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Anne-Maree Kelly

Publications and source records attributed to Anne-Maree Kelly.

At least 19 recordsLinked to original sources
PubMed2006

Emergency medicine training for Croatia: a Croatia-Australia partnership.

As part of a health system improvement project, the Republic of Croatia has been conducting a pilot project aimed at rationalizing care delivery across the primary care, hospital and secondary care systems. One component was the development of an emergency department at Dr T Bardek Hospital in Koprivnica and training of its staff. This paper describes how a training programme was conducted, using an established emergency department in Australia as the training host, and the outcome of the project. This type of training programme could form a model for specialist Emergency Medicine training in the future.

Australia↗
PubMed2006

One-handed versus two-handed chest compressions in paediatric cardio-pulmonary resuscitation.

OBJECTIVES: To determine emergency department (ED) staff preference for one- or two-handed paediatric chest compressions and to determine if there was a difference in compression rates delivered and fatigability between the techniques. METHODS: This was a randomised, cross-over observational study of paediatric CPR performed on a standard paediatric manikin by ED staff. Consenting, eligible staff [ED doctors and nurses] performed CPR in pairs with chest compressions delivered using a one- and two-handed technique. The outcomes of interest were compression rates for one- and two-handed CPR, decrease in compression rate over time for each technique and staff preference for technique. Data was analysed using descriptive statistics, Chi Square test and Mann-Whitney U-test as appropriate. RESULTS: Sixty-two ED staff participated in the study. Compression rates with both techniques were similar and higher than guidelines recommend (133.6 min(-1) for one-handed and 135.7 min(-1) for two-handed respectively). The compression rate slowed by 6.9 compressions/min over 1 min in one-handed compressions compared with 2.6 compressions/min in two-handed compressions (p = 0.0264). 65.6% of participants reported that they preferred the two-handed compression technique. CONCLUSION: This study showed that CPR compression rate is similar with one- and two-handed compression techniques, but compression rate decreased more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.

Cardiopulmonary Resuscitation↗
PubMed2006

Percutaneous revascularization of chronic total occlusions: review of the role of invasive and non-invasive imaging modalities.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has a lower success rate than PCI of non-occluded coronary stenosis. Failure to cross the occlusive lesion with a guide wire is the main cause of unsuccessful PCI of a CTO. Multi-imaging modalities may provide valuable information for PCI of CTO. This paper reviews the role of invasive and non-invasive imaging modalities such as intravascular ultrasound, optical coherent reflectometry, CT coronary angiography and cardiac magnetic resonance imaging in facilitating percutaneous coronary intervention of CTO.

Angioplasty, Balloon, Coronary↗
PubMed2006

Adverse events associated with the use of intravenous epinephrine in emergency department patients presenting with severe asthma.

STUDY OBJECTIVE: We determine the rate of adverse effects associated with the use of intravenous (IV) epinephrine by infusion for the treatment of severe asthma in the emergency department (ED). METHODS: This retrospective, structured, medical record review included adult patients who presented to the ED of Western Hospital between 1998 and 2003 and who were triaged as category 1, 2, or 3, had a discharge diagnosis of asthma, and were administered IV epinephrine in the ED. Patients were excluded if they were older than 55 years or if a diagnosis of asthma was not confirmed. The primary outcome measures were occurrence of cardiac arrhythmia or ischemia, local tissue ischemia, hypotension or hypertension, neurologic injury, or death related to epinephrine infusion. RESULTS: Two hundred twenty episodes of care met the inclusion criteria. Adverse events occurred in 67 episodes (30.5%; 95% confidence interval [CI] 24.5% to 37.1%); however, most were minor and self-limiting. There were no deaths. Major adverse events occurred in 3.6% of cases (8/220; 95% CI 1.7% to 7.3%), including 2 cases of supraventricular tachycardia, 1 case of chest pain with ECG changes, 1 case of incidental elevated troponin, and 4 cases of hypotension requiring intervention. CONCLUSION: IV epinephrine is associated with a low rate of major and a moderate rate of minor adverse events in patients with severe asthma; however, a causal relationship has not been established. Further research investigating effectiveness, as well as safety, is warranted.

Acute Disease↗
PubMed2006

Comparison between two methods for estimating pneumothorax size from chest X-rays.

