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
The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.
There are two trajectories of end of life in the emergency department: ‘unexpected’ and ‘expected’ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ≥ 65 who died in one emergency department were considered ‘expected’. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ‘unexpected’ and the ‘expected’ deaths among people aged ≥ 65 who die within 48 hours of emergency department presentation.
Sepsis is devastating infection, leading to organ dysfunction. Sepsis kills more children in Australia than road traffic accidents. One out of three survivors will suffer from long-term health problems. Faster recognition of sepsis can save lives. However, recognising sepsis in children can be difficult, as children with sepsis initially present with symptoms similar to common infections. Currently, the recognition of sepsis is based on physician assessment of patients, and laboratory tests. Sadly, a common finding in Coroner`s investigations of sepsis deaths is that parents represented several times to health-care facilities, stating their concerns that “something is wrong” with their child. There is at present great debate as to what role parental concern should have in sepsis recognition.
We hypothesise that parents as experts of their child provide important information to recognise disease severity in their child. We will perform questionnaires with parents, and with medical and nursing staff when a child is evaluated for sepsis. We will compare the value of measuring parental concern in comparison to healthcare worker assessment, clinical signs and symptoms, and routine infection markers.READ MORE
Improving patient experiences is part of Queensland’s 2016-2020 Strategic Plan to enable safe, quality healthcare services. Yet, current emergency department(ED) patient experience measures, including the burdensome 82-item Queensland Health (QH) ED patient experience survey, fail to reflect patient preferences for care experiences, inhibiting the design and evaluation of healthcare services that reflect patient preferences, and the delivery of value-based healthcare.
The aim of this project is to develop an ED patient experience classification system and accompanying scoring algorithm that can be used to both measure and value patient experiences in Queensland EDs. It will provide a proof of concept for an Australia-wide development, valuation and knowledge transfer study.READ MORE
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
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. 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
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
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