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Objective: To measure the prevalence of alcohol and/or other drug (AOD) detections in suspected major trauma patients with non‐transport injuries who presented to an adult major trauma centre. Methods: This registry‐based cohort study examined the prevalence of AOD detections in patients aged ≥18 years who: (i) sustained non‐transport injuries; and (ii) met predefined trauma call‐out criteria and were therefore managed by an interdisciplinary trauma team between 1 July 2021 and 31 December 2022. Prevalence was measured using routine in‐hospital blood alcohol and urine drug screens. Results: A total of 1469 cases met the inclusion criteria. Of cases with a valid blood test (n = 1248, 85.0%), alcohol was detected in 313 (25.1%) patients. Of the 733 (49.9%) cases with urine drug screen results, cannabinoids were most commonly detected (n = 103, 14.1%), followed by benzodiazepines (n = 98, 13.4%), amphetamine‐type substances (n = 80, 10.9%), opioids (n = 28, 3.8%) and cocaine (n = 17, 2.3%). Alcohol and/or at least one other drug was detected in 37.4% (n = 472) of cases with either a blood alcohol or urine drug test completed (n = 1263, 86.0%). Multiple substances were detected in 16.6% (n = 119) of cases with both blood alcohol and urine drug screens (n = 718, 48.9%). Detections were prevalent in cases of interpersonal violence (n = 123/179, 68.7%) and intentional self‐harm (n = 50/106, 47.2%), and in those occurring on Friday and Saturday nights (n = 118/191, 61.8%). Conclusion: AOD detections were common in trauma patients with non‐transport injury causes. Population‐level surveillance is needed to inform prevention strategies that address AOD use as a significant risk factor for serious injury. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The Broset Violence Checklist (BVC) can stratify the risk of violence and aggression in EDs. The aim of the present study was to report the initial uptake of introducing this checklist and associations with unplanned alerts to potential or actual violence in two EDs.The BVC was recommended in all patient care episodes. This retrospective review included routinely collected data from an adult tertiary referral hospital and a suburban mixed paediatric and adult ED over a 12‐month period. The primary outcome variable was completion of at least one BVC score and the secondary outcome was unplanned alerts to potential or actual violence episodes within the EDs.There were 121 330 presentations, of which 108 274 were included in the present study. The BVC was completed for 42 675 (39.4%) presentations. Using a cut‐off score of 3, BVC had a specificity of 99.2% (95% confidence interval [CI] 99.1–99.2) and a sensitivity of 15.6% (95% CI 12.5–19.3) for unplanned alerts to potential or actual violence events. Completion of a BVC was independently associated with more unplanned alerts to potential or actual violence events (adjusted odds ratio 1.37; 95% CI 1.12–1.66).The BVC was highly specific for violence and aggression but had low sensitivity. Completion of the BVC was associated with more frequent unplanned alerts to potential or actual violence events, suggesting that high‐risk patients might be identified intuitively, without formal scoring. Further exploration of the utility of the BVC in the ED is indicated with a focus on strategies to prevent violence and aggression. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The resuscitation of trauma patients with critical bleeding may follow a formulaic approach using high ratios of blood components or a viscoelastic haemostatic assay (VHA) guided approach. The aim of this study was to compare the two strategies for resuscitation of shocked trauma patients.This was a registry‐based cohort study including shocked trauma patients from two trauma centres–one practising a formulaic approach, with VHA unavailable during trauma resuscitation and the other practicing a VHA‐guided resuscitation strategy. The primary outcome was the total units of blood components transfused in 24 h after adjusting for differences in baseline characteristics and time to death.Between 01 Jan 2020 and 31 Dec 2022, 152 eligible patients were categorised to the formulaic group and 40 to the VHA group. Prehospital times were longer in the formulaic group (2.0 vs. 1.4 h), and more patients in the VHA group (38% vs. 17%) were transfused prehospital blood components. Formulaic resuscitation was associated with significantly more blood components transfused (adjusted incidence rate ratio 1.5; 95%CI: 1.4–1.7, p < 0.001). Using a formulaic approach, patients were administered more red blood cells, plasma and platelets, but fewer cryoprecipitate. There was no significant association of the formulaic approach with in‐hospital mortality (adjusted odds ratio 2.4; 95%CI: 0.7–8.0, p = 0.17).Given the cost and potential adverse effects of blood component transfusions, VHA‐guided transfusion strategies present an attractive option, particularly among centres managing high volumes of shocked patients. Further trials, enrolling the population most likely to benefit from precision transfusion strategies, are indicated. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder.This was a single‐centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure.After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23–1.69; P < 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83–3.33; P < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99–2.80; P = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65–1.23; P = 0.50), there was no significant association of the DLO service with time to disposition.The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient‐ and carer‐reported outcome measures and cost‐effectiveness studies are indicated. [ABSTRACT FROM AUTHOR]