The Viscoelastic Haemostatic Assay Landscape in Queensland, Australia: An Analysis of Use, Indications and Integration.

Background: Viscoelastic haemostatic assays (VHAs) guide transfusion decisions in bleeding patients. We assessed testing volumes, clinical indications and patient characteristics in a statewide population in Australia.

Methods: This retrospective study included all patients who underwent rotational thromboelastometry (ROTEM) or thromboelastography (TEG) across Queensland Health hospitals (1 January 2019 to 15 April 2025), using data from AUSLAB, the statewide laboratory information system and surveyed all hospitals for VHA device availability.

Reducing blood wastage through introduction of a transfusion team.

Background: In the intense setting of reception and resuscitation of critically bleeding patients, wastage of up to 10% of blood components occur, commonly due to prolonged breaks in the cold chain. Additionally, some transfusions may be avoidable. The aim of this study was to assess the impact of dedicated transfusion teams (staff focused solely on blood handling during resuscitation) on blood component wastage and transfusion volumes.

Yield of Continuous Cardiac Monitoring in Pre-Specified Low-Risk Patients: A Retrospective Cohort Study.

Objectives: The aim of this study was to quantify the yield of continuous cardiac monitoring (CCM) in patients with pre-specified low-risk criteria, including those with mildly elevated troponin levels.

Methods: This was a retrospective cohort study of patients admitted to the ward from the emergency department (ED) with CCM. The primary outcome was the occurrence of clinically relevant arrhythmia.

Tranexamic Acid Timing and Mortality Impact After Trauma.

Study Objective: Trauma resuscitation guidelines across the world have incorporated the administration of tranexamic acid (TXA) within 3 hours of injury. The 3-hour window was deduced from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial and has not been replicated. The aim of this study was to determine whether death within 28 days after trauma varied according to time from injury to the first TXA dose and, if so, precisely determine the therapeutic window.

Presenting to emergency departments with functional seizures: Motivators for attendance and experiences of care.

Objective: Patients with functional seizures frequently present to emergency departments, and often have unsatisfactory/negative experiences there. It has been proposed that many of these visits are preventable, but the patient perspectives have not been well-studied.

Methods: Past (≥1 appointment, discharged and no longer engaged with the clinic) and present (≥1 appointment, still engaged with the clinic) patients of the Alfred Hospital Functional Seizures clinic without comorbid epilepsy with an established diagnosis of functional seizure were invited to complete a survey on reasons for attending an emergency department and experiences of emergency care.

Variability in viscoelastic haemostatic assay in major haemorrhage protocols: A unified approach or mixed signals?

Background And Objectives: Viscoelastic haemostatic assays (VHA) are part of patient blood management (PBM) for bleeding, associated with reduced transfusions. This study reviewed all major haemorrhage protocols (MHPs) using VHA in Queensland, Australia, and assessed variability.

Methods: VHA platforms in Queensland Health include rotational thromboelastometry (ROTEM® Sigma) and thromboelastography (TEG 6 s).

Tranexamic acid did not attenuate the acute rise in plasma syndecan-1 in a severely injured cohort: a laboratory analysis of the PATCH clinical trial.

Background: Injury to the vascular endothelium occurs in up to 34% of patients acutely following severe traumatic injury and can be quantified clinically by measuring the plasma concentration of syndecan-1 (SDC-1). Tranexamic acid (TXA) attenuates endothelial damage in animal and cell culture models and has been associated with lower SDC-1 levels after prehospital TXA administration. The aim of this study was to assess the association of prehospital TXA on SDC-1 levels in a more severely injured prehospital cohort.

Coagulation and Transfusion Informatics in Chronic Liver Disease: A Data Linkage Study of Emergency Department Presentations.

Objective: To describe the application of data linkage for analysing coagulation abnormalities and blood transfusion practices in patients with chronic liver disease (CLD) presenting to emergency departments (EDs).

Methods: Patients with CLD presenting to 104 Queensland Health EDs (January 2016-August 2023) were identified using International Classification of Diseases codes. Phase 1 deterministically linked ED, admission, pathology, transfusion and death records using unique identifiers.

Core outcome set for research in necrotising soft tissue infection patients: an international, multidisciplinary, modified Delphi consensus study.

Introduction: Necrotising soft tissue infections (NSTI) are serious infections associated with considerable morbidity and mortality. Heterogeneity of outcome reporting in the NSTI literature precludes the synthesis of high-quality evidence. There is substantial interest in studying the efficacy of hyperbaric oxygen treatment as an adjunctive treatment in NSTI.

Diagnostic accuracy of visual triage checklist in early recognition of COVID-19 cases in the pediatric population: A retrospective cohort study.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities developed surveillance systems to identify patients suspected of having COVID-19 to segregate them during their hospital stay. As a part of this infection control strategy, the Ministry of Health in the Kingdom of Saudi Arabia developed a visual triage (VT) checklist for early screening and isolation of patients in the hospital. The aim of this study was to evaluate the diagnostic accuracy of this visual triage checklist in identifying children with COVID-19.

The incidence and determinants of traumatic brain injury deaths occurring outside hospital in Australia.

Objective: To identify the determinants of death occurring outside of hospital following moderate to severe traumatic brain injury (msTBI) across Australia.

Methods: Design, setting: Retrospective observational study using National Coronial Information System (NCIS) data.

Participants: People who died during the five-year study period between 2015 and 2020 and were recorded in the NCIS as having intracranial injury as a cause or contributor to death.

Effectiveness of inhaled methoxyflurane in acute pain in an emergency department - A systematic review of randomized controlled trials.

Introduction: Inhaled Methoxyflurane has emerged as a popular analgesic agent for the management of acute traumatic pain in emergency settings. The aim of this review was to assess the analgesic efficacy of methoxyflurane compared to placebo and standard analgesics.

