Riordan
- Department of Emergency Medicine; Nambour Hospital; Sunshine Coast Queensland Australia
| | - Kym Roberts
- Department of Emergency Medicine; Nambour Hospital; Sunshine Coast Queensland Australia
| | - Ogilvie Thom
- Department of Emergency Medicine; Nambour Hospital; Sunshine Coast Queensland Australia
| | - Gabriella Wood
- Department of Emergency Medicine; Nambour Hospital; Sunshine Coast Queensland Australia
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21
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Kelly AM, Keijzers G, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Holdgate A, Lawoko C, Laribi S, Cowell DL, Jain N, Villecourt T, Lee K, Chalkley D, Lozzi L, Asha SE, Duffy M, Watkins G, Rosengren D, Thone J, Martin S, Orda U, Thom O, Kinnear F, Watson M, Eley R, Ryan A, Morel DG, Furyk J, Smith RD, Grummisch M, Meek R, Rosengarten P, Chan B, Haythorne H, Archer P, Wilson K, Knott J, Ritchie P, Bryant M, MacDonald S, Mahlangu M, Scott M, Cheri T, Nguyen M, Chor MS, Wong CP, Wong TW, Leung L, Man CK, Rahman NH, Lee WY, Lee FCY, Goh SE, Russell K. An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Acad Emerg Med 2017; 24:328-336. [PMID: 27743490 DOI: 10.1111/acem.13118] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/29/2016] [Accepted: 09/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective was to describe the epidemiology of dyspnea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome. METHODS Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea. RESULTS A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%). CONCLUSION Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
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Affiliation(s)
- Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health Sunshine Hospital Parkville Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Parkville Australia
| | - Gerben Keijzers
- Department of Emergency Medicine Gold Coast University Hospital Gold Coast QLD Australia
- School of Medicine Bond University Gold Coast QLD Australia
- School of Medicine Griffith University Gold Coast QLD Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health Sunshine Hospital Parkville Australia
| | - Colin A. Graham
- Chinese University of Hong Kong Prince of Wales Hospital Shatin Hong Kong SAR
| | - Simon Craig
- Emergency Department Monash Medical Centre Clayton Australia
- School of Clinical Sciences Monash University Clayton Australia
- Murdoch Children's Research Institute Parkville Australia
| | - Win Sen Kuan
- Emergency Medicine Department National University Health System and the Department of Surgery Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Peter Jones
- Department of Emergency Medicine Auckland City Hospital Auckland New Zealand
| | - Anna Holdgate
- Department of Emergency Medicine Liverpool Hospital and the University of New South Wales (Southwest Clinical School) Sydney Australia
| | - Charles Lawoko
- Statistical Consulting Service Graduate Research Centre Victoria University Footscray Australia
| | - Said Laribi
- Emergency Medicine Department Tours University Hospital (SL) Tours France
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Chu KH, Howell TE, Keijzers G, Furyk JS, Eley RM, Kinnear FB, Thom O, Mahmoud I, Brown AFT. Acute Headache Presentations to the Emergency Department: A Statewide Cross-sectional Study. Acad Emerg Med 2017; 24:53-62. [PMID: 27473746 DOI: 10.1111/acem.13062] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined. METHODS A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined. RESULTS There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was "worst ever" in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography (CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and "primary headache not further specified" in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively. CONCLUSIONS The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions.
