In a severe trauma, major bleeding or haemorrhaging is associated significant morbidity and mortality. Haemorrhage can be compounded by Trauma Induced Coagulopathy. It is postulated that early replacement of low fibrinogen levels may reduce haemorrhage and improve outcomes. Fibrinogen concentrate is an alternative way to replace fibrinogen.
In the FEISTY pilot trial, we demonstrated that a guided fibrinogen replacement strategy utilising either fibrinogen concentrate or cryoprecipitate is feasible. We found that fibrinogen concentrate was significantly faster to administer. The follow-on FEISTY II Trial will evaluate relevant patient-centred endpoints of a guided dose of FC Vs cryoprecipitate in traumatic haemorrhage. This larger study builds on the success of FEISTY to include multiple trauma centres in Australia and overseas.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 (ARISE FLUIDS). 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).
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
Traumatic injuries in children are a leading cause of death and disability in Australia. In high income countries, 40% of child deaths are because of traumatic injuries. Fibrinogen is one of the key clotting factors that need to be replaced in severe traumatic bleeding.
Currently, fibrinogen is replaced using cryoprecipitate; a blood product obtained from healthy volunteer donors. This is a precious resource that is stored frozen in the blood bank; it can take a long time to administer and place significant strain on blood banks. Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is a product that is derived from blood plasma but stored in powder form and can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which may reduce haemorrhage and improve outcomes.
This study will enrol 30 children from three major paediatric trauma centres in Queensland admitted with severe traumatic bleeding. Time to administration of fibrinogen replacement and the effect of fibrinogen levels will be measured.READ MORE
Domestic and family violence (DFV) against women is the number one cause of hospitalisations in Australian girls and women aged 15-54 years. It is also the number one cause of death and disability in women aged 15 to 44. Although most victims of fatal DFV access health services in the 24 months prior to their deaths, many victims living with DFV go unnoticed in the community. Health care providers are well placed to identify DFV victims and refer them to appropriate services. The ED has been described as a good place to undertake identification of DFV victims in several published research papers. Yet, how to do this remains controversial, and there are no standard protocols in place in our EDs. In this project, we aim to describe the current DFV health practice culture in five Queensland EDs. Knowledge, beliefs, and attitudes, as well as what’s actually happening to detect cases of DFV, will be assessed among our front-line ED social workers, nurses, and doctors. We aim to determine how many presentations to ED are identified and referred to social worker services for DFV. Ultimately, this research will both raise awareness about the potential of the ED to detect DFV, and will help pave the way forward to a well-informed and structured ED DFV screening program for Queensland, with applicability internationally.READ MORE
Mild traumatic brain injury (mTBI) is a common injury with potentially profound consequences. Although many patients recover within a few days to a few weeks, an estimated 15-40% develop post-concussion syndrome (PCS), which consists of an array of cognitive, emotional, and physical symptoms.(TBI symptoms that persist beyond three months often develop into a chronic, potentially life-long, health problem.)
PCS is associated with problems returning to work, social difficulties, higher healthcare utilisation, and poorer quality of life. The mitigation of PCS represents a significant clinical problem. An effective evidence-based early intervention to prevent PCS is sorely needed.
There is a growing consensus that differences in patient outcomes from mTBI are due to a range of biopsychosocial factors. For example, stress, anxiety, cognitive biases, sleep disturbance, and structural brain damage are among a number of factors that influence PCS symptom report. A focus on modifiable psychosocial factors (e.g., thoughts and behaviours) offers a promising solution: Cognitive Behavioural therapy (CBT) is well suited to altering the maladaptive beliefs, misattributions, cognitive biases and coping behaviours that promote chronicity in PCS.
The purpose of this study is to examine the feasibility and effectiveness of a Cognitive-behavioural psychotherapy (CBT)-based early intervention for patients at high-risk of developing PCS after mTBI. It is a two-site non-blinded, parallel group, randomised controlled trial comparing treatment-as-usual (TAU) and TAU+CBT intervention.
Developing an effective intervention for PCS is a critical and much-needed step in advancing our approach to the clinical management of mTBI. The outcomes of this research can inform the coordination of post-discharge care and treatment pathways, and reduce readmissions and new occasions of care.READ MORE
This clinical trial aims to improve the quality of the resuscitation of patients with traumatic haemorrhage. We are enrolling 100 patients from four major trauma centres in Queensland. Patients admitted with severe traumatic bleeding will be given either Fibrinogen concentrate or cryoprecipitate. Time to administration of these products and effects on blood fibrinogen levels will be measured. We are using innovative technology to identify hypofibrinogenaemia; we will provide data to define the optimal method of replacement and monitoring of the end points of resuscitation; and provide data on the role of fibrinogen concentrate and its use in traumatic haemorrhage. We are also exposing a broad range of ED physicians to potential practice changing research that may be translated to use in other patient groups with critical bleeding.
