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Objective: To assess the feasibility of an ED presenting complaint (PC) tool that categorised all ED PCs into 10 categories., Methods: A retrospective analysis of 1445 consecutive patient encounters was conducted. The primary outcome was the frequency of use of the 10 PC categories., Results: Of the 1203 patient encounters meeting inclusion criteria, the PC tool was completed by clinicians in 574 (47.7%). When completed, the tool's 10 options were selected for most presentations (72.3%)., Conclusion: The PC tool captured the majority of presenting complaints in 10 categories. External validation is recommended., (© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Objective: To ascertain and develop recommendations for analgesic management, discharge planning and further healthcare utilisation of adults presenting to an Australian tertiary ED with radicular or low back pain (LBP). Methods: This prospective cohort study included adults presenting with non‐specific LBP or radicular pain to an Australian tertiary ED. Participants with trauma/cancer‐related pain, and those requiring hospital admission or surgical interventions were excluded. The primary outcome was pharmacological and non‐pharmacological management delivered in ED, retrospectively collected via electronic medical records. The secondary outcomes include discharge management use, and changes made due to post‐discharge healthcare utilisation, as observed by weekly telephone questionnaires over 4‐weeks follow‐up. Results: Of the 100 participants recruited, 94 completed follow‐up. In ED, pharmacological management was received by 85%, including opioids (62%) and non‐steroidal anti‐inflammatory drugs (NSAIDS, 63%). Non‐pharmacological management was received by 73%, including patient education (71%) and exercise prescription (37%). In the first‐week post‐discharge, changes to initial discharge plan occurred in 50%, mostly carried out by GPs (76%). Over the follow‐up period, 51% received additional investigations/referrals. Pharmacological use decreased by 38% and non‐pharmacological use decreased by 10%. 16% of opioid‐naïve patients continued using opioids 4‐weeks post‐discharge. Conclusion: ED presentations for LBP were more often treated pharmacologically than non‐pharmacologically, with opioids commonly prescribed and NSAIDs potentially under‐utilised. Post‐discharge, additional investigations/referrals, discharge analgesia reductions and maintenance of non‐pharmacological management were common. Opioid initiation as a result of LBP presentations, signifies a potential 'gateway' towards unintentional long‐term use. Key study findings form our nine recommendations to inform ED LBP pain management. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the effectiveness of methoxyflurane versus standard care for the initial management of severe pain among adult emergency department (ED) patients. Methods: This randomized parallel‐group open‐label phase IV trial of methoxyflurane was conducted in a tertiary hospital ED setting in Australia. Inclusion criteria required adult patients to have an initial pain score ≥ 8 on the 11‐point Numerical Rating Scale (NRS). Patients were randomized 1:1 to receive either inhaled methoxyflurane (3 mL) or standard analgesic treatment at ED triage. The primary outcome was the proportion of patients achieving clinically substantial pain reduction, defined as a ≥50% drop in the pain score at 30 minutes. Secondary outcomes included the pain score at multiple time points (15, 30, 60, 90 minutes) and the difference in the proportion of patients achieving a >2‐point reduction on the NRS. Results: There were 120 patients randomized and analyzed between September 4, 2019, and January 16, 2020. The primary outcome was achieved in six (10%) patients in the methoxyflurane arm and three (5%) in the standard care arm (p = 0.49). A higher proportion of patients in the methoxyflurane arm reported a >2‐point drop on the NRS at all time points (17% vs. 5% at 15 minutes, 25% vs. 9% at 30 minutes, 30% vs. 10% at 60 minutes, and 33% vs. 13% at 90 minutes). Methoxyflurane use was also associated with lower median pain scores at all time points. Conclusion: Initial management with inhaled methoxyflurane in the ED did not achieve the prespecified substantial reduction in pain, but was associated with clinically significant lower pain scores compared to standard therapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to describe the epidemiological and clinical features of