Periprocedural analgesia and sedation in air enema reduction for intussusception: A retrospective Australian cohort study.

AIM: Periprocedural analgesia or sedation for air enema reduction (AER) of intussusception is a matter of debate. We set out to review Australian periprocedural pain management in AER. METHODS: Retrospective electronic medical record review of emergency department presentations of intussusception at an Australian children's hospital over 2 years for periprocedural analgesia and sedation and short-term outcomes. RESULTS: A total of 73 patients (mean age 23 months) had ultrasound-confirmed intussusception. Prior to AER, analgesia was administered to 61 of 73 (83.5%) patients. Opioids were administered in 48 of 73 (65.8%) and 8 of 73 (11.0%) received sedation. Thirteen of 73 (17.8%, 95% confidence interval 9.0-26.6) had spontaneously reduced; 60/73 that underwent primary AER had successful reduction in 54 (90.0%, 95% confidence interval 82.4-97.6). A total of seven patients required surgery. No AER attempts were complicated by bowel perforation. CONCLUSION: The use of periprocedural analgesia for AER in this Australian series was common, whilst sedation use was infrequent. No perforations occurred.

What informs care? Descriptions by multidisciplinary teams about burns care for Aboriginal and Torres Strait Islander children.

OBJECTIVE: To investigate factors informing burns care for Aboriginal and Torres Strait Islander children. DESIGN: In-depth qualitative study with semi-structured interview questions. SETTING AND PARTICIPANTS: Multidisciplinary team members who provide care for Aboriginal and Torres Strait Islander children in six tertiary burn units across five Australian jurisdictions. RESULTS: Results from 76 interviews suggest that burns care in Australia is informed by a web of complex factors including evidence, resources and resourcing, individual clinician decision making processes and beliefs, and models of care. A Western biomedical health paradigm governs healthcare system policy for burns care, that participants report is not always aligned with Aboriginal and Torres Strait Islander families' concepts of health and healing. Within this paradigm, allocation of resources informs the provision (or not) of care; as does expert information and direction from senior clinicians. Participants reported that jurisdictional specific models of burns care developed using service and team experience, population data and other evidence derived in a scientific paradigm also influence delivery of care. CONCLUSION: There is a need for changes in the way evidence informs policy and practice in burns care for Aboriginal and Torres Strait Islander children and families so that it incorporates Indigenous constructs of health and wellbeing.

Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths.

BACKGROUND: Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period. METHODS: We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated. RESULTS: Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56). CONCLUSIONS: Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.