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Background: The heterogeneity of inpatient pulmonary embolism (PE) presentations may lead to computed tomography pulmonary angiograms (CTPA) being over‐requested. Current clinical predictors for PE, including Wells criteria and Pulmonary Embolism Rule‐out Criteria (PERC), have predominantly focussed on outpatient and emergency department populations. Aim: To determine the clinical indicators for ordering inpatient CTPA and the predictors of positive scans for PE. Methods: Consecutive inpatient CTPA (performed >24 h after admission) from January 2017 to December 2017 were retrospectively reviewed. Variables including baseline characteristics, vital signs and risk factors for PE were extracted. Results: A total of 312 CTPA was reviewed (average patient age 67 years; 46% male) and 36 CTPA were positive for PE (11.5%). The average time to inpatient CTPA request was 7 days. Clinical indicators associated with positive scans were hypoxia (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.1–5.6), tachypnoea (OR 2.5; 95% CI 1.2–6.0), recent surgery or immobilisation (OR 2.7; 95% CI 1.2–6.4), S1Q3T3 pattern on electrocardiogram (ECG; OR 7.2; 95% CI 1.4–35.7) and right bundle branch block pattern on ECG (OR 4.7; 95% CI 1.6–13.1). Hypotension, fever and malignancy were not significant. Both PERC and Wells criteria had poor positive predictive value (12% and 27% respectively), but the negative predictive value for PERC and Wells was 100% and 95.8% respectively. Conclusion: Inpatient CTPA appear to be over‐requested and can potentially be rationalised based on a combination of clinical predictors and Wells criteria and/or PERC rule. Further prospective studies are needed to develop accurate clinical decision tools targeted towards inpatients. [ABSTRACT FROM AUTHOR]

A clinician's perspective on the first 20 years of the Australian and New Zealand Intensive Care Society Clinical Trials Group and its influence on intensive care clinical practice over this same time period. This point of view discusses the importance of the Clinical Trials Group and the significance of several major published research trials. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the important role that strategies which attempt to restore myocardial perfusion play in the management of patients with acute coronary syndrome. A discussion of guidelines on reperfusion strategy for acute coronary syndrome patients which were developed in 2011 by the Australian Resuscitation Council and the New Zealand Resuscitation Council is presented.