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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]

Objective: To evaluate the impact of the Southeast Melbourne Virtual Emergency Department (SEMVED) on transfers from residential aged care facilities (RACFs) to traditional EDs. Methods: A cohort study of residents requesting transfer to the ED via ambulance within participating health networks' catchments from April to June 2022. Results: Two hundred thirty‐eight VED consultations occurred with 79% (188/238) avoiding transfer. This represented an avoidance of 12% (188/1511) of all requests for transfer during operating hours. Conclusions: SEMVED prevented unnecessary transfers and enabled in‐facility care. Integration into community outreach programmes could enhance care delivery. Patient safety outcomes were not formally assessed by our methodology. [ABSTRACT FROM AUTHOR]

Background and Objectives Materials and Methods Results Conclusion In the setting of trauma and suspected critical bleeding, indications to commence blood transfusions remain unclear, with high rates of potentially avoidable transfusions. Prehospital blood lactate measurements could help predict the need for blood transfusions. The aim of this study was to compare measurements detected by a point‐of‐care (POC) lactate device with laboratory measured lactate levels.This was a cross‐sectional study conducted in the emergency department. Eligible patients were those with suspected major trauma and critical bleeding. Venous or arterial blood samples were collected. POC measurements of lactate levels were conducted using a StatStrip Xpress® lactate meter and compared with laboratory values.Among 70 patients, the mean difference between the POC and laboratory lactate results was −0.19 mmol/L, with limits of agreement at −1.9 and 1.5. Most measurements (n = 66; 94.3%) were within the limits of agreement. A POC lactate level of >3.3 mmol/L had >90% specificity for transfusion, whereas a level <1.4 mmol/L had 90% sensitivity to rule out a transfusion.The level of agreement of POC lactate with the laboratory lactate was high. Research on clinical decision rules for pre‐hospital transfusion that incorporate POC lactate measures is therefore feasible. [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]

Introduction: Blunt cerebrovascular injuries (BCVIs) are uncommon but associated with ischemic stroke and disability, particularly in younger adults. There is a paucity of literature on the incidence and risk factors for BCVI. The aim of this study was to report the incidence and clinical characteristics of patients diagnosed with BCVI at an adult level 1 trauma centre. Methods: This was a registry-based cohort study. The accessible sample was all patients in the Alfred Hospital Trauma Registry (AHTR) who presented from January 2014 to June 2021 and were recorded to have BCVI. The diagnosis of BCVI was confirmed by independent, blinded neuroradiologists prior to study inclusion. Demographics, injury mechanism and associated injuries of patients were extracted from the AHTR and patient medical records. Results: There were 20,954 blunt trauma patients in the AHTR during the study period, of which 300 patients were confirmed to have 428 BCVIs. The incidence of BCVI was 1.4% (95%CI: 1.3–1.6). The mortality rate was 14% with a median survival time of 86 h from the time of injury. More men (65%) were diagnosed with BCVI than women and motor vehicle crashes (n = 180; 60%) were the most common mechanism of injury. Younger age, high transfer mechanisms, high injury severity, brain and chest trauma were associated with carotid artery injuries, while vertebral artery injuries were associated with older age, higher presenting GCS and cervical spinal injuries. Conclusion: The incidence of BCVI was low. The risk profile for patients with CAIs and VAIs were different. Consistent with the modified Denver criteria, high energy transfer mechanisms and cervical spinal injuries were identified to be high-risk features, but they impacted carotid and vertebral arteries differently. Any trauma involving these mechanisms should trigger investigation for the detection of BCVIs. [ABSTRACT FROM AUTHOR]