Methods: We performed a systematic review of the literature with searches of seven databases (Medline Complete, CINAHL Complete, OVID Emcare, Embase Classic + Embase, Cochrane Library, Scopus and Web of Science Core Collection) for randomized controlled trials where patients presented to the emergency department with acute traumatic pain and were administered inhaled methoxyflurane compared to placebo or standard analgesics.

Imaging for older patients with head impact at baseline conscious state.

Objective: To describe CT brain (CTB) and neurosurgical management among head injured patients aged ≥ 85 years and minimal or no change in Glasgow Coma Scale (GCS).

Methods: A retrospective cohort study was undertaken using radiology and administrative data from two tertiary referral hospitals.

Results: There were 3833 patients included and 40% were taking anticoagulant or antiplatelet medications.

Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department.

Background: Switching from conventional to high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific reference rates for threshold troponin levels enables detection of smaller amounts of myocardial damage. However, the real-world impact of these assays on patient outcomes and health service costs is poorly understood. We investigated the cost-effectiveness of switching to hs-cTn assays for patients presenting to Australian Emergency Departments (EDs) with suspected acute coronary syndrome (ACS) with a 12-month follow-up period.

Evaluating the satisfaction of patients utilising the virtual emergency department service in southeast region of Melbourne.

Objectives: Evaluate patient satisfaction with paramedic and residential aged care facility (RACF) staff-initiated tele-emergency care through the Southeast Melbourne Virtual ED.

Methods: Patient satisfaction surveys were conducted across two of the constituent virtual EDs (VEDs).

Results: Of 452 responses, 427 (94.

Evaluating the utility of chest x-rays for non-traumatic chest pain in Australia- a retrospective cohort study.

Purpose: The aim of this study was to quantify the proportion of chest x-rays (CXRs) for non-traumatic chest pain (NTCP) in the emergency department (ED) that were abnormal and assess the clinical significance of these abnormalities. We also aimed to explore the variables associated with abnormal and clinically significant abnormal CXRs, to predict a population where CXRs can be safely avoided.

Methods: A single center retrospective cohort study was conducted including all adult patients presenting to a single ED with NTCP between 01 Jan 2022 and 31 Dec 2022.

Next-Day Serum Glial Fibrillary Acidic Protein Levels to Aid Diagnosis of Sport-Related Concussion.

Background And Objectives: Previous studies on sport-related concussion (SRC) may have measured brain injury blood-based biomarker, glial fibrillary acidic protein (GFAP), either before or after its peak, potentially underestimating the diagnostic value. The primary aim of this study was to evaluate the diagnostic performance of serum GFAP at 24 hours post-SRC. Secondary objectives included assessing whether the timing of sample collection relative to an Australian football match (with or without SRC) affected GFAP levels, evaluating if combining GFAP with symptoms improved discrimination of SRC compared with symptoms alone, and determining the diagnostic utility of serum neurofilament light (NfL) levels at 24 hours post-SRC.

The determinants for death in hospital following moderate to severe traumatic brain injury in Australia.

Objectives: To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia.

Design, Setting, Participants: Retrospective analysis of Australia New Zealand Trauma Registry (ANZTR) data. Cases were included if they presented to a participating hospital between 1 July 2015 and 30 June 2020 and had an Abbreviated Injury Severity (AIS) score - head greater than 2.

Transitioning to high-sensitivity troponin: 1-year mortality outcomes in patients with suspected acute coronary syndrome presenting to emergency departments.

Background: Switching from a conventional to a high-sensitivity cardiac troponin (hs-cTn) assay enables detection of smaller amounts of myocardial damage, but the clinical benefit is unclear. We investigated whether switching to a hs-cTnI assay with a sex-specific 99th centile diagnostic threshold was associated with lower 1-year death or new myocardial infarction (MI) in patients with suspected acute coronary syndrome (ACS).

Methods: This pre-post study included nine tertiary hospitals in Australia.

Prevalence of Alcohol Exposure in Burns-related Injuries.

The aim of this registry-based cohort study was to quantify the prevalence, injury characteristics, and outcomes of alcohol exposure in burn-related injuries. All patients ≥ 18 years presenting to The Alfred Emergency & Trauma Centre, a major trauma center in Victoria, Australia, between January 1, 2019 and December 31, 2022 and recorded in the Victorian Adult Burns Service registry were included. An explicit chart review was performed to verify retrieved data, with alcohol exposure coded when documented in medical records, laboratory evidence of a blood alcohol concentration > 2 mmol/L, or recorded in discharge ICD-10-AM codes.

Rate and yield of imaging for acute pyelonephritis in the emergency department: A retrospective cohort study.

Objectives: The role of imaging in acute pyelonephritis (APN) in the ED is poorly understood, with variability among clinical guidelines for when patients should be imaged, and the modality of imaging. The objective of this study was to identify the proportion of patients with APN being imaged, the proportion abnormal findings, and the association between abnormal imaging and discharge disposition.

Methods: A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital over a 5-year period (2018-2022) was conducted.

Research outputs after the Coursework Pathway.

Objectives: The aim of the present study was to quantify research outputs after completing a Coursework Pathway (CP).

Methods: Emergency medicine trainees who completed a CP during 2012-2022 were included. Research outputs were identified using Medline, EMBASE, Pubmed and Google Scholar.

Introduction of the Broset Violence Checklist in the emergency department: A retrospective cohort study.

Objective: The Broset Violence Checklist (BVC) can stratify the risk of violence and aggression in EDs. The aim of the present study was to report the initial uptake of introducing this checklist and associations with unplanned alerts to potential or actual violence in two EDs.

Methods: The BVC was recommended in all patient care episodes.