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Fan‐first heat‐health protection

Angie Bone, Federico Tartarini and Ollie Jay
Med J Aust || doi: 10.5694/mja2.52662
Published online: 2 June 2025

Heat‐related illnesses occur when environmental heat stress exceeds the body's physiological limits of heat tolerance. This most often arises when these limits are already constrained by cofactors such as older age, chronic diseases and certain medications.1 Global heat‐related mortality, estimated to be about 489 000 deaths per year,2 is predicted to increase substantially as climate change progresses.3

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Current gaps in knowledge and future research directions for Aboriginal and Torres Strait Islander children with cancer

Alexandra Truong, Kayla Williams‐Tucker (Ngarluma, Wongutha, Wudjari Noongar), Ahmi Narkle (Whadjuk Goreng Noongar), Eden Slicer (Gundungurra), Jessica‐Elise Chapman (Kamilaroi, Bundjalung), Jessica Lawler, Rishi S Kotecha, Hetal Dholaria, Justine R Clark (Adnyamathanha), Alex Brown (Yuin), Raelene Endersby, Nicholas G Gottardo and Jessica Buck (Kamilaroi)
Med J Aust 2025; 222 (10): . || doi: 10.5694/mja2.52650
Published online: 2 June 2025

Summary

  • Paediatric cancer is the leading cause of disease‐related death in Australian children. Limited research focuses on cancer in Aboriginal and Torres Strait Islander children.
  • Although there appears to be a lower incidence of cancer overall in Aboriginal and Torres Strait Islander children compared with non‐Indigenous children, a high proportion of Aboriginal and Torres Strait Islander children are diagnosed with acute myeloid leukaemia.
  • Five‐year overall survival is lower for many cancer types in Aboriginal and Torres Strait Islander children.
  • There is a need for Indigenous‐specific research focused on molecular and genetic profiles, pharmacogenomics and survivorship, both within Australia and globally.
  • Future research in this space should be co‐designed and led by Aboriginal and Torres Strait Islander communities; alongside clinicians, researchers and services to ensure that the priorities of Aboriginal and Torres Strait Islander people are met.

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  • 1 WA Kids Cancer Centre, The Kids Research Institute Australia, Perth, WA
  • 2 Centre for Child Health Research, The University of Western Australia, Perth, WA
  • 3 The University of Notre Dame Australia, Fremantle, WA
  • 4 University of New South Wales, Sydney, NSW
  • 5 Perth Children's Hospital, Perth, WA
  • 6 The Kids Research Institute Australia, Adelaide, SA


Correspondence: jessica.buck@thekids.org.au


Open access:

Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.


Acknowledgements: 

We acknowledge the First Nations Childhood Cancer Advisory Group for their advice in preparing this manuscript. We acknowledge our Elders and the communities in which we live and write. We also acknowledge First Nations people living with and passed from cancer, and their families.

Competing interests:

No relevant disclosures.

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Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies

Feby Savira, Madison Frith, Clarissa J Aditya, Sean Randall, Naomi White, Andrew Giddy, Lauren Spark, Jamie Swann and Suzanne Robinson
Med J Aust 2025; 222 (9): . || doi: 10.5694/mja2.52663
Published online: 19 May 2025

Abstract

Objectives: To identify published studies that examined the impact of urgent care centres on the numbers of presentations to emergency departments (EDs), or explored the experiences and views of patients and practitioners regarding urgent care centres as alternative sources of health care and advice.

Study design: Scoping review of qualitative and quantitative studies published to 28 August 2024.

Data sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases; grey literature searches.

Data synthesis: Of 2698 potentially relevant publications, 51 met our inclusion criteria (30 quantitative studies; 21 qualitative studies). Urgent care centres of various types were led by general practitioners in 41 of 51 studies, primarily managed people with non‐urgent conditions or minor illnesses in 34 studies and non‐emergency but urgent conditions in eight, and nine of the 22 studies that discussed funding indicated that access to the centres was free of charge. The effect of urgent care centres on ED presentation numbers was mixed; all seven studies of after‐hours clinics, one of two studies of 24‐hour clinics, and four of five studies of walk‐in centres reported reduced ED visit numbers; in eleven studies that reported effects on hospital admissions from the ED, they were lower in seven (studies of an urgent cancer care centre, four community health centres, and a general practitioner cooperative). Patient satisfaction with urgent care centres is generally as high as with other primary care services; they preferred them to EDs, and preferred personal triage to telephone triage. Reasons for people choosing urgent care centres included easier access and the unavailability of doctors or appointments elsewhere. Clinicians reported increased workload, mixed experiences with the coordination of care, concerns about unregistered or undocumented people using the services, and protocol confusion, particularly with respect to triage. Continuity of care was a concern for both clinicians and patients.

