Procedural sedation in emergency departments is performed on a daily basis. The current management plan arguably inflicts unnecessary pain and distress on children. This open label, multicenter, randomised control trial is investigating whether paediatric procedural sedation can be achieved with just one needle. The research team’s focus is the on determining the best outcome for the child in procedural sedation, prioritising psychological as well as medical consequences.READ MORE
The question of fluid volume in resuscitation has been identified as the top priority in sepsis research by emergency physicians in the United Kingdom, Australia and New Zealand. Guidelines and sepsis pathways recommend an initial intravenous (IV) fluid bolus of 30ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack of evidence from clinical trials to support this strategy. Both observational data as well as randomised studies suggest there may be harm associated with injudicious use of fluids in sepsis. Since there is equipoise regarding a more liberal or restricted fluid volume resuscitation as first line treatment for sepsis-related hypotension, we conducted the pilot multicentre REstricted Fluid REsuscitation in Sepsis-associated Hypotension (REFRESH) trial comparing a restricted fluid protocol with early initiation of vasopressor support against standard guideline care.
The data from REFRESH will inform feasibility of a large, multicentre phase III study. However, further ground work is essential for the optimal design of a Phase III trial that will provide valuable information on feasibility (road test recruitment rate and screening processes) as well as refinement of the protocol (sample size estimation, processes of care, prevalence of the population of interest, real world clinical practice regarding fluid use).
In this ARISE Fluids study, we aim to provide more insight into current practice by conducting a bi-national multi-site prospective observational study of fluid administration in (suspected) sepsis and hypotension in the Emergency Departments of Australia and New Zealand hospitals. Sites have been selected on the basis of having expressed interest in participating in a phase III trial.READ MORE
This study will collect information from the records of 3000 children from 30 hospitals presenting after a head injury in 2016 and will interview staff to look at different factors influencing the care provided. APHIRST-Gap is expected to provided crucial information on scan rates and inform strategies, including national guideline development to standardise and improve the care of children with head injury across Australia and New Zealand.
Head injury is a common reason children present to Emergency Departments in Australia and New Zealand. While most are minor the important issue for emergency clinicians is to determine whether a particular child is at risk of a serious head injury such as a bleed on the brain. A computerised tomography(CT) scan is the investigation of choice to look for these injuries. Its use is not without risks though, including those of sedation, and radiation induced cancer.
Several “rules” have been designed to guide doctors in the decision between risk of injury and risk of scan. The recently published Australasian APHIRST study examined three of these rules in our context. It found that all three rules performed well, clinicians made good judgements on who to scan, and the overall rate of CT scan use was low(10%). APHIRST was limited to 10 large metropolitan, and predominately children specific hospitals. Most children in Australia are not seen in these hospitals. Further research is required to determine whether there is a large variation in scan use between different hospitals and how best to apply these findings to a broader range of hospitals.
This trial is being run by the PREDICT network and the Principal Investigator is A/Prof Franz Babl.READ MORE
Most children with asthma presenting to an emergency department (ED) are managed with inhaled medications and oral steroids. Infrequently, some children are very unwell, and require assistance with their breathing, or intravenous medication Currently, there is minimal information to guide clinicians on which treatment to choose for severe acute asthma. All have side-effects, and we do not know which is most effective. Studies from the UK and Australasia demonstrate significant variation in practice, although Australasian data is nearly 10 years out of date. When comparing treatments, it is important to determine whether or not they can reduce the risk of severe complications, or whether they make a difference in important treatment outcomes.
This project will allow us to determine current management practices for children with severe acute asthma and/or wheeze; how common severe acute asthma is and also how frequently complications of severe asthma occur; and understand where differences in therapy exist between states/regions. We will be looking at sites across Australia and New Zealand. Once complete, this project will provide important data to allow us to design future research to establish the best treatments for severe asthma.
EMF is funding the Queensland sites taking part in this Australasian trial. This study is being run by the PREDICT network. The Chief Investigatory is A/Prof Simon Craig. The study will include 18,000 children aged 1 – 18 years treated for asthma in the ED.READ MORE
Bell’s palsy or acute idiopathic lower motor neurone facial paralysis is characterised by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. It is the third most common neurological reason for children to present acutely to hospital.
In adults, there is conclusive evidence from two major recent trials that a short course of prednisolone, a cheap, widely available and safe steroid, can significantly increase the number of Bell’s palsy patients who completely recover. While the medical problems associated with Bell’s palsy are similar, in children there is no good evidence that prednisolone is an effective treatment.
Many neurological conditions progress differently in children and treatment methods sometimes vary. Children may react differently to prednisolone and without paediatric evidence; treatment guidelines for children with Bell’s palsy remain absent or vague, with variable and overall low rates of steroid use in children by physicians.
The lack of evidence and clinical uncertainty in the treatment of Bell’s palsy in children warrants a definitive trial to determine the efficacy of prednisolone as a treatment for this condition in children. The aim of this study is to assess the utility of steroids in Bell’s palsy in children in a large multicentre randomised, placebo-controlled, trial. The trial will take place in at least 10 hospitals within Australia and New Zealand, involving more than 500 children.READ MORE
Fluid therapy is a valuable entity and a valuable clinical entity. However there is uncertainty regarding the fluid responsiveness of patients, particularly those with severe infections. Potential risks of fluid overload (i.e. too much fluid) exist. Excessive fluid administration is associated with increased morbidity and mortality.