AIM: To compare the estimated size of spontaneous pneumothoraces using the established Rhea inter-pleural distances method with the CT-derived Collins method. METHOD: Adult patients with spontaneous pneumothorax treated conservatively were identified from the ED databases. X-rays were reviewed independently by two researchers and measured according to the methods described by Rhea and Collins. Estimates of size derived by the two methods were compared using bias plot analysis techniques. RESULTS: A total of 156 X-rays in 57 patients were identified. A total of 82% were male with a median age of 22 years. Pneumothoraces varied in size from 4% to 88%. The average difference between methods was 4% (Collins method estimating larger size) with 95% limits of agreement -3.8% to 11.7%. Agreement was very close for small pneumothoraces but deteriorated with increasing pneumothorax size (Collins methods estimated larger pneumothorax size). CONCLUSION: The Rhea method for estimating pneumothorax size is acceptably accurate for smaller pneumothoraces but may significantly under-estimate the size of larger pneumothoraces.

Adult↗
PubMed2006

The case for venous rather than arterial blood gases in diabetic ketoacidosis.

OBJECTIVES: For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. METHODS: Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. RESULTS: In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement -0.009 to +0.021 pH units) and between arterial and venous bicarbonate was -1.88 mEq/L. CONCLUSIONS: There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation.

Arteries↗
PubMed2006

Head computed tomography guidelines are being followed.

OBJECTIVE: Several guidelines have been developed to direct the ordering of head computed tomography (CT) for patients, but most are clinical presentation-specific. Recently, an integrated guideline for ordering emergent head CT for patients who present to the ED of Western Hospital, Footscray, Victoria, Australia, was developed in response to concerns raised regarding perceived over-utilization of head CT for ED patients. Our aim was to determine compliance with the guideline. METHODS: This was an explicit retrospective medical record review of patients who presented to the ED of Western Hospital between 1/04/2004 and 17/6/2004 and had a head CT as part of their assessment. Clinical information for these cases was compared with guideline recommendations. Data are described by descriptive statistics. RESULTS: Of the 231 cases that were included in the study, 65 (28.1%, 95% confidence interval 23-35%) had abnormal CT findings. Guidelines were adhered to in 217 (93.9%, 95% confidence interval 91-97%) cases. For the cases where the guidelines were not adhered to (14; [6.1%]), there was only one abnormal scan the clinical significance of which is not clear. CONCLUSION: The study found that compliance with head CT guideline was high. This suggests that the guideline is both clinically relevant and supported by ED doctors or conversely that the guideline is concordant with existing ordering practices of the ED.

Adolescent↗
PubMed2005

Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose.

OBJECTIVE: To determine the effectiveness of intranasal (IN) naloxone compared with intramuscular (IM) naloxone for treatment of respiratory depression due to suspected opiate overdose in the prehospital setting. DESIGN: Prospective, randomised, unblinded trial of either 2 mg naloxone injected intramuscularly or 2 mg naloxone delivered intranasally with a mucosal atomiser. PARTICIPANTS AND SETTING: 155 patients (71 IM and 84 IN) requiring treatment for suspected opiate overdose and attended by paramedics of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria (RAV) in Victoria. MAIN OUTCOME MEASURES: Response time to regain a respiratory rate greater than 10 per minute. Secondary outcome measures were proportion of patients with respiratory rate greater than 10 per minute at 8 minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue naloxone; rate of adverse events; proportion of the IN group for whom IN naloxone alone was sufficient treatment. RESULTS: The IM group had more rapid response than the IN group, and were more likely to have more than 10 spontaneous respirations per minute within 8 minutes (82% v 63%; P = 0.0173). There was no statistically significant difference between the IM and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group]; P = 0.0558). There were no major adverse events. For patients treated with IN naloxone, this was sufficient to reverse opiate toxicity in 74%. CONCLUSION: IN naloxone is effective in treating opiate-induced respiratory depression, but is not as effective as IM naloxone. IN delivery of naxolone could reduce the risk of needlestick injury to ambulance officers and, being relatively safe to make more widely available, could increase access to life-saving treatment in the community.

Administration, Intranasal↗
PubMed2005

The quality of medical record review studies in the international emergency medicine literature.

