Australia's first cardiac emergency department: Patient profile, activity and performance in the initial 6 months.

OBJECTIVE: To profile the initial 6-month experience at the Victorian Heart Hospital (VHH) cardiac emergency (CE). The primary objective was to describe VHH CE patient characteristics, including presenting complaint, final diagnosis and disposition. Secondary objectives were to report on patient numbers, patient source and quality indicator performance including ambulance off-load by 40 min, waiting time and length of stay (LOS). METHODS: A retrospective review included all patients who presented to the VHH CE from 9 March 2023 to 8 September 2023. Patient reports containing the relevant clinical information were generated from the CE electronic medical record system. Diagnoses of MI were checked for accuracy by full record review. RESULTS: There were 3303 CE presentations in the first 6 months of operation, of which 6% were transferred from other sites. Median age was 65 years (interquartile range [IQR]: 53-77), 56% were males; the most common presenting complaints were presumed cardiac chest pain (67%) and arrhythmia (17%). The admission, discharge and transfer rates were 38%, 54% and 8%, respectively. In total, 15% were diagnosed with MI. The most common diagnoses for discharged and admitted patients were non-specific chest pain (57%) and ST-elevation MI (22%), respectively. Ambulance off-load by 40 min was met for 96%. Median waiting time was 6 min (IQR: 3-10). Median CE LOS for discharged and admitted patients was 3.2 h (IQR: 2.5-4.0) and 3.7 h (IQR: 1.8-6.0), with 75% and 56% being <4 h, respectively. CONCLUSIONS: The population predominantly had cardiovascular disease as expected. Some performance indicators, including ED LOS, were identified as requiring intervention.

Gender differences in female and male Australian football concussion injury: A prospective observational study of emergency department presentations.

OBJECTIVE: To examine gender differences in Australian football (AF)-related concussion presentations to EDs in regional Australia. METHODS: A prospective observational study of patients presenting to 1 of the 10 EDs in Western Victoria, Australia, with an AF-related concussion was conducted. Patients were part of a larger study investigating AF injuries over a complete AF season, including pre-season training and practice matches. Information regarding concussion injuries was extracted from patient medical records, including clinical features, concurrent injuries, mechanism and context of injury. Female and male data were compared with chi-squared and Fisher's exact tests. P < 0.05 was considered significant. RESULTS: From the original cohort of 1635 patients with AF-related injuries (242 female and 1393 male), 231 (14.1%) patients were diagnosed with concussion. Thirty-eight (15.7%) females had concussions versus 193 (13.9%) males (P > 0.05). Females over the age of 16 were more likely to be concussed than males in the same age range (females n = 26, 68.4% vs males n = 94, 48.7%; P = 0.026). Neurosurgically significant head injury was rare (one case). Similar rates of concurrent injury were found between females 15 (39.5%) and males 64 (33.2%), with neck injury the single most common in 24 (10.3%) concussions. Sixty-nine patients (29%) were admitted for observation or to await the results of scans. The majority of concussions occurred in match play (87.9%). Females were more likely injured in contested ball situations (63.2% vs 37.3%; P < 0.05). CONCLUSION: Concussion rates for community-level AF presentations to regional EDs were similar between genders. Serious head injury was rare, although hospital admission for observation was common. Concurrent injuries were common, with associated neck injury most often identified. Match play accounted for the majority of head injuries.

Childhood obesity in the ED: A prospective Australian study.

OBJECTIVE: To determine (i) the prevalence of overweight and obesity among children presenting to all EDs in a large regional Australian city and (ii) whether age, sex, socioeconomic status (SES) or hospital setting (public vs private) were associated with overweight and obesity. METHODS: This prospective observational study included children aged ≥2 and <18 years who presented to any of three EDs over an 18 month period who had their height and weight measured. Age, sex and residential postcode were collected. Weight category was determined by sex and age standardised body mass index (BMI) z-score. Weight category was assessed by sex, age, SES and hospital setting with chi-squared tests, and ordinal logistic regression with cluster sandwich error estimators. Results were reported using odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Data were collected for 3827 children, of which 11.6% were obese and 19.8% overweight. The prevalence of obesity was highest in those aged 8-14 years and in those from lower SES postcodes. The likelihood of obesity was higher in the public than the private hospitals (OR 0.66, 95% CI 0.51-0.86), whereas the likelihood of overweight was similar (OR 1.00, 95% CI 0.83-1.22). CONCLUSIONS: Almost one-third of children who presented to EDs were overweight or obese. Obesity was particularly high in those aged 8-14 years and those from lower SES postcodes. In the evolving obesity crisis, the high proportion of children presenting to EDs above a healthy weight might represent an opportunity for EDs to identify and refer children for body weight and lifestyle management.

Wrist, hand and finger injuries in Australian football: A prospective observational study of emergency department presentations.