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Affiliation(s)
- Kevin H. Chu
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Tegwen E. Howell
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Gerben Keijzers
- School of Medicine Griffith University Nathan Queensland Australia
- School of Medicine Bond University Gold Coast Queensland Australia
- Department of Emergency Medicine Gold Coast University Hospital Gold Coast Queensland Australia
| | - Jeremy S. Furyk
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
- Department of Emergency Medicine The Townsville Hospital Townsville Queensland Australia
| | - Robert M. Eley
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine Princess Alexandra Hospital Brisbane Queensland Australia
| | - Frances B. Kinnear
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine The Prince Charles Hospital Brisbane Queensland Australia
| | - Ogilvie Thom
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine Nambour General Hospital Nambour Queensland Australia
| | - Ibrahim Mahmoud
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Anthony F. T. Brown
- School of Medicine University of Queensland Herston Queensland Australia
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia
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Johnston A, Abraham L, Greenslade J, Thom O, Carlstrom E, Wallis M, Crilly J. Review article: Staff perception of the emergency department working environment: Integrative review of the literature. Emerg Med Australas 2016; 28:7-26. [PMID: 26784282 PMCID: PMC4755193 DOI: 10.1111/1742-6723.12522] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/01/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
Abstract
Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative-descriptive studies, four mixed descriptive/comparative (non-randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence-based interventions to improve staff morale.
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Affiliation(s)
- Amy Johnston
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia
| | - Louisa Abraham
- Department of Emergency MedicineNambour HospitalNambourQueenslandAustralia
- Department of Emergency MedicineCaloundra HospitalCaloundraQueenslandAustralia
| | - Jaimi Greenslade
- Department of Emergency MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Ogilvie Thom
- Department of Emergency MedicineNambour HospitalNambourQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | | | - Marianne Wallis
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- School of Nursing and MidwiferyUniversity of the Sunshine CoastMaroochydoreQueenslandAustralia
| | - Julia Crilly
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia
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Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, Torpie T, Dux C, Narula R. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2015.06.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rickard CM, Marsh N, Webster J, Playford EG, McGrail MR, Larsen E, Keogh S, McMillan D, Whitty JA, Choudhury MA, Dunster KR, Reynolds H, Marshall A, Crilly J, Young J, Thom O, Gowardman J, Corley A, Fraser JF. Securing All intraVenous devices Effectively in hospitalised patients--the SAVE trial: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e008689. [PMID: 26399574 PMCID: PMC4593168 DOI: 10.1136/bmjopen-2015-008689] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Over 70% of all hospital admissions have a peripheral intravenous device (PIV) inserted; however, the failure rate of PIVs is unacceptably high, with up to 69% of these devices failing before treatment is complete. Failure can be due to dislodgement, phlebitis, occlusion/infiltration and/or infection. This results in interrupted medical therapy; painful phlebitis and reinsertions; increased hospital length of stay, morbidity and mortality from infections; and wasted medical/nursing time. Appropriate PIV dressing and securement may prevent many cases of PIV failure, but little comparative data exist regarding the efficacy of various PIV dressing and securement methods. This trial will investigate the clinical and cost-effectiveness of 4 methods of PIV dressing and securement in preventing PIV failure. METHODS AND ANALYSIS A multicentre, parallel group, superiority randomised controlled trial with 4 arms, 3 experimental groups (tissue adhesive, bordered polyurethane dressing, sutureless securement device) and 1 control (standard polyurethane dressing) is planned. There will be a 3-year recruitment of 1708 adult patients, with allocation concealment until randomisation by a centralised web-based service. The primary outcome is PIV failure which includes any of: dislodgement, occlusion/infiltration, phlebitis and infection. Secondary outcomes include: types of PIV failure, PIV dwell time, costs, device colonisation, skin colonisation, patient and staff satisfaction. Relative incidence rates of device failure per 100 devices and per 1000 device days with 95% CIs will summarise the impact of each dressing, and test differences between groups. Kaplan-Meier survival curves (with log-rank Mantel-Cox test) will compare device failure over time. p Values of <0.05 will be considered significant. Secondary end points will be compared between groups using parametric or non-parametric techniques appropriate to level of measurement. ETHICS AND DISSEMINATION Ethical approval has been received from Queensland Health (HREC/11/QRCH/152) and Griffith University (NRS/46/11/HREC). Results will be published according to the CONSORT statement and presented at relevant conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN); 12611000769987.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Rural Health, Monash University, Churchill, Victoria, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David McMillan
