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1. Diagnostic accuracy of a machine learning algorithm using point-of-care high-sensitivity cardiac troponin I for rapid rule-out of myocardial infarction: a retrospective study

Author

Stephensen, Laura, Brownlee, Emily, McCormick, Ellyse, Fincher, Gavin, Hall, Emma J., Hancock, Rebecca, Gaikwad, Niranjan, Gangathimmaiah, Vinay, Hamilton-Craig, Christian, Hobbins-King, Andrew, Keijzers, Gerben, Bayat, Maryam Khorramshahi, Mahmoodi, Ehsan, Perez, Siegfried, Ranasinghe, Isuru, Staib, Andrew, Zournazi, Anna, Than, Martin, Toprak, Betül, Solleder, Hugo, Di Carluccio, Eleonora, Greenslade, Jaimi H, Parsonage, William A, Schulz, Karen, Cullen, Louise, Apple, Fred S, Ziegler, Andreas, and Blankenberg, Stefan

Published
2024
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2. Machine learning for diagnosis of myocardial infarction using cardiac troponin concentrations

Author

Doudesis, Dimitrios, Lee, Kuan Ken, Boeddinghaus, Jasper, Bularga, Anda, Ferry, Amy V., Tuck, Chris, Lowry, Matthew T. H., Lopez-Ayala, Pedro, Nestelberger, Thomas, Koechlin, Luca, Bernabeu, Miguel O., Neubeck, Lis, Anand, Atul, Schulz, Karen, Apple, Fred S., Parsonage, William, Greenslade, Jaimi H., Cullen, Louise, Pickering, John W., Than, Martin P., Gray, Alasdair, Mueller, Christian, and Mills, Nicholas L.

Published
2023
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3. Single High-Sensitivity Point-of-Care Whole-Blood Cardiac Troponin I Measurement to Rule Out Acute Myocardial Infarction at Low Risk

Author

Apple, Fred S., Smith, Stephen W., Greenslade, Jaimi H., Sandoval, Yader, Parsonage, William, Ranasinghe, Isuru, Gaikwad, Niranjan, Schulz, Karen, Stephensen, Laura, Schmidt, Christian W., Okeson, Brynn, Cullen, Louise, Brownlee, Emily, Fincher, Gavin, Hall, Emma, Hancock, Rebecca, Gangathimmaiah, Vinay, Hamilton-Craig, Christian, Hobbins-King, Andrew, Keijzers, Gerben, Bayat, Maryam Khorramshahi, McCormick, Ellyse, Mahmoodi, Ehsan, Perez, Siegfried, Staib, Andrew, Zournazi, Anna, and Than, Martin

Published
2022
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4. Diagnostic accuracy of a machine learning algorithm using point-of-care high-sensitivity cardiac troponin I for rapid rule-out of myocardial infarction: a retrospective study

Author

Toprak, Betül, Solleder, Hugo, Di Carluccio, Eleonora, Greenslade, Jaimi H, Parsonage, William A, Schulz, Karen, Cullen, Louise, Apple, Fred S, Ziegler, Andreas, Blankenberg, Stefan, Stephensen, Laura, Brownlee, Emily, McCormick, Ellyse, Fincher, Gavin, Hall, Emma J., Hancock, Rebecca, Gaikwad, Niranjan, Gangathimmaiah, Vinay, Hamilton-Craig, Christian, Hobbins-King, Andrew, Keijzers, Gerben, Bayat, Maryam Khorramshahi, Mahmoodi, Ehsan, Perez, Siegfried, Ranasinghe, Isuru, Staib, Andrew, Zournazi, Anna, and Than, Martin

Abstract

Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) assays have been shown to provide similar analytical precision despite substantially shorter turnaround times compared with laboratory-based hs-cTn assays. We applied the previously developed machine learning based personalised Artificial Intelligence in Suspected Myocardial Infarction Study (ARTEMIS) algorithm, which can predict the individual probability of myocardial infarction, with a single POC hs-cTn measurement, and compared its diagnostic performance with standard-of-care pathways for rapid rule-out of myocardial infarction.