OBJECTIVES: Investigate the characteristics of wrist, hand and finger (WHF) injuries in Australian footballers presenting to EDs and determine if injury profiles differed between females and males, and between children and adults. METHODS: In this prospective observational study that took place during an entire football season, patients attended 1 of 10 EDs in Victoria, Australia with a WHF injury sustained while playing Australian football. Data were extracted from patient medical records by trained researchers. Data included injury type (e.g. fracture), body part (e.g. metacarpal) and mechanism of injury. Males versus females, and children versus adults were compared using chi-squared tests or Fisher's exact tests. RESULTS: In total, 528 patients had a WHF injury, of which 105 (19.9%) were female and 308 (59.2%) were children. Fractures and sprains were the most common injury types (45.3% and 38.6%, respectively). Fingers were more often injured than wrists or hands (62.5%, 23.5% and 15.0%, respectively). Ball contact was the most common mechanism of injury (38.1% of injuries). Females were more likely than males to (i) have a sprain/strain injury, (ii) injure a finger (rather than wrist or hand) and (iii) injure themselves through ball contact. Children were more likely to injure their wrists, have a sprain/strain injury, or be injured falling to the ground. Adults were more likely to dislocate a joint or injure their hands. CONCLUSIONS: Differences in injury type, location and mechanism between females and males, and children and adults, suggest an opportunity for customised injury prevention and management strategies by sex and age.

Economic consequences of injury in female Australian footballers: A prospective observational study of emergency department presentations.

OBJECTIVE: Investigate the economic consequences of injuries to female Australian footballers from a health sector and societal perspective. METHODS: This prospective observational study invited 242 females to complete an online questionnaire 3-6 months following an Australian football injury which involved presentation to an ED in Victoria, Australia. The questionnaire inquired regarding healthcare use, time off work, return to playing football and extent of recovery following injury. Relevant information was also extracted from respondents' medical records regarding injury-type, body part injured, investigations and treatments. Healthcare costs were determined for each respondent's ED presentation, hospital admission/s (when relevant), and subsequent healthcare use. Societal costs were determined as lost income to the respondent and/or carer. RESULTS: A total of 108 people responded to the questionnaire. Sprains/strains and fractures accounted for 84.2% of respondents' injuries. Sixteen respondents (14.8%) required admission to hospital at the time of injury and 81 (75.0%) required subsequent healthcare appointments following discharge from the ED or hospital. Time off work or school following the injury was common (64.8% of respondents) and 27.8% of respondents had a carer take time off work. More than 80% of respondents missed training and matches following the injury. The median healthcare cost per respondent was AUD$753 and the median cost due to work absence was AUD$1393. One-quarter of respondents reported a full recovery. CONCLUSIONS: Injuries to female Australian footballers can produce substantial healthcare and societal costs, which has important implications for healthcare provision and prioritising and implementing injury prevention programmes and post-injury rehabilitation.

Gender differences in female and male Australian Football injuries - A prospective observational study of emergency department presentations.

OBJECTIVES: To compare injury-profiles of females and males presenting to Emergency Departments (EDs) with an Australian Football injury. DESIGN: Prospective observational study. METHODS: All patients presenting to one of 10 EDs in Victoria, Australia, with an Australian Football injury were included in the study. Data were prospectively collected over a 10 month period, coinciding with a complete Australian Football season, including pre-season training and practice matches. Relevant information was extracted from patient medical records regarding injury-type, body part injured, investigations and treatments required. Female and male data were compared with chi-squared and Fisher's exact tests. RESULTS: 1635 patients were included, of whom 242 (14.8%) were female. Females had a higher proportion of hand/finger injuries (34.3% v 23.4%), neck injuries (6.6% v 2.5%) and patella dislocations (2.9% v 0.6%). Males had a higher proportion of shoulder injuries (11.5% v 5.8%), skin lacerations (8.0% v 1.7%), and thorax/abdominal/pelvic injuries (5.7% v 2.1%). Concussion rates were similar between the genders, occurring in 14.1% of all patients. Anterior cruciate ligament injuries were infrequent (1.0%) and not significantly different between genders. Females received more imaging investigations (83.1% v 74.7%) and analgesia (62.4% v 48.5%). A higher proportion of males required admission to hospital (5.0% v 2.1%), usually for surgery. CONCLUSION: Australian Football injury profiles differed between females and males. Gender-specific injury prevention and management programs would be indicated based on the study findings.

Implementation of a checklist to assist in the rapid identification of seriously ill children in the emergency department: an observational study.

AIM: Interventions are required to expedite the identification and treatment of seriously ill children in the emergency department (ED). The aim of this study was to test the hypothesis that the implementation of a features of serious illness in children checklist (FSIC) for ED nursing staff would be associated with a reduction in the presentation-to-treatment time (PTTT) among children who required hospital admission and active treatment. METHODS: An observational study was conducted 8 weeks before and 8 weeks after the implementation of the FSIC. The study was conducted in a busy combined adult and paediatric ED. Participants were children admitted to the hospital via the ED with a potentially life-threatening illness. RESULTS: A total of 3640 patients age less than 18 years attended the ED during the observation period. Of these, 214 patients met the eligibility criteria: 111 pre-FSIC and 103 post-FSIC. The overall ED workload and case-mix were similar during the two observation periods. The PTTT was on average 16% (95% confidence interval, 17-33%; P = 0.302) longer following the implementation of the FSIC. CONCLUSION: The implementation of a checklist to assist ED nursing staff in the identification of seriously ill children was not effective in reducing the delay between presentation and the initiation of treatment among children who were admitted to the hospital. Larger studies are required to determine whether similar strategies are effective among a more critically ill subgroup. Consideration should also be given to alternative strategies to expedite the identification and treatment of seriously ill children in the ED.

Gluteal compartment syndrome.

Gluteal compartment syndrome is uncommon and is often diagnosed late, resulting in muscle necrosis and sciatic nerve palsy. The mainstay of treatment is prompt diagnosis and early surgery. A high index of suspicion is essential, especially in the setting of major bleeding and excessive pain. Embolization and hyperbaric oxygen may be considered as adjuncts to surgery.