Carotid doppler ultrasound and passive leg raise is a way of estimating fluid responsiveness. By using this technique we believe that it will tell us if a patient will tolerate an intravenous fluid bolus of 500ml.
The aim of this study is to determine if doppler ultrasound of the common carotid artery blood flow before and after PLR is a realistic method by which to determine fluid responsiveness in the acute care setting. Also the review the ease of which this can be taught to emergency doctors.
Participants volunteered will be shown an instructional video, given practice session and have an observational assessment of performing the technique. Post this confidence in the technique will be surveyed.READ MORE
Emergency Department (ED) presentations are disproportionately greater in young children than all other age-groups. Young children are a vulnerable population and are at risk for injury and serious medical illness. In Australia, 13 per cent of all ED presentations were from children less than 5 years of age. Factors that lead to greater ED presentation rates in young children are incompletely understood and need further investigation.
This project has access to unique data from another existing study, the Environments for Healthy Living study (EFHL), run by the School of Medicine, Griffith University. EFHL recruited pregnant mothers in the Logan, Tweed and Gold Coast region and collected data since 2006 on more than 3000 children from birth with follow-up at 1, 3 and 5 years. Based on this fundamental initial work, the researchers will develop further research that aims to improve health care access and health care quality for this vulnerable population. This will better inform health care policy and education and reconfiguration of ED models of care that will enable more appropriate and efficient use of the ED to better meet the needs of the populations they serve.
This study aims to describe health care use by children aged 0-5 years living in the Logan, Gold Coast and Tweed regions. It will link the EFHL data with routinely collected data by Queensland and NSW Health (ED, inpatient and cost data) and Medicare Australia data (includes data on GP visits, medications prescribed and vaccination status). The project will focus on describing the health care use of these young children. This will include ED visits, hospital admissions, GP visits and medication use. It will aim to describe any associations between social, demographic, geographic and economic patient characteristics and common ED presentations and diagnoses (such as fever, asthma and injuries).READ MORE
This research aimed to investigate the impact of opening a new ED within a health service district. The study involved linking ambulance, emergency department (ED) and hospital data from three EDs to better understand the patient journey and patient and health service outcomes when a new ED opens within the health service. The project aims were to:
1. Describe and compare patient and health service outcomes at three EDs before and 12 months after Robina ED opening;
2. Describe and compare outcomes for patients arriving to ED by ambulance based on whether off stretcher time is/is not delayed by >30 mins.
Primary spontaneous pneumothorax (PSP) is defined as a collapsed lung with air in the pleural cavity that occurs in the absence of clinically apparent underlying lung disease. PSP is a significant global health problem affecting adolescents and young adults. Throughout the 20th century the treatment of PSP was predominantly bed rest, with invasive treatment reserved for severely symptomatic episodes. A study in 1966 suggested that managing large and small PSP in the community was safe. Despite this, rates of intervention have steadily increased over the decades. The reasons for this are unclear and this approach has recently been questioned in the scientific literature. Preliminary data suggests that a conservative approach to management may allow faster healing and reduce the risk of recurrence from around 25 per cent to 5 per cent in the first year. Conservative management is also likely to reduce the risks of prolonged admission due to persistent leak from approximately 30 per cent to less than 10 per cent and of other complications related to interventional management. Clinicians are, however, unlikely to change a practice entrenched for decades and re-enforced by current international guidelines without robust evidence.
If allowing the lung to remain collapsed initially does improve healing of the pleural defect and lower recurrence rates, then this study will contribute to improved outcomes and a reduction in the morbidity associated with current treatment. This would mean a major change in current medical practice and international consensus guidelines. It would also be of substantial economic benefit due to reduced hospital admission rates on first presentation and also a reduction in the risk of subsequent recurrences, admissions and associated procedures.READ MORE
Increasing demand for hospital Emergency Departments (EDs) has resulted in long ED waiting times attracting media commentary and political attention. There are many factors contributing to the increasing demand in EDs, among which are increasing numbers of elderly patients in an aging population. Further more, a significant proportion of elderly patients attending EDs are from nursing homes where medical support is limited.
To actively address this challenge, EDs in Queensland hospitals have been implementing a Hospital In the Nursing Homes (HINH) program, which involves sending clinical staff to nursing home facilities to provide acute medical care for residents, to provide support and education for nursing staff in nursing homes, to coordinate the transitional acute care service including senior medical staff becoming involved at an early stage when such patients present to the EDs, and to coordinate the discharge from EDs and in-patient unit. The main objective of HINH is to avoid ED presentation from nursing homes, decrease the length of stay at EDs and in-patient unit, and provide better transitional care for the elderly patients from nursing homes.
It would be highly valuable to determine if this program is effective. The study will answer the following questions:
1. What is the burden of the residents in Nursing Homes on the acute care sector in three Queensland hospitals?
2. Does the HINH program have any positive effect on the above burden?
3. What is the quality of transitional care between Nursing Homes and EDs?
4. Does the HINH program have any positive effect on the above quality measures?
The study design is a prospective cross-sectional observational study, with both quantitative and qualitative research methods.READ MORE