Published
2024
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12. Personalized diagnosis in suspected myocardial infarction

Author

Neumann , Johannes T, Twerenbold , Raphael, Ojeda, Francisco M, Aldous, Sally J., Allen, Brandon R., Apple, Fred S, Babel, Hugo, Christenson, Robert H., Cullen , Louise, Di Carluccio, Eleonora, Doudesis, Dimitrios, Ekelund, Ulf, Giannitsis, Evangelos, Greenslade, Jaimi H, Inoue, Kenji, Jernberg, Tomas, Kavsak, Peter A, Keller, Till, Lee, Kuan Ken, Lindahl, Bertil, Lorenz, Thiess, Mahler, Simon, Mills, Nicholas L, Mokhtari, Arash, Parsonage, William, Pickering, John W, Pemberton, Christopher J, Reichetzeder, Christoph, Richards, A Mark, Sandoval, Yader, Than , Martin P, Toprak, Betül, Troughton, Richard W, Worster, Andrew, Zeller, Tanja, Ziegler, Andreas, and Blankenberg, Stefan

Subjects
machine learning, troponin, probability, Validation, biomarker, Acute myocardial infarction, super learner
Abstract

Background. In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hs-cTn)-based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays.Methods. In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs cTn assays were derived to estimate the individual MI probability (ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1,688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients.Results. Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92-0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline-recommended strategy.Conclusion. We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care.

Published
2023
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14. External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction

Author

Cullen, Louise, Greenslade, Jaimi H, Stephensen, Laura, Ranasinghe, Isuru, Gaikwad, Niranjan, Khorramshahi Bayat, Maryam, Mahmoodi, Ehsan, Than, Martin, Apple, Fred, and Parsonage, William

Abstract

ObjectiveWe sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI).MethodsThis was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals between November 2020 and September 2021. Participants included those with symptoms of suspected AMI (without ST-segment elevation MI on presentation ECG). The Siemen’s Atellica IM hs-cTnI laboratory-based assay was used to measure troponin concentrations at admission and after 2–3 hours and cardiologists adjudicated final diagnoses. The HighSTEACS diagnostic algorithm was evaluated, incorporating hs-cTnI concentrations at presentation and absolute changes within the first 2 to 3 hours. The primary outcome was index AMI, including type 1 or 2 non-ST segment elevation MI (NSTEMI) or ST-elevation MI (STEMI) following presentation. 30-day major adverse cardiac outcomes (including AMI, urgent revascularisation or cardiac death) were also reported. The trial was registered with the Australian and New Zealand Clinical Trials Registry.Results1994 patients were included. The average age was 56.2 years (SD=15.6), and 44.9% were women. 118 (5.9%) patients had confirmed index AMI. The 2-hour algorithm defined 61.3% of patients as low risk. Sensitivity was 99.1% (94.0%–99.9%) and negative predictive value was 99.9% (99.3%–100%). 24.4% of patients were deemed intermediate risk. When applying the parameters for high risk, 252 (14.3%) were identified, with a specificity of 91.5% (88.7%–93.6%) and a PPV of 42.0% (35.6–48.7%).ConclusionsA 2-hour algorithm based on the HighSTEACS strategy using the Siemens Atellica IM hs-cTnI laboratory-based assay enables safe and efficient risk assessment of emergency patients with suspected AMI.Trial registration numberACTRN12621000053820.

Published
2024
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16. Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients

Author

Meller, Bernadette, Cullen, Louise, Parsonage, William A., Greenslade, Jaimi H., Aldous, Sally, Reichlin, Tobias, Wildi, Karin, Twerenbold, Raphael, Jaeger, Cedric, Hillinger, Petra, Haaf, Philip, Puelacher, Christian, Kern, Vera, Rentsch, Katharina, Stallone, Fabio, Rubini Gimenez, Maria, Ballarino, Paola, Bassetti, Stefano, Walukiewicz, Astrid, Troughton, Richard, Pemberton, Christopher J., Richards, A. Mark, Chu, Kevin, Reid, Christopher M., Than, Martin, and Mueller, Christian

Published
2015
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17. Emergency department presentations during the COVID‐19 pandemic in Queensland (to June 2021): interrupted time series analysis

