Sepsis is a leading cause of death and disability in children, globally accounting for more than one million childhood deaths per year. Recommended sepsis treatment currently consists of intravenous antibiotics and aggressive fluid boluses followed by inotropes and consideration for intravenous steroids. However, the evidence for interventions other than antibiotics is limited and aggressive fluid administration may be associated with harm. Therefore, fluid-sparing algorithms using early inotropes to treat shock have been proposed. Another strategy to hasten shock resolution consists in intravenous steroids, alone or in combination with thiamine and vitamin C, postulated to support metabolic dysfunction in recent studies.
In this project, the research team is conducting a randomised controlled pilot trial in children presenting with septic shock. They are assessing the feasibility of a fluid-sparing algorithm using early inotropes and early intravenous administration of Vitamin C, Thiamine and Hydrocortisone and the impact on survival free of organ dysfunction.READ MORE
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
Grass pollen is the major outdoor allergen globally and grass pollen exposure has an important measurable and manageable impact on the medical burden of asthma. We propose investigating the role of allergy status on triggers for asthma in patients visiting hospital emergency departments in two regions of south east Queensland over a two year period, coinciding with NHMRC and ARC funded environmental health research led by collaborator CI Davies.
Data on weather and pollen exposure will be integrated with direct assessment of specific IgE profiles and respiratory viral triggers of asthma. Patients, including children over 12 years, presenting with primary diagnosis of asthma to a major urban hospital in a subtropical region and rural hospitals in the temperate regions of the Darling Downs will be recruited with informed consent.
Outcomes of this study are expected to inform need for utilising local current pollen exposure information to manage emergency department demand surges and underpin better management of pollen allergies outside of hospital by allergy physician and general practice.READ MORE
The objective of this study is to describe the impact of the 2018 Commonwealth Games held in Queensland, Australia on the emergency departments in the Gold Coast region. This research has two key aims, which align with two discrete but related studies:
Study 1 Aim: To describe and determine whether changes in patient, health service, and economic outcomes occur before, during and after the Commonwealth Games.
Study 2 Aim: To explore healthcare staff experience of planning, preparedness and lessons learnt from the Commonwealth Games.
Findings from this study will provide an evidence base regarding the impact of a large sporting mass gathering on public and private emergency departments, forming an invaluable resource for future Commonwealth Games planners, as well as response planning for other mass gatherings, sporting or otherwise.READ MORE
Advances in health have led to populations living longer with more chronic disease and frailty. Frail older people presenting to emergency departments (EDs) have special needs that are often overlooked. In response, the innovative Geriatric Emergency Department Intervention (GEDI) was developed by clinicians at Nambour Hospital, Queensland.
GEDI is a unique nurse-led, physician-championed model of service delivery which facilitates advanced assessment tailored to the individual, nurse-initiated specialist referral, fast-tracking of care through the ED and appropriate safe discharge planning for persons aged 70 and over, including those from residential aged care facilities. A successful trial in one ED was awarded the 2016 Queensland Premier’s Award for Excellence. The evaluative research we conducted found that when older adults presented to ED during the times the GEDI team was working they were more likely to be discharged, if admitted they spent, on average, 24 hours less in hospital and the costs of their care were reduced by up to 30%.
The staffing for a trial of GEDI in two further Queensland EDs will be funded by the Queensland Health Improvement Unit. This EMF-funded evaluation project employs the principles of implementation science to evaluate the introduction of GEDI into these EDs to determine whether the knowledge learned from the trial can be translated to other sites and to determine the best strategies for future implementations of GEDI across Queensland and interstate. If implementation is found to be successful future roll out of GEDI will improve patient outcomes and reduce costs in Queensland and across the country.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
After whiplash injury, half of patients never fully recover. The human and economic cost is enormous, and current mainstay treatments are ineffective. Most recovery, if it occurs, takes place in the first two to three months. This early time period offers a ‘window of opportunity’ to pro-actively intervene and prevent the chronic pain. The Emergency Department (ED) is ideally placed to provide very early intervention. We have shown that upregulation of pain in the central nervous system occurs soon after whiplash injury and predicts poor recovery. We aim to target these central nervous system processes with pregabalin in conjunction with evidence based physiotherapy advice/exercise in the ED. The results have potential to fundamentally change the treatment of acute whiplash injury.READ MORE
Life threatening bacterial infections such as sepsis are a leading cause of childhood mortality. International authorities recognise the urgent need for better recognition, diagnosis, and management of children with sepsis. Children in regional and remote settings are at particular risk for late or inaccurate diagnosis resulting in worse outcomes.
In this study, we are testing the feasibility, performance, time-to-diagnosis, and cost impact of applying the most advanced genomics-based sepsis diagnostic tools. This could lead to better treatment of infections, reduce unnecessary antibiotic use, shorten hospital length of stay, improve patient outcomes, and allow patients and families to be managed closer to home, with the aim to provide the same care for all children around the state. We are recruiting acutely ill children presenting with suspected sepsis to Emergency Departments, including regional and remote centres in Queensland.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