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Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.
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OBJECTIVE: To identify risk factors for thunderstorm asthma (TA) in subjects ≥15 years of age from information available in routine clinical records. METHODS: Retrospective and hospital-based case-control study of various clinical factors in all TA cases (n = 53) who presented to a single-site ED in November 2016 (TA16) and in a control group of patients (n = 156) who presented to the same ED with asthma during the pollen season over eight non-TA years. Bivariate analysis and multivariable logistic regression modelling was performed to calculate the odds of TA asthma in the presence of potential risk factors. RESULTS: A logistic regression model revealed that the odds of TA were lower for age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95-0.99), higher for Asian country of birth (OR 4.09, 95% CI 1.40-11.95) and higher for oral beta-blocker use (OR 6.43, 95% CI 1.58-26.33) compared to controls. No difference was found between TA16 cases and controls for allergies (to medication, grass pollen, animal), hayfever, smoking, oral non-steroidal anti-inflammatory drugs, or aspirin. Newly diagnosed asthma was higher in TA16 cases versus controls (32.1% vs 12.2%, P = 0.001). CONCLUSIONS: Oral beta-blocker medications, younger age and Asian-born heritage are risk factors for TA. Further study is required to explore the potential association between beta-blockers and TA.
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Antagonistas Adrenérgicos beta/uso terapêutico , Asma/tratamento farmacológico , Estações do Ano , Tempo (Meteorologia) , Adulto , Asma/epidemiologia , Asma/etnologia , Asma/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Acute urinary retention (AUR) is a common presentation to emergency departments. This article updates the reader on the appropriate management, investigations and guidelines for AUR. It looks at the mechanism of normal micturition and describes the theories of AUR. It outlines urethral catheterization techniques for difficult cases, reviews suprapubic catheterization procedures and describes the management of AUR in polytrauma. Although emergency management is by bladder drainage, key points in the history and examination may expose significant, latent pathologies.
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Serviços Médicos de Emergência , Cateterismo Urinário , Retenção Urinária/terapia , Doença Aguda , Serviços Médicos de Emergência/métodos , Humanos , Cateterismo Urinário/métodosRESUMO
Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo.
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Vertigem Posicional Paroxística Benigna/diagnóstico , Nistagmo Patológico/diagnóstico , Vertigem/diagnóstico , Neuronite Vestibular/diagnóstico , Doença Aguda , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/fisiopatologia , Diagnóstico Diferencial , Feminino , Teste do Impulso da Cabeça , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/fisiopatologia , Exame Físico , Valor Preditivo dos Testes , Reflexo Vestíbulo-Ocular , Acidente Vascular Cerebral/diagnóstico , Vertigem/fisiopatologia , Neuronite Vestibular/fisiopatologiaRESUMO
BACKGROUND: Public hospital EDs in Australia have become increasingly congested because of increasing demand and access block. Six per cent of ED patients attend private hospital EDs whereas 45% of the population hold private health insurance. OBJECTIVES: This study describes the patients attending a small selection of four private hospital EDs in Queensland and Victoria, and tests the feasibility of a private ED database. METHODS: De-identified routinely collected patient data were provided by the four participating private hospital and amalgamated into a single data set. RESULT: The mean age of private ED patients was 52 years. Males outnumbered females in all age groups except > 80 years. Attendance was higher on weekends and Mondays, and between 08.00 and 20.00 h. There were 6.6% of the patients triaged as categories 1 and 2, and 60% were categories 4 or 5. There were 36.4% that required hospital admission. Also, 96% of the patients had some kind of insurance. Furthermore, 72% were self-referred and 12% were referred by private medical practitioners. Approximately 25% arrived by ambulance. There were 69% that completed their ED treatment within 4 h. CONCLUSION: This study is the first public description of patients attending private EDs in Australia. Private EDs have a significant role to play in acute medical care and in providing access to private hospitals which could alleviate pressure on public EDs. This study demonstrates the need for consolidated data based on a consistent data set and data dictionary to enable system-wide analysis, benchmarking and evaluation.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Seguro Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Queensland/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Triagem/estatística & dados numéricos , Vitória/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: To determine the agreement between the chemical dot NexTemp thermometer with mercury and tympanic thermometers and the repeatability of measurements using these devices. METHODS: A prospective study involving a convenience sample of 194 consenting adult patients presenting to the ED, Freemasons Hospital, East Melbourne, Victoria, Australia. A survey of emergency medical staff was conducted to determine what they considered an acceptable level of agreement and repeatability for a putative new thermometer. The NexTemp thermometer's performance was judged against this. For each thermometer, a set of two temperature measurements was made in every patient. The sequence of the set of readings (and hence device) was random between patients and the staff member performing one set was blinded to the results of the other two sets of readings in each patient. The method of Bland and Altman was used for assessing agreement and repeatability. RESULTS: Clinicians considered that a new thermometer should exhibit repeatability of +/- 0.3 degrees C and agree with existing devices within +/- 0.5 degrees C. The tympanic thermometer had 95% limits of repeatability of -0.8-0.5 degrees C compared with the NexTemp (-0.3-0.4 degrees C) and mercury thermometers (-0.3-0.4 degrees C). The NexTemp thermometer agreed with mercury thermometer within -0.6-0.5 degrees C. The tympanic thermometer agreed with the mercury thermometer within -1.0-1.1 degrees C. CONCLUSION: Based on temperature measurement only, the NexTemp thermometer can be used interchangeably with current mercury and tympanic thermometers.