Author

Sweeny, Amy L, primary, Keijzers, Gerben, additional, Marshall, Andrea, additional, Hall, Emma J, additional, Ranse, Jamie, additional, Zhang, Ping, additional, Grant, Gary, additional, Huang, Ya‐Ling, additional, Palipana, Dinesh, additional, Teng, Yang D, additional, Gerhardy, Benjamin, additional, Greenslade, Jaimi H, additional, Jones, Philip, additional, and Crilly, Julia L, additional

Published
2022
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18. Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department

Author

Kavsak, Peter A., Neumann, Johannes T., Cullen, Louise, Than, Martin, Shortt, Colleen, Greenslade, Jaimi H., Pickering, John W., Ojeda, Francisco, Ma, Jinhui, Clayton, Natasha, Sherbino, Jonathan, Hill, Stephen A., McQueen, Matthew, Westermann, Dirk, Sorensen, Nils A., Parsonage, William A., Griffith, Lauren, Mehta, Shamir R., Devereaux, P.J., Richards, Mark, Troughton, Richard, Pemberton, Chris, Aldous, Sally, Blankenberg, Stefan, and Worster, Andrew

Subjects
Abbott Laboratories (Abbott Park, Illinois), Mortality -- United States -- Australia -- New Zealand, Glucose, Hospital emergency services, Troponin, Coronary heart disease -- Diagnosis, Medical research, Cardiac patients, Pharmaceutical industry, Health
Abstract

BACKGROUND: Testing for high-sensitivity cardiac troponin (hs-cTn) may assist triage and clinical decision-making in patients presenting to the emergency department with symptoms of acute coronary syndrome; however, this could result in the misclassification of risk because of analytical variation or laboratory error. We sought to evaluate a new laboratory-based risk-stratification tool that incorporates tests for hs-cTn, glucose level and estimated glomerular filtration rate to identify patients at risk of myocardial infarction or death when presenting to the emergency department. METHODS: We constructed the clinical chemistry score (CCS) (range 0-5 points) and validated it as a predictor of 30-day myocardial infarction (MI) or death using data from 4 cohort studies involving patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome. We calculated diagnostic parameters for the CCS score separately using high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT). RESULTS: For the combined cohorts (n = 4245), 17.1% of participants had an MI or died within 30 days. A CCS score of 0 points best identified low-risk participants: the hs-cTnI CCS had a sensitivity of 100% (95% confidence interval [Cl] 99.5%-100%), with 8.9% (95% CI 8.1%-9.8%) of the population classified as being at low risk of MI or death within 30 days; the hs-cTnT CCS had a sensitivity of 99.9% (95% CI 99.2%-100%), with 10.5% (95% CI 9.6%-11.4%) of the population classified as being at low risk. The CCS had better sensitivity than hs-cTn alone (hs-cTnI < 5 ng/L: 96.6%, 95% Cl 95.0%-97.8%; hs-cTnT < 6 ng/L: 98.2%, 95% CI 97.0%-99.0%). A CCS score of 5 points best identified patients at high risk (hs-cTnI CCS: specificity 96.6%, 95% Cl 96.0%-97.2%; 11.2% [95% CI 10.3%-12.2%] of the population classified as being at high risk; hs-cTnT CCS: specificity 94.0%, 95% CI 93.1%-94.7%; 13.1% [95% Cl 12.1%-14.1%] of the population classified as being at high risk) compared with using the overall 99th percentiles for the hs-cTn assays (specificity of hs-cTnI 93.2%, 95% CI 92.3-94.0; specificity of hs-cTnT 73.8%, 95% CI 72.3-75.2). INTERPRETATION: The CCS score at the chosen cut-offs was more sensitive and specific than hs-cTn alone for risk stratification of patients presenting to the emergency department with suspected acute coronary syndrome. Study registration: ClinicalTrials.gov, nos. NCT01994577; NCT02355457, The use of a single high-sensitivity cardiac troponin (hs-cTn) test concentration on presentation to the emergency department has been proposed for triage and early decision-making in patients with suspected acute [...]