ED patients with suspected and confirmed COVID‐19. Methods: The COVID‐19 Emergency Department (COVED) Project is an ongoing prospective cohort study that includes all adult patients presenting to The Alfred Hospital ED who undergo testing for SARS‐CoV‐2. Current guidelines recommend testing for patients with fevers or chills, acute respiratory symptoms or a high‐risk exposure history, as well as implementation of infection prevention and control precautions for all suspected and confirmed cases. Study outcomes include a positive SARS‐CoV‐2 test result and intensive respiratory support. Results: In the period 1–30 April 2020, 702 of 3453 ED patients (20%; 95% CI 19–22) were tested, with a significant increase during the study period (incident rate ratio 1.019; 95% confidence interval 1.017–1.021, P < 0.001). The primary outcome of a positive SARS‐CoV‐2 test was recorded in 14 patients (2%; 95% confidence interval 1–3). Shortness of breath (77%), fatigue (100%), myalgia (67%) and diarrhoea (67%) were common among positive cases, while close contact (9%), fever (0%) and healthcare occupation (0%) were not. No positive cases required intensive respiratory support in the ED. Conclusions: The volume of ED patients with suspected COVID‐19 is increasing. Low numbers of positive cases precluded development of accurate predictive tools, but the COVED Project is fulfilling an important role in monitoring the burden of infection prevention and control requirements on the ED. The increasing number of patients meeting isolation criteria has the potential to impact on patient flow and may lead to ED overcrowding. [ABSTRACT FROM AUTHOR]

Objective: In Australia, the current ED burden related to COVID‐19 is from 'suspected' rather than 'confirmed' cases. The initial aim of the Registry for Emergency Care (REC) Project is to determine the impact of isolation processes on the emergency care of all patients. Methods: The REC Project builds on the COVID‐19 Emergency Department Quality Improvement (COVED) Project. Outcomes measured include times to critical assessment and management. Results: Clinical tools will be generated to inform emergency care, both during and beyond the COVID‐19 pandemic. Conclusions: The REC Project will support ED clinicians in the emergency care of all patients. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 Emergency Department (COVED) Quality Improvement Project aims to provide regular and real‐time clinical information to ED clinicians caring for patients with suspected and confirmed COVID‐19. The present study summarises data from the first 2 weeks of the study. Methods: COVED is an ongoing prospective cohort study that commenced on 1 April 2020. It includes all adult patients presenting to a participating ED who undergo testing for SARS‐CoV‐2. Data are collected prospectively and entered into a bespoke registry. Outcomes include a positive SARS‐CoV‐2 polymerase chain reaction test result and requirement for intensive respiratory support. Results: In the period 1–14 April 2020, 240 (16%) of 1508 patients presenting to The Alfred Emergency and Trauma Centre met inclusion criteria. Of these, 11 (5%) tested positive for SARS‐CoV‐2. The mean age of patients was 60 years and the commonest symptoms were acute shortness of breath (n = 122 [67%]), cough (n = 108 [56%]) or fever (n = 98 [51%]). Overseas travel or known contact with a confirmed case was reported by 24 (14%) and 16 (10%) patients, respectively. Fever or hypoxia was recorded in 23 (10%) and 11 (5%) patients, respectively. Eleven (5%) patients received mechanical ventilation in the ED, of whom none tested positive for SARS‐CoV‐2. Conclusions: Among patients presenting to a tertiary ED with suspected COVID‐19, only a small proportion tested positive for SARS‐CoV‐2. Although the low incidence of positive cases currently precludes the development of predictive tools, the COVED Project demonstrates that the rapid establishment of an agile clinical registry for emergency care is feasible. [ABSTRACT FROM AUTHOR]

Objectives: There is an urgency to support Australian ED clinicians with real‐time tools as the COVID‐19 pandemic evolves. The COVID‐19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED‐relevant clinical outcomes. Methods: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID‐19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. Results: Outcomes measured include being COVID‐19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. Conclusion: This project will support EDs during this pandemic. [ABSTRACT FROM AUTHOR]