STUDY OBJECTIVE: We assess the methodologic quality of studies using medical record review methodology in 4 international emergency medicine journals. A secondary aim was to compare methodology quality among these journals and across years. METHODS: This was an observational study of articles whose main methodology was medical record review published in Academic Emergency Medicine (AEM) , Annals of Emergency Medicine (Annals) , Emergency Medicine Journal (EMJ) , and Emergency Medicine Australasia (EMA) between January 2002 and May 2004. Eligible articles were reviewed for reporting of a clear hypothesis or objective, training of abstractors, defined inclusion and exclusion criteria, use of a standard abstraction form, definition of important variables, monitoring of abstractor performance, blinding of abstractors to study hypothesis, reporting of interrater reliability, sample size or power calculation, reporting of ethics approval or waiver, and disclosure of funding source. The primary outcome was the proportion of articles meeting each criterion. Secondary outcomes were comparison of the proportions of articles meeting each criterion among journals and by years. RESULTS: One hundred seven articles were analyzed; 31 were published in AEM, 29 in Annals, 29 in EMJ, and 18 in EMA . A clear aim was reported in 93% of articles, standardized abstraction forms were reported in 51%, interrater reliability was reported in 25%, ethics approval or waiver was reported in 68%, and sample size or power calculation was reported in 10%. CONCLUSION: Adherence to the quality criteria for medical record reviews was suboptimal, and there were significant differences among journals in overall methodologic quality.

Emergency Medicine↗
PubMed2005

Implementation of the Canadian C-spine rule reduces cervical spine x-ray rate for alert patients with potential neck injury.

The objectives of this before-and-after study of alert, stable adult patients presenting to the Emergency Department of Western Hospital with potential neck injuries who were immobilized in hard cervical collars were to determine the impact of implementation of the Canadian C-spine rule on x-ray ordering rates and whether implementation of the rule reduced time in hard collars for patients with potential neck injury. Data collected included demographics, mechanism of injury, x-ray rate, and time in hard collar. Data analysis was by chi-square test for proportions and Mann-Whitney U test for continuous variables. There were 211 patients studied. The x-ray ordering rate decreased from 67% to 50% (25% relative reduction, p = 0.0187). Time in hard collar was also reduced from a median of 128 min to a median of 103 min (effect size 25.5 min), but this did not reach statistical significance. Implementation of the Canadian C-spine rule reduced x-ray ordering by 25%.

Adolescent↗
PubMed2005

Validation of venous pCO2 to screen for arterial hypercarbia in patients with chronic obstructive airways disease.

To validate a previously derived venous pCO2 (pvCO2) cut-off for ruling out arterial hypercarbia in patients with chronic obstructive pulmonary disease (COPD), matched arterial and venous blood gas samples were taken from a convenience sample of patients who presented to the Emergency Department (ED) with COPD deemed by their treating doctor to require arterial blood gas (ABG) analysis as part of their care. The screening cut-off was defined as pvCO2 of > 45 mm Hg and arterial hypercarbia was defined as arterial pCO2 (paCO2) of > 50 mm Hg. Descriptive statistics were employed. Sensitivity, specificity and negative predictive value were calculated. There were 112 patients enrolled in the study, of whom 107 had complete data for analysis. Forty-three patients had arterial hypercarbia (range of 51 to 90 mm Hg, median 60 mm Hg). All cases of arterial hypercarbia were detected by the screening cut-off (sensitivity 100%; 43/43; 95% CI 91-100%; specificity 47%, 95% CI 35-59%). The negative predictive value of pvCO2 < 45 mm Hg was 100% (30/30, 95% CI 89-100%). Assuming the ABG was performed to assess hypercarbia, 29% of ABGs potentially could have been avoided if a venous screening test was employed. In conclusion, pvCO2 can be used as a screening test for arterial hypercarbia, and if employed, can potentially reduce the requirement for ABG sampling.

Aged↗
PubMed2005

Air pollution and childhood asthma emergency hospital admissions: estimating intra-city regional variations.

In recent years childhood asthma has increased. Although the precipitants of childhood asthma are yet to be established possible contributing factors are local ambient air pollutants. This study aims to assess associations of regional ambient air pollutants on emergency department childhood asthma presentations across four regions of the city of Melbourne, Australia. Daily emergency department (ED) presentations for asthma in children were studied for the years 2000 and 2001. Estimates of local air pollutant levels were obtained using simulation modelling techniques. Generalized Additive Models were used to examine associations between combined local levels of air pollutants and childhood asthma ED presentations adjusting for seasonal variation, day of week effects, and meteorological variables. There was consistent associations between childhood ED asthma presentations and regional concentration of PM10, with a strongest association of RR = 1.17 (95% CI 1.05 to 1.31) in the central district of Melbourne. NO2 and Ozone was associated with increased childhood asthma ED presentations in the Western districts. This study suggests that regional concentrations of PM10 may have a significant effect on childhood asthma morbidity. In addition, ozone may play a role however, its effect may vary by geographical region.

Adolescent↗
PubMed2005

How accurate is weight estimation in the emergency department?