Conclusions: Urgent care centres, especially walk‐in and after‐hours clinics, can help reduce the number of ED presentations and reduce health care costs. Patient satisfaction with such clinics is high, but public health education could guide people to appropriate care for non‐urgent health problems. Training in the management of conditions frequently seen in urgent care centres is needed to ensure consistent, effective care.

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  • 1 Institute for Health Transformation, Deakin University, Melbourne, VIC
  • 2 Western Victoria Primary Health Network, Ballarat, VIC
  • 3 Melbourne, VIC


Correspondence: feby.savira@deakin.edu.au


Open access:

Open access publishing facilitated by Deakin University, as part of the Wiley – Deakin University agreement via the Council of Australian University Librarians.


Acknowledgements: 

The study was funded by Western Victoria Primary Health Network as part of the Priority Primary Care Centre evaluation program. The funders had no role in the planning, writing, or publication of this review. We acknowledge the support received from the Western Victoria Primary Health Network to conduct this study and to ensure evidence‐based research in Victoria and Australia.

Competing interests:

Naomi White, Andrew Giddy, and Jamie Swann are employees of the Western Victoria Primary Health Network.

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Shifting focus to adolescent wellbeing and inclusive participation in the digital age

Stephanie R Partridge, Allyson R Todd, Si Si Jia and Rebecca Raeside, with the Health Advisory Panel for Youth at the University of Sydney (HAPYUS)
Med J Aust || doi: 10.5694/mja2.52653
Published online: 19 May 2025

Older generations often say the “youth of today aren't resilient” yet Gen Z faces a rapidly changing world, such as COVID‐19, climate change and technological advancements.

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  • 1 University of Sydney, Sydney, NSW
  • 2 Charles Perkins Centre, University of Sydney, Sydney, NSW



Open access:

Open access publishing facilitated by The University of Sydney, as part of the Wiley – The University of Sydney agreement via the Council of Australian University Librarians.


Acknowledgements: 

Stephanie Partridge is supported by a University of Sydney Horizon Fellowship and a National Heart Foundation Future Leader Fellowship (Grant No. 106646). Allyson Todd is a young person and PhD student supported by a Postgraduate Research Scholarship in Adolescent Health and Nutrition from the University of Sydney. Rebecca Raeside is supported by a National Health and Medical Research Council SOLVE CHD Primary and Supplementary Research Scholarship. Si Si Jia is supported on a Research Training Program Stipend Scholarship and a Postgraduate Research Scholarship from the King and Amy O'Malley Trust. The Health Advisory Panel for Youth at the University of Sydney (HAPYUS) is funded by the Australian Government Department of Health and Aged Care Medical Research Future Fund Primary Care Grant (2006315). These funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results.

The Health Advisory Panel for Youth at the University of Sydney (HAPYUS): Sara Wardak, Shuwei Guo, Yi Ying Lim, Moudasir Jalili, Lucy Goodyer, Lucy Gee, Lucy Agland, Natalie Ryan, Nitika Sharma, Caitlyn Lee, Chloe Caldwell, Elena Wang; University of Sydney, Sydney, NSW.

Competing interests:

No relevant disclosures.