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
- Biomedical Engineering and Medical Physics, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Heather Reynolds
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrea Marshall
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Jeanine Young
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Ogilvie Thom
- Nambour General Hospital, Nambour, Queensland, Australia
- Sunshine Coast Clinical School, The University of Queensland, Nambour, Queensland, Australia
| | - John Gowardman
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- Alliance for Vascular Access Teaching and Research, NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
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Keys M, Sim BZ, Thom O, Tunbridge MJ, Barnett AG, Fraser JF. Efforts to Attenuate the Spread of Infection (EASI): a prospective, observational multicentre survey of ultrasound equipment in Australian emergency departments and intensive care units. CRIT CARE RESUSC 2015; 17:43-46. [PMID: 25702761] [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: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Ultrasound is a common and necessary part of acute care medicine, but may present an infection risk to patients secondary to transfer of infectious agents between patients. Our primary objective was to detect blood contamination on ultrasound equipment in emergency departments (EDs) and intensive care units. Secondary objectives included detection of microbial contamination and determination of factors associated with contamination. DESIGN AND SETTING We tested ultrasound equipment used in five EDs and five ICUs for blood and microbial contamination, and collated and analysed contamination data using tables and multiple logistic regression. MAIN OUTCOME MEASURES AND RESULTS We performed 109 tests for blood and 131 tests for microbial contamination, with 61% of samples testing positive for blood contamination (95% CI, 52%-71%) and 48% testing positive for microbiological contamination (95% CI, 40%-57%). Transducer leads and transducers had high blood contamination (88% and 57%, respectively) and microbiological contamination (62% and 46%, respectively). Equipment from ICUs was less likely to test positive (odds ratio, 0.55; 95% CI, 0.37-0.79). Only 51% of blood-contaminated samples were visibly stained, and visible staining was not associated with microbiological contamination (57%; P=1). CONCLUSION Our results show significant contamination of ultrasound equipment, and that visual inspection of equipment is neither sufficient nor reliable in excluding contamination. Ultrasound equipment is a possible factor in the transmission of infectious diseases in EDs and ICUs. Guidelines must be formulated, disseminated and rapidly adopted to ensure the safety of the most acutely ill patients exposed to ultrasound procedures in acute care settings.
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Affiliation(s)
- Matthew Keys
- Critical Care Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Beatrice Z Sim
- Critical Care Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ogilvie Thom
- Critical Care Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Matthew J Tunbridge
- Critical Care Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, University of Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia
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Abstract
OBJECTIVE To determine trainee perspectives of the utility of a trainee research project (TRP) or the coursework pathway (CP) in completing the Trainee Research Requirement of the ACEM. METHODS A survey based on the ACEM learning objectives for research was sent to all trainees and Fellows who had completed or intending to complete the Trainee Research Requirement between 2010 and 2012. Participants were asked to rate the value of the TRP or CP on a scale of 1 to 10 (1 = 'not useful' and 10 = 'invaluable'). In addition, open-ended questions were asked for qualitative assessment. RESULTS Survey response was 142/621 (23%). Most participants had undertaken the CP (113/142, 79%). Median scores were better for the CP compared with the TRP, and when results were dichotomised to scores of 1-5 as being not useful and 6-10 as being useful, a significantly higher proportion of participants rated the CP as being useful across all learning objectives (P ≤ 0.01). There was a bimodal distribution of scores for TRPs, with a minority of trainees reporting a very poor TRP experience. Cost was the most commonly cited negative aspect of the CP, whereas the TRP was perceived as time consuming and being difficult to attain. CONCLUSIONS More ACEM trainees are undertaking the CP compared with a TRP. The CP was associated with better self-reported fulfilment of the ACEM learning objectives for research. There is scope for the ACEM to improve the experience of trainees wishing to undertake their own research projects.