Published
2018
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20. Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Author

Eggers, Kai M., primary, Hammarsten, Ola, additional, Aldous, Sally J., additional, Cullen, Louise, additional, Greenslade, Jaimi H., additional, Lindahl, Bertil, additional, Parsonage, William A., additional, Pemberton, Christopher J., additional, Pickering, John W., additional, Richards, A. Mark, additional, Troughton, Richard W., additional, and Than, Martin P., additional

Published
2022
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24. Validation of High-Sensitivity Troponin I in a 2-Hour Diagnostic Strategy to Assess 30-Day Outcomes in Emergency Department Patients With Possible Acute Coronary Syndrome

Author

Cullen, Louise, Mueller, Christian, Parsonage, William A., Wildi, Karin, Greenslade, Jaimi H., Twerenbold, Raphael, Aldous, Sally, Meller, Bernadette, Tate, Jillian R., Reichlin, Tobias, Hammett, Christopher J., Zellweger, Christa, Ungerer, Jacobus P.J., Rubini Gimenez, Maria, Troughton, Richard, Murray, Karsten, Brown, Anthony F.T., Mueller, Mira, George, Peter, Mosimann, Tamina, Flaws, Dylan F., Reiter, Miriam, Lamanna, Arvin, Haaf, Philip, Pemberton, Christopher J., Richards, A. Mark, Chu, Kevin, Reid, Christopher M., Peacock, William Frank, Jaffe, Allan S., Florkowski, Christopher, Deely, Joanne M., and Than, Martin

Published
2013
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26. Value of single troponin values in the emergency department for excluding acute myocardial infarction in Aboriginal and Torres Strait Islander people

Author

Greenslade, Jaimi H., Berndt, Sara, Stephensen, Laura, Starmer, Katrina, Starmer, Greg, Parsonage, William, Lau, Victor, Drahm-Butler, Tileah, Davis, Tania, Campbell, Virginia, Stone, Richard, Bonnin, Robert, Ashover, Sarah, Milburn, Tanya, Mowatt, Elizabeth, Proctor, Karlie, Brazzale, Anthony, Cullen, Louise Ann, Greenslade, Jaimi H., Berndt, Sara, Stephensen, Laura, Starmer, Katrina, Starmer, Greg, Parsonage, William, Lau, Victor, Drahm-Butler, Tileah, Davis, Tania, Campbell, Virginia, Stone, Richard, Bonnin, Robert, Ashover, Sarah, Milburn, Tanya, Mowatt, Elizabeth, Proctor, Karlie, Brazzale, Anthony, and Cullen, Louise Ann

Published
2022

28. Retrospective study of the prevalence and characteristics of adverse drug events in adults who present to an Australian emergency department

Author

Brown, Nathan J., Doran, Elizabeth, Greenslade, Jaimi H., Lukin, Bill, Cottrell, Neil, Jaramillo, Fabian, Coombes, Ian, Donovan, Peter, Cullen, Louise, Brown, Nathan J., Doran, Elizabeth, Greenslade, Jaimi H., Lukin, Bill, Cottrell, Neil, Jaramillo, Fabian, Coombes, Ian, Donovan, Peter, and Cullen, Louise

Abstract

Objective: To determine the burden, on the ED, of harm from unintentional adverse drug events (ADEs) in the community. Methods: A retrospective, observational study of 936 randomly selected presentations to a level 6 ED at a principal referral hospital in Brisbane, Australia, in November 2017. Clinical records were screened by a pharmacist, who identified suspected ADEs. All suspected ADEs and a random selection of presentations without ADEs were reviewed by an expert panel, which classified, by consensus: occurrence and type of ADE, contribution of ADE to presentation, severity of harm and preventability of presentation. Medication-related ED presentations (ADE-Ps) and potential ADEs were, respectively, defined as presentations directly attributable to an ADE, and medication events that occurred but did not cause the ED presentation. Descriptive data analysis was performed. Results: The median (interquartile range) age of patients was 40 (27–58) years, with 49.7% (95% confidence interval [CI] 46.5–52.9) being male. The prevalences of ADE-Ps and potential ADEs were 9.2% (95% CI 7.5–11.3) and 5.0% (95% CI 3.8–6.6), respectively. The severity of harm was classified as ‘death or likely permanent harm’ in 4.7% (95% CI 0.2–9.1) of ADE-Ps, ‘temporary harm’ (89.5%, 95% CI 83.1–96.0) and ‘minimal or no harm’ (5.8%, 95% CI 0.9–10.8). Most (79.1%, 95% CI 70.5–87.7) ADE-Ps were preventable. Conclusions: There is a high burden on emergency care because of unintended medication harm in the community. Interventions to reduce such harm are likely to require a co-ordinated primary, acute and public healthcare response. The high proportion of presentations with potential ADEs indicates opportunity for harm mitigation in the ED.