More than 7000 Australians are treated for severe trauma every year. Major bleeding in the setting of trauma is associated with poor outcomes and increased rates of death. Severe trauma causes a decrease in the factors within the blood that helps clots to form and stop bleeding. This loss of clotting factors is associated with worse outcomes and it is proposed that early replacement of these factors may reduce bleeding and improve outcomes. Fibrinogen is one of the key clotting factors that needs to be replaced in severe traumatic bleeding. Currently fibrinogen is replaced using cryoprecipitate; a blood product obtained from healthy volunteer donors. This is a precious resource that is stored frozen in the blood bank; it can take a long time to administer and place significant strain on blood banks. Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is stored in powder form, can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which will reduce haemorrhage and improve outcomes. With positive impact for both large urban metropolitan areas and remote isolated communities.READ MORE
Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.READ MORE
One of the causes of patients getting sick in hospital is the transfer of bacteria from one patient to the other (nosocomial infection). This transfer of bacteria can lead to serious illness, even death. There are numerous precautions taken in hospital to prevent this, such as hand washing, wearing gloves, sterile gowns and gloves during procedures etc. There has been a tremendous growth in the use of point of care ultrasound to assist clinicians in the Emergency Department, Intensive Care Unit and Anaesthetic Department. We suspect that probes, which are in contact with patients’ skin are not cleaned as often or as thoroughly as they should be. This might lead to bacterial colonization.
Often the ultrasound probes are used to assist with invasive procedures such as the placement of central and peripheral venous catheters. There is a potential for the probes to be contaminated by patients’ blood during these procedures, as well as their skin bacteria. This situation would clearly pose a risk to the well being of our patients and staff, and these procedures are most commonly performed on our sickest, most at risk patients.
We aim to investigate the bacterial colonization and blood contamination on ultrasound probes in the Emergency Departments and Intensive Care Units across numerous hospitals in South East Queensland. The amount of bacteria, the type of bacteria and the amount of blood contamination will be investigated and reported. This study has the potential to demonstrate possible contamination of our sickest patients by blood and pathogenic bacteria from ultrasound probes used by the clinicians who are caring for them. The results should lead to recommendations regarding standardised work practices for the use of this equipment in the Intensive Care Unit and the Emergency Department.READ MORE
Shortness of breath is one of the most common reasons for presentation to Australian Emergency Departments, with millions of presentations each year. A new patient, unable to speak properly because they cannot breathe present difficulties in immediate diagnosis and therefore treatment, to emergency doctors and nurses. Immediate management involves the application of oxygen via a face-mask in addition to drug therapy and investigations including x-rays and blood tests. If breathlessness gets worse, the patient may need invasive support for breathing; a process that involves more staff, expensive machines, and resultant considerable cost to the health care system. A simpler support device that provides non-invasive humidified high flow nasal cannula is one alternative to the provision of oxygen and is currently utilised safely in adult and paediatric patients. The “high flow” delivery of humidified oxygen and air provides moderate support, which reduces the work that the exhausted patient does while breathing in and to help splint the airways open. This support is a driving pressure, which is not present during simple mask oxygen therapy. If we treat patients early with high flow therapy rather than standard facemask, we may be able to relieve symptoms of breathlessness sooner and avoid worsening of breathing difficulties. Similar work has been completed on paediatric patients with positive results and we hope to mimic this in the adult population. If possible this would reduce health care costs and allow for earlier discharge from the emergency department and/or hospital by providing this early intervention of breathing support.READ MORE
Patient demand on Emergency Departments (EDs) is rising by over 3% per annum contributing to congestion. ED congestion is known to be associated with poor health outcomes and reduced efficiency; the latter is characterised by increased waiting time, length of stay and ambulance diversion. Even though the National Emergency Access Target (the four-hour rule) has reduced the level of access block, initiatives to reduce ED demands have not had significant effect to date.
Previous research undertaken by the emergency health research group at QUT has described in detail the increases in demand and has identified some contributing factors. Our research highlighted reduced access to primary healthcare is one important factor associated with increased ED demand.
The aim of this project is built on our earlier work investigating factors that influence the choice made by patients between ED and primary healthcare for acute illness, and to thus identify viable primary healthcare alternatives for diverting ED patients so as to reduce ED demand. This project will provide the necessary evidence base to subsequently develop a NHMRC grant application to trial a national model of expanded primary healthcare practice to reduce ED demand. Importantly, this project will facilitate better integration and knowledge exchange between existing primary and secondary health sectors in Queensland through the stakeholder involvement.READ MORE