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Burkett E, Marwick T, Thom O, Kelly AM. A comparative analysis of risk stratification tools for emergency department patients with chest pain. Int J Emerg Med 2014; 7:10. [PMID: 24506937 PMCID: PMC3922183 DOI: 10.1186/1865-1380-7-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 10/18/2013] [Accepted: 01/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS). Methods This prospective observational study evaluated ED patients aged ≥30 years with non-traumatic chest pain for which no definitive non-ischemic cause was found. Data collected included demographic and clinical information, investigation findings and occurrence of MACE by 30 days. The outcome of interest was the comparative predictive performance of the risk tools for MACE at 30 days, as analyzed by receiver operator curves (ROC). Results Two hundred eighty-one patients were studied; the rate of MACE was 14.1%. Area under the curve (AUC) of the HFA, TIMI RS and Goldman tools for the endpoint of MACE was 0.54, 0.71 and 0.67, respectively, with the difference between the tools in predictive ability for MACE being highly significant [chi2 (3) = 67.21, N = 276, p < 0.0001]. Conclusion The TIMI RS and Goldman tools performed better than the HFA in this undifferentiated ED chest pain population, but selection of cutoffs balancing sensitivity and specificity was problematic. There is an urgent need for validated risk stratification tools specific for the ED chest pain population.
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Affiliation(s)
| | | | | | - Anne-Maree Kelly
- School of Public Health, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
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Thom O, Keijzers G, Davies S, McD Taylor D, Knott J, Middleton PM. Clinical research priorities in emergency medicine: Results of a consensus meeting and development of a weighting method for assessment of clinical research priorities. Emerg Med Australas 2014; 26:28-33. [DOI: 10.1111/1742-6723.12186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine; Nambour General Hospital; Sunshine Coast Queensland Australia
- School of Medicine; University of Queensland; Sunshine Coast Queensland Australia
| | - Gerben Keijzers
- Department of Emergency Medicine; Gold Coast University Hospital; Gold Coast Queensland Australia
- School of Medicine; Bond University; Gold Coast Queensland Australia
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Suzanne Davies
- Distributed Research in Emergency and Acute Medicine (DREAM) Collaboration; Sydney New South Wales Australia
- Australian Resuscitation Council; NSW Branch; Australia
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - David McD Taylor
- Emergency and General Medicine Research; Austin Health; Melbourne Victoria Australia
- University of Melbourne; Parkville Victoria Australia
| | - Jonathan Knott
- University of Melbourne; Parkville Victoria Australia
- Department of Emergency Medicine; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Paul M Middleton
- Distributed Research in Emergency and Acute Medicine (DREAM) Collaboration; Sydney New South Wales Australia
- Australian Resuscitation Council; NSW Branch; Australia
- Discipline of Emergency Medicine; University of Sydney; Sydney New South Wales Australia
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McDonald CI, Fraser JF, Shekar K, Dunster KR, Thom O, Fung YL. Transfusion of packed red blood cells reduces selenium levels and increases lipid peroxidation in anin vivoovine model. Transfus Med 2013; 24:50-4. [DOI: 10.1111/tme.12087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. I. McDonald
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
- Department of Anaesthesia and Perfusion; The Prince Charles Hospital; Chermside 4032 Australia
| | - J. F. Fraser
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
- Adult Intensive Care Unit; The Prince Charles Hospital; Chermside 4032 Australia
| | - K. Shekar
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
- Adult Intensive Care Unit; The Prince Charles Hospital; Chermside 4032 Australia
| | - K. R. Dunster
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
| | - O. Thom
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
- Department of Emergency Medicine; The Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Y. L. Fung
- Critical Care Research Group; The University of Queensland and The Prince Charles Hospital; Chermside 4032 Australia
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Abstract
OBJECTIVE To determine the clinical research priorities of Fellows of the Australasian College for Emergency Medicine (ACEM) in order to inform the strategic research agenda specific to multicentre clinical research. METHODS An anonymous survey of all ACEM Fellows (FACEMs) listed on the ACEM researcher database was conducted between January and March 2013. RESULTS Of 108 FACEMs invited to participate, 54 (50%) responded. Over half of respondents (61%) had a higher research degree but only a minority (24%) had funded research positions. The top research categories identified as priorities were resuscitation, trauma, cardiology, ED ultrasound, acute behavioural disturbance and geriatrics. The most common specific sub-categories included anterior chest pain, fluid resuscitation in trauma, and drug therapy for both atrial fibrillation and acute behavioural disturbance. Several specific research questions related to chest pain, resuscitation/sepsis, stroke, paediatrics and pulmonary embolus. CONCLUSION The findings provide guidance and support for research areas amenable to collaborative multicentre clinical research within emergency medicine. Discussion rounds are planned to translate these perceived research priorities to actual priorities.