Introduction: Rapidly progressive necrotising soft tissue infections (NSTIs) are associated with high mortality and morbidity. Low incidence and disease heterogeneity contribute to low event rates and inadequately powered studies. The Necrotising Infections Clinical Composite Endpoint (NICCE) provides a binary outcome with which to assess interventions for NSTIs. Partly with a view towards studies of hyperbaric oxygen treatment in NSTIs we aimed to validate NICCE in a retrospective cohort of NSTI patients. Methods: Eligible patients were admitted between 2012 and 2021 to an adult major referral hospital in Victoria, Australia with surgically confirmed NSTI. The NICCE and its constituents were assessed in the whole cohort (n = 235). The cohort was divided into two groups using the modified sequential organ failure assessment (mSOFA) score, with an admission mSOFA score = 3 defined as high acuity. Results: Baseline characteristics of the whole (n = 235), the high (n = 188) and the low acuity cohorts (n = 47) were similar. Survival rates were high (91.1%). Patients with an admission mSOFA = 3 were less likely to meet NICCE criteria for 'success' compared to the lower acuity cohort (34.1% and 64.7% respectively). Meeting NICCE criteria was significantly associated with lower resource utilisation, measured by intensive care unit days, ventilator days, and hospital length of stay for all patients and for those with high acuity on presentation. Conclusions: The NICCE provides greater discriminative ability than mortality alone. It accurately selects patients at high risk of adverse outcomes, thereby enhancing feasibility of trials. Adaptation of NICCE to include patient-centred outcomes could strengthen its clinical relevance. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Any patient presenting with trismus should have tetanus considered as a differential diagnosis. Early recognition, timely treatment and supportive care can improve patient outcomes. Treatment with tetanus immunoglobulin to neutralize the toxin, antimicrobials to treat the infection and sedation in the intensive care unit are key therapeutic options. [ABSTRACT FROM AUTHOR]

Background: There is little consensus regarding the indications and utility of urinary tract imaging and type of imaging to perform in patients presenting with acute pyelonephritis (APN). Aims: The aims of this systematic review were to, among patients with APN, (i) identify the proportion of patients investigated with ultrasound (US), (ii) identify the proportion of abnormal US and (iii) identify the proportion of patients with a change in management resulting from abnormal US. Methods: A comprehensive search covered two electronic databases (Medline and EMBASE), with selection of studies performed independently by two investigators. Inclusion criteria were English language APN diagnosis and quantification of patients assessed with US or abnormal US results. Quality appraisal used the Newcastle–Ottawa instrument. Results: There were 35 studies included. The proportion of patients assessed with US was reported in 16 manuscripts and ranged from 20% to 94%, with significant heterogeneity and publication bias. The proportion of abnormal US was reported in 31 manuscripts and ranged from 7% to 79%. The proportion of abnormal US leading to change in management was reported in five studies and ranged from 7% to 59%. There was marked heterogeneity among studies included in all three subgroups. Conclusions: Patients with APN are commonly investigated with US, but only a small proportion have abnormalities and appear to be associated with changes in clinical management. The use of routine US for APN is therefore questioned. The identification of clinical variables for appropriate selection of patients to investigate with US requires further research. [ABSTRACT FROM AUTHOR]

Aim: Partnered Pharmacist Medication Charting (PPMC) in patients admitted under general medical units has been shown to reduce medication errors. The aim of this study is to evaluate the impact of the PPMC model on medication errors in patients admitted under cancer units in Victorian hospitals. Methods: A prospective cohort study comparing cohorts before and after the introduction of PPMC was conducted. This included a 2-month pre-intervention phase and 3-month intervention phase. PPMC was implemented during the intervention phase as new model of care that enabled credentialed pharmacists to chart all admission medications, including pre-admission or new medications and cancer therapies, in collaboration with the admitting medical officer. The proportion of medication charts with at least one error was the primary outcome measure. Results: Seven health services across Victoria were included in the study. The majority of health services were using paper-based prescribing systems for oncology. Of the 547 patients who received standard medical medication charting, 331 (60.5%) had at least one medication error identified compared to 18 out of 416 patients (4.3%) using the PPMC model (p < 0.001). The median (interquartile range) inpatient length of stay was 5 (2.9–10.6) days in pre-intervention and 4.9 (2.9–11) days in intervention (p = 0.88). In the intervention arm, 42 patients had cancer therapy charted by a pharmacist with no errors. Conclusions: PPMC was successfully scaled into cancer units as a collaborative medication safety strategy. The model was associated with significantly lower rates of medication errors, including cancer therapies. PPMC should be adopted more widely in cancer units in Australia. [ABSTRACT FROM AUTHOR]