Published
2022

29. Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain

Author

Eggers, Kai M., Hammarsten, Ola, Aldous, Sally J., Cullen, Louise, Greenslade, Jaimi H., Lindahl, Bertil, Parsonage, William A., Pemberton, Christopher J., Pickering, John W., Richards, A. Mark, Troughton, Richard W., Than, Martin P., Eggers, Kai M., Hammarsten, Ola, Aldous, Sally J., Cullen, Louise, Greenslade, Jaimi H., Lindahl, Bertil, Parsonage, William A., Pemberton, Christopher J., Pickering, John W., Richards, A. Mark, Troughton, Richard W., and Than, Martin P.

Abstract

Background Elevations of high-sensitivity cardiac troponin (hs-cTn) concentrations not related to type 1 myocardial infarction are common in chest pain patients presenting to emergency departments. The discrimination of these patients from those with type 1 myocardial infarction (MI) is challenging and resource-consuming. We aimed to investigate whether the hs-cTn I/T ratio might provide diagnostic and prognostic increment in this context. Methods We calculated the hs-cTn I/T ratio in 888 chest pain patients having hs-cTnI (Abbott Laboratories) or hs-cTnT (Roche Diagnostics) concentrations above the respective 99(th) percentile at 2 hours from presentation. All patients were followed for one year regarding mortality. Results The median hs-cTn I/T ratio was 3.45 (25(th), 75(th) percentiles 1.80-6.59) in type 1 MI patients (n = 408 (sic) 46.0%]), 1.18 (0.81-1.90) in type 2 MI patients (n = 56 (sic) 6.3%]) and 0.67 (0.39-1.12) in patients without MI. The hs-cTn I/T ratio provided good discrimination of type 1 MI from no type 1 MI (area under the receiver-operator characteristic curve 0.89 (sic) 95% confidence interval 0.86-0.91]), of type 1 MI from type 2 MI (area under the curve 0.81 (sic) 95% confidence interval 0.74-0.87]), and was associated with type 1 MI in adjusted analyses. The hs-cTn I/T ratio provided no consistent prognostic value. Conclusions The hs-cTn I/T ratio appears to be useful for early diagnosis of type 1 MI and its discrimination from type 2 MI in chest pain patients presenting with elevated hs-cTn. Differences in hs-cTn I/T ratio values may reflect variations in hs-cTn release mechanisms in response to different types of myocardial injury.

Published
2022
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30. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

Author

Chapman, Andrew R., Lee, Kuan Ken, McAllister, David A., Cullen, Louise, Greenslade, Jaimi H., Parsonage, William, Worster, Andrew, Kavsak, Peter A., Blankenberg, Stefan, Neumann, Johannes, Söerensen, Nils A., Westermann, Dirk, Buijs, Madelon M., Verdel, Gerard J. E., Pickering, John W., Than, Martin P., Twerenbold, Raphael, Badertscher, Patrick, Sabti, Zaid, Mueller, Christian, Anand, Atul, Adamson, Philip, Strachan, Fiona E., Ferry, Amy, Sandeman, Dennis, Gray, Alasdair, Body, Richard, Keevil, Brian, Carlton, Edward, Greaves, Kim, Korley, Frederick K., Metkus, Thomas S., Sandoval, Yader, Apple, Fred S., Newby, David E., Shah, Anoop S. V., and Mills, Nicholas L.