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Affiliation(s)
- Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Fung YL, Tung JP, Foley SR, Simonova G, Thom O, Staib A, Collier J, Dunster KR, Solano C, Shekar K, Chew MS, Fraser JF. Stored blood transfusion induces transient pulmonary arterial hypertension without impairing coagulation in an ovine model of nontraumatic haemorrhage. Vox Sang 2013; 105:150-8. [PMID: 23458181 DOI: 10.1111/vox.12032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 11/26/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion of blood products in particular older products is associated with patient morbidity. Previously, we demonstrated a higher incidence of acute lung injury in lipopolysaccharide-treated sheep transfused with stored blood products. As transfusion following haemorrhage is more common, we aimed to determine whether a 'first hit' of isolated haemorrhage would precipitate similar detrimental effects following transfusion and also disrupt haemostasis. MATERIALS AND METHODS Anaesthetized sheep had 33% of their total blood volume collected into Leukotrap bags (Pall Medical), which were processed into packed red blood cells and cross-matched for transfusion into other sheep. After 30 mins, the sheep were resuscitated with either: fresh (<5 days old) or stored (35-42 days old) ovine blood followed by 4% albumin to replacement volume, albumin alone or normal saline alone and monitored for 4 h. RESULTS The first hit of haemorrhage precipitated substantial decreases in mean arterial pressure however haemostasis was preserved. Transfusion of stored ovine blood induced (1) transient pulmonary arterial hypertension but no oedema and (2) reduced fibrinogen levels more than fresh blood, but neither induced coagulopathy. Thus, transfusion of stored blood affected pulmonary function even in the absence of overt organ injury. CONCLUSION The fact that stored blood transfusions: (1) did not induce acute lung injury in contrast to previous lipopolysaccharide-primed animal models identifies the 'first hit' as an important determinant of the severity of transfusion-mediated injury; (2) impaired pulmonary dynamics verifies the sensitivity and vulnerability of the pulmonary system to injury.
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Affiliation(s)
- Y L Fung
- Critical Care Research Group, University of Queensland and The Prince Charles Hospital, Brisbane, QLD, Australia.
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Hansen K, Thom O, Rodda H, Price M, Jackson C, Bennetts S, Doherty S, Bartlett H. Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments. Emerg Med Australas 2011; 24:64-71. [DOI: 10.1111/j.1742-6723.2011.01491.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holdgate A, Taylor DM, Bell A, MacBean C, Huynh T, Thom O, Augello M, Millar R, Day R, Williams A, Ritchie P, Pasco J. Factors associated with failure to successfully complete a procedure during emergency department sedation. Emerg Med Australas 2011; 23:474-8. [PMID: 21824315 DOI: 10.1111/j.1742-6723.2011.01420.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine factors associated with failure to successfully complete a procedure during sedation in the ED. METHODS Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure and the success or failure of the procedure was recorded. RESULTS Data were available for 2567 patients. Of these, 1548 (60.3%, 95% CI 58.4-62.2) were male and 456 (17.8%, 95% CI 16.3-19.3) were age <16 years. The most common procedures performed were reduction of major joints and laceration repair. A total of 149 procedures (5.8%, 95% CI 5.0-6.8) failed. There were significant differences in failure rates between the types of procedure undertaken, with reduction of hips, digits and mandibles associated with the highest failure rates (P < 0.001). In adults, body weight >100 kg was also associated with increased risk of procedural failure (odds ratio 2.3, 95% CI 1.3-4.1). Ketamine used as a single agent had the lowest procedural failure rate (2.5%, 95% CI 1.1-5.4) whereas propofol had the highest (5.9%, 95% CI 4.6-7.6). However, these two drugs were generally used in different age groups and for different procedures. CONCLUSIONS Procedures performed under sedation in the ED have a low failure rate. However, increased body weight and specific procedures, such as hip reduction, are associated with significantly higher failure rates. Special consideration should be given to these patient groups before undertaking sedation in the ED.