OBJECTIVE: To determine the accuracy of medical staff, nursing staff and patients for estimating weight in an ED population. METHODS: This is a prospective, observational study. Medical staff, nursing staff and patients were asked to estimate patient weight that was then measured. The main outcome was average per cent error in weight estimation for each group. RESULTS: Average per cent error in estimates was 3.9% for patients (95% CI 3.6-4.1%), 7.7% (95% CI 7.2-8.2%) for nurses and 11% (95% CI 10.2-11.7%) for physicians. Ninety-one per cent of patients (95% CI 90-93%), 78% of nurses (95% CI 75-80%) and 59% of physicians (95% CI 56-63%) made weight estimates accurate to within 10% of actual weight. CONCLUSION: Patients are generally accurate in estimating their true weight and health care workers showed only moderate accuracy. Where possible, drug dose calculations should be based on measured weight and if this is not possible, patient estimate of weight should be sought. Health care worker estimation should be used only when this is not possible.

Adolescent↗
PubMed2004

Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma?

AIM: To determine if severity assessment after 1 h of treatment is better than assessment at presentation for predicting the requirement for hospital admission for emergency department (ED) patients with acute asthma. METHODS: Prospective, observational study conducted in 36 Australian ED for a 2-week period in 2001 involving patients aged 1-55 years presenting with asthma. Data collected included severity assessment according to the National Asthma Guidelines (Australia) at presentation and 1 h, and disposition. Descriptive analysis was applied. RESULTS: 720 cases were analysed. Patients with 'mild' asthma at either assessment time had a greater than 80% chance of discharge home. Patients assessed as 'severe' at either assessment had a greater than 85% chance of requiring hospital admission, but the 1 h assessment was better at predicting the need for Intensive Care Unit (ICU) admission. For the 'moderate' group, the initial assessment was a poor predictor of the need for admission however those who met the criteria for 'moderate' severity at 1 h had an 84% chance of requiring admission. CONCLUSION: Assessment of asthma severity after 1 h of treatment is better than initial severity assessment for determining the need for hospital admission for patients initially assessed as having 'moderate' asthma and for predicting the need for ICU in patients initially assessed as 'severe'.

Acute Disease↗
PubMed2004

How long does stridor at rest persist in croup after the administration of oral prednisolone?

OBJECTIVES: To determine the duration of stridor at rest (SAR) after the administration of oral prednisolone (1 mg/kg) to children admitted to hospital with croup from the ED. The secondary objective was to determine whether children with mild croup had a more rapid resolution of SAR. METHODS: This was a retrospective explicit chart review of all children admitted to the paediatric ward of a community, paediatric teaching hospital with a diagnosis of croup over one year. Data collected included patient demographics, Westley and Geelhoed croup scores on presentation to the ED and the duration of SAR after administration of steroids. RESULTS: For the 188 cases analyzed, median duration of SAR was 6.5 h (95% CI 6-7 h, range 0.5-82 h). Children with a Westley score of < or = 2 or a Geelhoed score of < or = 3 had a shorter duration of SAR than those with higher scores (6 h vs. 7 h, P < 0.05), which although statistically significant is unlikely to be of clinical significance. CONCLUSIONS: Stridor at rest resolves promptly after the administration of oral steroids in the vast majority of cases. This suggests that a subset of patients previously admitted to hospital with croup may be able to be treated and discharged from the ED.

Administration, Oral↗
PubMed2004

Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: a pilot study.

OBJECTIVE: To determine whether intermediate dose metoclopramide is more effective than standard dose metoclopramide for patients who present to the ED with nausea and vomiting. METHODS: This prospective, single-blind, randomized trial was conducted in the ED of two community teaching hospitals in a convenience sample of adult patients who presented to ED with nausea and vomiting. Patients were randomized to receive either 10 mg metoclopramide IV or 0.4 mg/kg IV (up to a maximum dose of 32 mg). The outcomes measured were: change in nausea score (measured on a 11-point verbal rating scale), requirement for other anti-emetic drug administration, and presence of side-effects. RESULTS: Fifty-eight patients were eligible for analysis (34 in 10 mg group and 24 in 0.4 mg/kg group). Median reduction in nausea score in 10 mg group was four (range 0-10, 95% CI 3-5) compared with five for 0.4 mg/kg group (range -1-10, 95% CI 4-6). This difference was not statistically significant (P = 0.629). Five patients in the 10 mg group required rescue anti-emetic, compared with three in the 0.4 mg/kg group (P = 1.00). There were no side-effects in the 10 mg group and two in the 0.4 mg/kg group. CONCLUSION: This study suggests that there is no difference in effectiveness between 10 mg and 0.4 mg/kg of metoclopramide in the ED population with nausea and vomiting.

Adolescent↗