Systematic review of trends in emergency department attendances: an Australian perspective.

Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety.

Stress testing before discharge is not required for patients with low and intermediate risk of acute coronary syndrome after emergency department short stay assessment.

Objective: To investigate the usefulness of stress testing before discharge in patients assessed low to intermediate risk of acute coronary syndrome (ACS).

Methods: A prospective observational study was undertaken of patients presenting to the ED with suspected myocardial ischaemia. After negative initial electrocardiogram (ECG) and serum troponin testing, patients were admitted to the emergency short stay unit (ESSU) for further evaluation using a chest pain protocol that included stress testing as the final risk stratification tool.

Tram-related trauma in Melbourne, Victoria.

Objectives: To establish the incidence and pattern of injuries in patients presenting to hospital with tram-related injuries.

Methods: Data on tram-related injury pertaining to 2001-2008 calendar years were extracted from three datasets: the population-based Victorian State Trauma Registry for major trauma cases, the Victorian Emergency Minimum Dataset for ED presentations and the National Coroners' Information System for deaths. Incidence rates adjusted for the population of Melbourne, and trends in the incidence of tram-related ED presentations and major trauma cases, were analysed and presented as incidence rate ratios (IRR).

The diagnosis of acute urethral trauma.

Background: During trauma resuscitation, blind catheterization of an injured urethra may aggravate the injury by disrupting a partially torn urethra. In busy trauma centers, retrograde urethrograms (RUG) prior to catheterisation for all patients with unstable pelvic fractures presents a challenge during trauma resuscitation, and the procedure is not commonly practiced despite Advanced Trauma Life Support (ATLS) and World Health Organisation recommendations. The aim of this study was to determine the presenting clinical features of patients with urethral injuries and to predict major trauma patients needing further investigation to exclude this injury.

Applying composite performance measures to trauma care.

Background: To investigate the association between a number of hospital level composite index methodologies developed from trauma indicators with inhospital mortality.

Methods: Data from January 2001 to December 2006 were extracted from the Victorian State Trauma Registry (Australia) and the Trauma Audit and Research Network (United Kingdom). Three composite methods were explored, including two denominator-based weight approaches and a factor analysis technique.

Aortic transection: demographics, treatment and outcomes in Victoria, Australia.

Objective: The epidemiology of aortic transection is changing with improvements in road safety and the use of endovascular stents. This research investigates the profile of cases and outcomes of traumatic thoracic aortic transection in Victoria, Australia.

Methods: Data were extracted from the Victorian State Trauma Registry for the period July 2001 to December 2007.

Evaluation of instruments for measuring the burden of sport and active recreation injury.

Sport and active recreation injuries are common. Participants are generally young, healthy and physically active individuals and as a result their injuries can have long-ranging effects for both the individuals and society. Accurate and appropriate measurement of the outcomes of sport and active recreation injuries is essential for understanding the time frame and quality of recovery, and quantifying the burden of these injuries.

Recombinant activated factor VII in obstetric hemorrhage: experiences from the Australian and New Zealand Haemostasis Registry.

Objective: Through the Australian and New Zealand Haemostasis Registry, we report on the Australian and New Zealand experience with recombinant activated factor VII (rFVIIa) in obstetric patients.

Methods: The role of rFVIIa for off-label indications, including trauma, cardiac surgery, and severe postpartum hemorrhage, remains controversial. The Haemostasis Registry established by Monash University in Melbourne, Australia monitors off-label use of rFVIIa across Australia and New Zealand.

Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review.

Although deep surgical site infection (SSI) is a major complication of primary total hip arthroplasty (THA), there are conflicting data regarding the incidence of deep SSI, and no comprehensive evaluation of the associated risk factors has been undertaken. We performed a systematic review of the literature; undertaking computer-aided searches of electronic databases, assessment of methodological quality, and a best-evidence synthesis. The incidence of SSI ranged from 0.

Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation.

Introduction: Recent retrospective studies have found high fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratios during trauma resuscitation to be associated with improved mortality. Whilst this association may be related to a mortality bias present in these studies, there has been an overall tendency towards a 1:1 FFP:PRBC ratio in massive transfusion guidelines worldwide. The aim of this study was to retrospectively review the administration of FFP in patients undergoing massive transfusion during trauma resuscitation, to add to the evidence base for massive transfusion guidelines.

Black Saturday: the immediate impact of the February 2009 bushfires in Victoria, Australia.

Objective: To examine the response of the Victorian State Trauma System to the February 2009 bushfires.

Design And Setting: A retrospective review of the strategic response required to treat patients with bushfire-related injury in the first 72 hours of the Victorian bushfires that began on 7 February 2009. Emergency department (ED) presentations and initial management of patients presenting to the state's adult burns centre (The Alfred Hospital [The Alfred]) were analysed, as well as injuries and deaths associated with the fires.

Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury.

Introduction: Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. While TBI in older adults is less common, it still contributes to significant morbidity and mortality in this group. Understanding the patient characteristics that result in good and poor outcome after TBI is important in the clinical management and prognosis of older adult TBI patients.

Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.

Aim: Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ).

Methods: Three-month prospective, multi-centre, observational study of all adult patients with sepsis and hypoperfusion or septic shock in the ED of 32 ANZ tertiary-referral, metropolitan and rural hospitals.

Results: 324 patients were enrolled (mean [SD] age 63.

Access block can be managed.

Hospitals cannot manage their emergency patients when there is significant access block. There are solutions that should be implemented but require national leadership to be effective. These solutions include an immediate increase in the number of acute hospital beds, improved coordination and increased community capacity to manage medical patients with complex conditions outside acute public hospitals, improved hospital processes, and better standardisation of treatment within emergency departments.

Bicycling injuries and mortality in Victoria, 2001-2006.

Objective: To investigate the incidence of bicycling injuries and bicycle injury characteristics in the Victorian population.

Design: Review of prospectively collected data.

Setting: Bicycling injury data were extracted from four datasets for the period July 2001 to June 2006: (i) emergency department (ED) presentations from the Victorian Emergency Minimum Dataset; (ii) hospital admissions from the Victorian Admitted Episodes Data Set; (iii) major trauma cases from the Victorian State Trauma Registry (VSTR); and (iv) deaths from the National Coroners Information System.

Incidence and outcomes of major trauma assaults: a population-based study in Victoria.

Objective: To describe the incidence and outcomes of assault resulting in serious injury in Victoria.

Design And Setting: Analysis of population-based data from the Victorian State Trauma Registry for assaults between 1 July 2001 and 30 June 2007.

Main Outcome Measures: Overall trends in the rate of assault-related major trauma, inhospital mortality, and functional outcomes 6 months after injury as measured by the Extended Glasgow Outcome Scale.

Predictors of moderate or severe pain 6 months after orthopaedic injury: a prospective cohort study.

Objective: To determine predictors of moderate or severe pain 6 months after orthopaedic injury.

Design: Prospective cohort study.

Setting: Two adult level 1 trauma centers in Victoria, Australia.