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Affiliation(s)
- Anna Holdgate
- Liverpool Hospital, Sydney, New South Wales, Australia
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Bell A, Taylor DM, Holdgate A, MacBean C, Huynh T, Thom O, Augello M, Millar R, Day R, Williams A, Ritchie P, Pasco J. Procedural sedation practices in Australian Emergency Departments. Emerg Med Australas 2011; 23:458-65. [DOI: 10.1111/j.1742-6723.2011.01418.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taylor DM, Bell A, Holdgate A, MacBean C, Huynh T, Thom O, Augello M, Millar R, Day R, Williams A, Ritchie P, Pasco J. Risk factors for sedation-related events during procedural sedation in the emergency department. Emerg Med Australas 2011; 23:466-73. [PMID: 21824314 DOI: 10.1111/j.1742-6723.2011.01419.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the nature, incidence and risk factors for sedation-related events during ED procedural sedation, with particular focus on the drugs administered. METHODS Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and employed a specifically designed form. Multivariate logistic regression was employed to determine risk factors for sedation-related events. RESULTS Two thousand, six hundred and twenty-three patients were enrolled (60.3% male, mean age 39.2 years). Reductions of fracture/dislocations of shoulders, wrists and ankles were most common. Four hundred and sixty-one (17.6%) cases experienced at least one airway event that required intervention. Airway obstruction, hypoventilation and desaturation occurred in 12.7%, 6.4% and 3.7% of all patients, respectively. Two thousand, one hundred and forty-six cases had complete datasets for further analyses. Increasing age and level of sedation, pre-medication with fentanyl, and sedation with propofol, midazolam or fentanyl were risk factors for an airway event (P < 0.05). Ketamine was a protective factor. Hypotension (systolic pressure <80 mmHg) occurred in 34 (1.6%) cases with midazolam being a significant risk factor (P < 0.001). Vomiting also occurred in 34 (1.6%) cases, 12 of whom required an intervention. One patient aspirated. Vomiting occurred after administration of all drugs but was not associated with fasting status. Other events were rare. CONCLUSIONS Sedation-related events, especially airway events, are common but very rarely have an adverse outcome. Elderly patients, deeply sedated with short-acting agents, are at particular risk. The results will help tailor sedation to individual patients.
