This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.
Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.
This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.READ MORE
From a health perspective, a disaster overwhelms the normal operating capacity of a health service, where an outside health response is required to restore and maintain the normal day-to-day health services and standards of care for the disaster-affected community. The Australian healthcare system is tested annually with disasters of a conventional nature (e.g., floods, cyclones, bushfires), however, the Australian healthcare system has not been recently tested by non-conventional disasters such as Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) disasters. As a result, the ability to determine the healthcare system response is difficult. Further, there is no research specific to the Australian emergency department’s capacity for disaster response in CBRNe events.
This study addresses this gap. We will use a mixed methods approach to undertake two discrete, yet related studies. Study 1 involves undertaking surveys with key emergency disaster personnel from seven Queensland hospitals to describe the capacity of hospital emergency care services ability to respond following a CBRNe disaster. Study 2 includes undertaking focus groups with key clinicians and leaders from the participating sites to identify and explore enablers and barriers within emergency care services to provide CBRNe disaster response. Findings from these studies will provide an evidence base regarding the capacity for several Queensland emergency departments, located in metropolitan, regional and rural settings, to respond to disasters.READ MORE
Convulsive Status Epilepticus (CSE) is the most common childhood neurological emergency, sometimes resulting in death or serious disability. CSE is managed with anticonvulsant medications in a step-wise approach until seizures stop. While some management strategies for CSE are well supported by evidence (e.g. initial administration of benzodiazepines), subsequent strategies are based on expert consensus and not evidence. Phenytoin, the traditional second line agent for CSE has a high failure rate, causes adverse events and must be administered slowly. Levetiracetam, a newer anticonvulsant, has a favourable adverse events profile, can be administered quickly and has good efficacy for various seizure types.
This research project proposes to undertake a randomised controlled trial of the second line anticonvulsants phenytoin and levetiracetam for CSE in children. This multi-centre study was a world first and is likely to have a profound impact on the management of CSE in children in New Zealand, Australia and worldwide, in either confirming the current second line medication used or recommending a newer second line medication.READ MORE