Published
2017
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31. Abstract 13566: High-Sensitivity Cardiac Troponin I at Presentation in Patients With Suspected Acute Coronary Syndrome

Author

Chapman, Andrew R, Lee, Kuan Ken, McAllister, David A, Cullen, Louise, Greenslade, Jaimi H, Parsonage, William, Worster, Andrew, Kavsak, Peter, Blankenberg, Stefan, Neumann, Johannes, Söerensen, Nils, Westermann, Dirk, Buijs, Madelon M, Verdel, Gerard J, Pickering, John W, Than, Martin P, Twerenbold, Raphael, Badertscher, Patrick, Sabti, Zaid, Mueller, Christian, Anand, Atul, Adamson, Philip, Strachan, Fiona E, Gray, Alasdair, Body, Richard, Keevil, Brian, Carlton, Edward, Greaves, Kim, Korley, Frederick K, Metkus, Thomas, Sandoval, Yader, Apple, Fred S, Newby, David, Shah, Anoop, and Mills, Nicholas L

Published
2017

34. Snapshot of suspected acute coronary syndrome assessment processes in the emergency department: A national cross‐sectional survey.

Author

Brownlee, Emily, Greenslade, Jaimi H, Kelly, Anne‐Maree, Meek, Robert A, Parsonage, William A, and Cullen, Louise

Subjects
*TROPONIN, *EXERCISE tests, *ECHOCARDIOGRAPHY, *HOSPITAL emergency services, *CROSS-sectional method, *CARDIOPULMONARY system, *ACUTE coronary syndrome, *RISK assessment, *MEDICAL protocols, *SURVEYS, *PUBLIC hospitals, *PROPRIETARY hospitals
Abstract

Objective: The Snapshot of Suspected ACS Assessment (SSAASY) study aims to describe the assessment processes for patients with suspected acute coronary syndrome (ACS) in Australian EDs, and to compare these processes with the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (NHFA/CSANZ) guidelines. Methods: Between March and May 2021, a cross‐sectional survey of Australian EDs was undertaken to investigate the assessment strategies used within the ED. All public and private hospitals identified as having dedicated EDs were invited to participate. Respondents provided data on hospital, ED and cardiac service characteristics. They also provided data on the risk stratification process recommended within their department (risk scores, troponin testing, objective testing for coronary artery disease). Awareness of the NHFA/CSANZ guidelines was assessed. Results: Responses were received from 109/162 departments (67%). Most sites (n = 100, 92%) reported using dedicated protocols developed by ED clinicians that included risk stratification scores. Highly sensitive troponin assays were used at 103 (94%) sites. Serial troponin testing was performed over 2 h for low‐risk patients in 53 (49%) sites and 2–3 h for intermediate and high‐risk patients in 74 (68%) sites. Further investigations included exercise stress tests (48%) and stress echocardiography (38%), with 45% of sites ordering outpatient investigations. Conclusions: The SSAASY study reported the strategies used to assess suspected ACS. In line with current NHFA/CSANZ guidelines, highly sensitive troponin assays are widely utilised. However, serial sampling intervals were longer than guideline recommendations, suggesting a translational gap between guidelines and clinical practice. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Value of single troponin values in the emergency department for excluding acute myocardial infarction in Aboriginal and Torres Strait Islander people

Author

Greenslade, Jaimi H, primary, Berndt, Sara, additional, Stephensen, Laura, additional, Starmer, Katrina, additional, Starmer, Greg, additional, Parsonage, William, additional, Lau, Victor, additional, Drahm‐Butler, Tileah, additional, Davis, Tania, additional, Campbell, Virginia, additional, Stone, Richard, additional, Bonnin, Robert, additional, Ashover, Sarah, additional, Milburn, Tanya, additional, Mowatt, Elizabeth, additional, Proctor, Karlie, additional, Brazzale, Anthony, additional, and Cullen, Louise Ann, additional

Published
2022
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41. Emergency department presentations during the COVID‐19 pandemic in Queensland (to June 2021): interrupted time series analysis.

Author

Sweeny, Amy L, Keijzers, Gerben, Marshall, Andrea, Hall, Emma J, Ranse, Jamie, Zhang, Ping, Grant, Gary, Huang, Ya‐Ling, Palipana, Dinesh, Teng, Yang D, Gerhardy, Benjamin, Greenslade, Jaimi H, Jones, Philip, and Crilly, Julia L

Abstract

Objectives: To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID‐19) pandemic to mid‐2021, a period of relatively low COVID‐19 case numbers. Design: Interrupted time series analysis. Setting: All 105 Queensland public hospital EDs. Main outcome measures: Numbers of ED presentations during the COVID‐19 lockdown period (11 March 2020 – 30 June 2020) and the period of easing restrictions (1 July 2020 – 30 June 2021), compared with pre‐pandemic period (1 January 2018 – 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury‐related conditions) and conditions (stroke, sepsis) (weekly numbers). Results: During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, –20.9% to –17.9%) than during the pre‐pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12‐month post‐lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. Conclusions: The COVID‐19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs. [ABSTRACT FROM AUTHOR]