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Thom O, Taylor DM, Wolfe RE, Myles P, Krum H, Wolfe R. Pilot study of the prevalence, outcomes and detection of occult hypoperfusion in trauma patients. Emerg Med J 2010; 27:470-2. [DOI: 10.1136/emj.2009.073254] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Thom O, Taylor D, Wolfe R, Cade J, Myles P, Krum H, Wolfe R. Comparison of a supra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheter. Br J Anaesth 2009; 103:800-4. [DOI: 10.1093/bja/aep296] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thom O. Search for a non-invasive cardiac output monitor. Emerg Med Australas 2008; 20:199-200. [DOI: 10.1111/j.1742-6723.2008.01092.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thom O, Taylor D, Wolfe R, Judson R, Myles P, Krum H, Wolfe R. 9: A Comparison of the USCOM Cardiac Output Monitor With Base Excess for Detecting Occult Hypoperfusion in Emergency Department Trauma Patients. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE For many years, ambulance services throughout Australia have been administering methoxyflurane as a first-line analgesic agent. However, there is a paucity of literature regarding its efficacy, safety and usage profile. The present study was designed to examine the efficacy of methoxyflurane in adults. METHODS An observational case series was conducted over a 10 month period. Adults to whom methoxyflurane was administered while traveling by ambulance to an urban teaching hospital were enrolled. Data analysed included indications for use, verbal numerical pain scores, depth of sedation and adverse effects. Data were collected via paramedic, patient and ED staff surveys. RESULTS Eighty-three adult patients were enrolled over a 10 month period. A mean reduction in verbal numerical rating scale (VNRS) scores of 2.47 +/- 0.24 (on a 10-point scale) was recorded 5 min post methoxyflurane, with a total reduction of 3.21 +/- 0.24 at time of arrival at the ED. Both VNRS scores were significantly different from baseline (P < 0.0001). Fifteen patients (18.1%, 95% CI 9.8-26.4%) reported mild side-effects either during or shortly after administration. A total of 68 (81.9%, 95% CI 72.0-89.5%) of the paramedics and 60 (72.3%, 95% CI 61.4-81.6%) of the patients interviewed said that they felt satisfied with the level of analgesia provided by methoxyflurane. CONCLUSION The use of methoxyflurane as a prehospital analgesic significantly reduced pain in patients, with no significant side-effects attributed to its use. The majority of patients and paramedics interviewed were satisfied with its effects and indicated a willingness to use it again.
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Affiliation(s)
- Paul Buntine
- Emergency Department, Box Hill Hospital, Box Hill, Victoria, Australia.
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Abstract
OBJECTIVES To examine the published evidence regarding the use of transthoracic electric bioimpedance (TEB) for the non-invasive monitoring of cardiac output in the ED. METHOD Databases of the medical literature, relevant textbooks and the Internet were searched for articles regarding TEB. Criteria for inclusion were drawn up prior to examination of the articles and included adherence to guidelines for comparing methods of clinical measurement. RESULTS Results are discussed under the following headings: technological capability, diagnostic accuracy, limitations, range of possible uses, therapeutic impact, impact on health care providers, patient outcome and future directions. CONCLUSION TEB is a technique for the non-invasive monitoring of cardiac output whose ease of use, continuous data acquisition and versatility suggest it may have a role to play in the care of patients in our EDs.
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Affiliation(s)
- Ogilvie Thom
- Department of Epidemiology and Preventive Medicine, Monash University, Box Hill Hospital, Victoria, Australia.
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Abstract
The relationship between cell-mediated immunity and alcohol intake was studied in an Antarctic wintering group. Cell-mediated immune responses have previously been shown to be significantly lowered on the Antarctic Continent. The cause for this is yet to be elucidated. The cutaneous CMI Multitest was used to assess cell-mediated immunity. Carbohydrate deficient transferrin (CDT) was used to assess chronic alcohol consumption and acute consumption was self-reported. Results showed a significantly elevated incidence of anergy when compared with previous results (53 v. 6.5%). The incidence of hypoergy was similar to previously reported levels (34%). There was no relationship demonstrated between both acute or chronic alcohol consumption and levels of cell-mediated immunity using the Spearman Rank Correlation Coefficient. There was also no correlation found between CDT and self-reported alcohol intake. It is concluded that factors other than alcohol are responsible for the decrease in cell-mediated immunity in Antarctic wintering personnel.
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Affiliation(s)
- Ogilvie Thom
- Polar Medicine, Antarctic Division, Channel Highway, Kingston, Tasmania, Australia
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Pietsch A, Hilgendorff W, Thom O, Eggers R. Basic investigation of integrating a membrane unit into high-pressure decaffeination processing. Sep Purif Technol 1998. [DOI: 10.1016/s1383-5866(98)00065-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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