Medicine (Western Health) - Research Publications
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ItemVale Joseph Epstein AM FIFEM(WILEY, 2022-10)
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ItemIs headache during pregnancy a higher risk for serious secondary headache cause? A HEAD study report(WILEY, 2022-08)OBJECTIVES: Pregnancy is defined as a 'red flag' in headache assessment. We aimed to describe the prevalence and causes of serious secondary headache in pregnant ED patients. METHODS: Unplanned secondary analysis of HEAD Study/HEAD Colombia data. RESULTS: 3.2% (117/3643) of ED headache patients aged 18-50 years were pregnant, of whom six (5.1%) had a serious secondary cause identified. The proportion of patients with serious headache causes was not significantly different between pregnant female, non-pregnant female and male patient subgroups (P = 0.89). CONCLUSION: Inclusion of pregnancy as a 'red flag' in ED headache assessment is not supported by these data.
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ItemWho should provide expert opinion in emergency medicine-related medical litigation?(WILEY, 2022-06)Expert evidence plays a central role in establishing the relevant standard of care in medical litigation. In Australia, little is known about the expert witnesses who provide evidence about the standard of care provided in ED. A sample of recent published case law suggests that a proportion of expert evidence about breach of the standard of reasonable care in ED is provided by medical practitioners who are not emergency physicians and/or have no recent practice experience in an ED. This may potentially distort the identification of the relevant standard of care. In the United States, the American College of Emergency Physicians has attempted to address this issue by developing and promulgating expert witness guidelines. Is there a case for the Australasian College for Emergency Medicine to assume an advocacy role and/or develop standards in this area?
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ItemIs waiver of consent for the use of health information for research acceptable to emergency department patients?(WILEY, 2021-04)Some emergency medicine research, especially retrospective studies using medical records review, rely on waiver of consent for use of personal health information (PHI) contained in clinical records. This is a secondary use of PHI and waiver of consent raises ethical, legal and practical issues. Granting of a waiver of consent is often (but not always) approved by a human research ethics committee and requires separate but inter-related consideration of the legal and ethical issues. In part, this involves a balancing of the public interest versus the risk to privacy and an evaluation of whether subjects would, mostly likely, have agreed to the use of their PHI had they been asked. To date, there are no robust data about whether use of PHI without consent for research would be acceptable to people who attend Australasian EDs for care.
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ItemWhy the aortic dissection detection risk score is problematic in emergency departments(Open Exploration Publishing, 2021-01-01)Acute aortic syndromes, including aortic dissection (AD), are rare. The AD detection risk score (ADDRS) and associated investigation pathway were developed to reduce missed diagnosis of AD. The methodology for its development was sub-optimal and it has not been robustly validated in the emergency department chest pain population. Recent research suggests that it will drive over-investigation and that the risks of missed diagnosis may not be in balance with the risks of the testing strategy. There are serious doubts about whether the score and investigation pathway are fit for purpose.
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ItemNo Preview AvailableIs COVID-19 the straw that broke the back of the emergency nursing workforce?(WILEY, 2021-12)OBJECTIVES: To explore the intentions of Australian emergency nurses to remain in or leave emergency nursing after the first year of the SARS-CoV-2 (COVID-19) pandemic. METHODS: Sub-study of a survey of Australian emergency nurses about the impact of COVID-19 on their work, life and career. This sub-study focused on future career intentions, especially intentions to remain in or leave emergency nursing. RESULTS: There were 398 eligible responses. 48.2% of respondents reported that they intended to leave emergency nursing within 5 years. Nurses in EDs who received COVID positive patients were more likely to express an intention to leave ED nursing (P = 0.016). Having directly cared for a COVID positive patient was not statistically associated with intention to leave ED nursing (P = 0.17). Excluding nurses aged >60 years, there was no statistical difference in expressed intention to leave ED nursing between age groups (P = 0.32), nurses with/without a higher qualification (P = 0.32) or number of years in ED nursing (P = 0.54). Intention to leave emergency nursing was associated with not feeling more connected to their emergency nursing colleagues (P = 0.03), the broader ED team (P = 0.008) and their organisation (P = 0.03) since the onset of the pandemic. CONCLUSION: The data suggest that approximately 1 year after the onset of the COVID-19 pandemic in Australia, a high proportion of ED nurses intend to leave ED nursing within 5 years, which will exacerbate pre-existing shortages. Active strategies to address this are urgently needed.
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ItemHow well does the Best Guess method predict children's weight in an emergency department in 2018-2019?(WILEY, 2020-02)OBJECTIVE: For seriously ill children, weight is often required to direct critical interventions. As it is not always feasible to measure weight in emergencies, age-based weight prediction formulae may be used as an alternative. The Best Guess formulae, derived in Australia, have been shown to be among the most accurate age-based methods in Australian children. They were validated in 2010. The present study aims to re-validate the Best Guess formulae and compare their performance to the previous validation cohort. METHODS: A prospective observational study was conducted in the paediatric ED of a community teaching hospital. It included a convenience sample of children aged 1 month to 10 years who presented between July 2018 and April 2019. Seriously ill children were excluded. Data collected included measured weight, height, gender, age and ethnic group. The outcomes of interest were predictive performance of Best Guess formulae and comparison of predictive accuracy with a 2005 cohort from the same ED. RESULTS: A total of 961 patients were included; 42% girls, median age 3 years. The sample was ethnically diverse. Mean percent difference in weight was -3.3% with the formulae usually over-estimating weight. Overall, agreement within 10% was 41.8%; agreement within 20% was 72.6%. Predictive accuracy was not significantly different between the cohorts. CONCLUSION: The Best Guess method has not reduced in accuracy as a weight estimation method in emergent situations in this Australian cohort, despite a tendency to slightly over-estimate children's weight. Further study is needed to test the Best Guess method's accuracy in ethnic subgroups.
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ItemOperational challenges of international research collaborations(WILEY, 2020-02)