Published
2023
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46. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol

Author

Than, Martin, Flaws, Dylan, Sanders, Sharon, Doust, Jenny, Glasziou, Paul, Kline, Jeffery, Aldous, Sally, Troughton, Richard, Reid, Christopher, Parsonage, William A, Frampton, Christopher, Greenslade, Jaimi H, Deely, Joanne M, Hess, Erik, Sadiq, Amr Bin, Singleton, Rose, Shopland, Rosie, Vercoe, Laura, Woolhouse-Williams, Morgana, Ardagh, Michael, Bossuyt, Patrick, Bannister, Laura, and Cullen, Louise

Published
2014
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49. Key occupational stressors in the ED: An international comparison

Author

Greenslade, Jaimi H., Wallis, Marianne, Johnston, Amy N.B., Carlström, Eric, Wilhelms, Daniel B., Crilly, Julia, Greenslade, Jaimi H., Wallis, Marianne, Johnston, Amy N.B., Carlström, Eric, Wilhelms, Daniel B., and Crilly, Julia

Abstract

Background: The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden). Method: This was a cross-sectional survey of staff working in eight hospitals in Australia and Sweden. Data were collected between July 2016 and June 2017 (depending on local site approvals) via a printed survey incorporating the 15-item ED stressor scale. The median stress score for each item and the frequency of experiencing each event was reported. Results: Events causing most distress include heavy workload, death or sexual abuse of a child, inability to provide optimum care and workplace violence. Stressors reported most frequently include dealing with high acuity patients, heavy workload and crowding. Violence, workload, inability to provide optimal care, poor professional relations, poor professional development and dealing with high-acuity patients were reported more commonly by Australian staff. Swedish respondents reported more frequent exposure to mass casualty incidents, crisis management and administrative concerns. Conclusions: Workload, inability to provide optimal care, workplace violence and death or sexual abuse of a child were consistently reported as the most distressing events across sites. The frequency with which these occurred differed in Australia and Sweden, likely due to differences in the healthcare systems.

Published
2020

50. Factors influencing physician risk estimates for acute cardiac events in emergency patients with suspected acute coronary syndrome

Author

Greenslade, Jaimi H., Sieben, Nicolas, Parsonage, William A., Knowlman, Thomas, Ruane, Lorcan, Than, Martin, Pickering, John W., Hawkins, Tracey, Cullen, Louise, Greenslade, Jaimi H., Sieben, Nicolas, Parsonage, William A., Knowlman, Thomas, Ruane, Lorcan, Than, Martin, Pickering, John W., Hawkins, Tracey, and Cullen, Louise

Abstract

Background Emergency physicians frequently assess risk of acute cardiac events (ACEs) in patients with undifferentiated chest pain. Such estimates have been shown to have moderate to high sensitivity for ACE but are conservative. Little is known about the factors implicitly used by physicians to determine the pretest probability of risk. This study sought to identify the accuracy of physician risk estimates for ACE in patients presenting to the ED with chest pain and to identify the demographic and clinical information emergency physicians use in their determination of patient risk. Methods This study used data from two prospective studies of consenting adult patients presenting to the ED with symptoms of possible acute coronary syndrome. ED physicians estimated the pretest probability of ACE. Multiple linear regression analysis was used to identify predictors of physician risk estimates. Logistic regression was used to determine whether there was a correlation between physicians' estimated risk and ACE. Results Increasing age, male sex, abnormal ECG features, heavy/crushing chest pain and risk factors were correlated with physician risk estimates. Physician risk estimates were consistently found to be higher than the expected proportion of ACE from the sampled population. Conclusion Physicians systematically overestimate ACE risk. A range of factors are associated with physician risk estimates. These include factors strongly predictive of ACE, such as age and ECG characteristics. They also include other factors that have been shown to be unreliable predictors of ACE in an ED setting, such as typicality of pain and risk factors.

Published
2020

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