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Preparing Australia for future pandemics: strengthening trust, social capital and resilience

Shanti Narayanasamy, Alisa Pedrana, Katherine B Gibney, Lisa Gibbs and Margaret E Hellard
Med J Aust || doi: 10.5694/mja2.52652
Published online: 12 May 2025

The findings of the COVID‐19 Response Inquiry, an independent report, which was commissioned by the Albanese government into Australia's response to the coronavirus disease 2019 (COVID‐19) pandemic, were released on 29 October 2024. The independent panel, which had substantial experience in public health and economic policy, made nine guiding recommendations and 26 actions to improve Australia's preparedness to manage future public health emergencies.1 Following extensive stakeholder engagement,2,3 the Inquiry highlighted the loss of trust and eroded confidence in government, and emphasised the importance of rebuilding trust and resilience with populations, communities and settings that were most negatively affected by the COVID‐19 pandemic and related measures. Equity was emphasised as a cornerstone for pandemic preparedness, to proactively address populations most at risk and consider existing inequities in health when developing pandemic responses.1 The Inquiry found that, in Australia, similar to other high and middle‐income countries,4,5,6 the COVID‐19 pandemic disproportionately affected priority populations through morbidity, mortality and the impact of the pandemic response measures.1 Priority populations were defined as those groups who experienced an inequitable burden of disease and disparities in health and economic outcomes during the COVID‐19 pandemic.1 These differences arise due to inequities in the social determinants of health, including education, employment, socio‐economic group, housing stability, access to health care, and experiences of racism.1 Individuals may also experience intersecting layers of inequity and face disproportionate impacts from pandemic response measures.1

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  • 1 Austin Health, Melbourne, VIC
  • 2 Centre for Population Health, Burnet Institute, Melbourne, VIC
  • 3 University of Melbourne, Melbourne, VIC
  • 4 Peter Doherty Institute for Infection and Immunity, Melbourne, VIC



Competing interests:

No relevant disclosures.

  • 1. Australian Government Department of the Prime Minister and Cabinet. COVID‐19 Response Inquiry final report. Canberra: Commonwealth of Australia, 2024. https://www.pmc.gov.au/news/covid‐19‐response‐inquiry‐final‐report (viewed Mar 2025).
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The prevalence of intimate partner violence in Australia: a national survey

Ben Mathews, Kelsey L Hegarty, Harriet L MacMillan, Monica Madzoska, Holly E Erskine, Rosana Pacella, James G Scott, Hannah Thomas, Franziska Meinck, Daryl Higgins, David M Lawrence, Divna Haslam, Sara Roetman, Eva Malacova and Timothy Cubitt
Med J Aust || doi: 10.5694/mja2.52660
Published online: 5 May 2025

Abstract

Objectives: To estimate the prevalence in Australia of intimate partner violence, each intimate partner violence type, and multitype intimate partner violence, overall and by gender, age group, and sexual orientation.

Study design: National survey; Composite Abuse Scale (Revised)—Short Form administered in mobile telephone interviews, as a component of the Australian Child Maltreatment Study.

Setting: Australia, 9 April – 11 October 2021.

Participants: 8503 people aged 16 years or older: 3500 aged 16–24 years and about 1000 each aged 25–34, 35–44, 45–54, 55–64, or 65 years or older.

Main outcome measures: Proportions of participants who had ever been in an intimate partner relationship since the age of 16 years (overall, and by gender, age group, and sexual orientation) who reported ever experiencing intimate partner physical, sexual, or psychological violence.

Results: Survey data were available for 8503 eligible participants (14% of eligible persons contacted), of whom 7022 had been in intimate relationships. The prevalence of experiencing any intimate partner violence was 44.8% (95% confidence interval [CI], 43.3–46.2%); physical violence was reported by 29.1% (95% CI, 27.7–30.4%) of participants, sexual violence by 11.7% (95% CI, 10.8–12.7%), and psychological violence by 41.2% (95% CI, 39.8–42.6%). The prevalence of experiencing intimate partner violence was significantly higher among women (48.4%; 95% CI, 46.3–50.4%) than men (40.4%; 95% CI, 38.3–42.5%); the prevalence of physical, sexual, and psychological violence were also higher for women. The proportion of participants of diverse genders who reported experiencing intimate partner violence was high (62 of 88 participants; 69%; 95% CI, 55–83%). The proportion of non‐heterosexual participants who reported experiencing intimate partner violence (70.2%; 95% CI, 65.7–74.7%) was larger than for those of heterosexual orientation (43.1%; 95% CI, 41.6–44.6%). More women (33.7%; 95% CI, 31.7–35.6%) than men (22.7%; 95% CI, 20.9–24.5%) reported multitype intimate partner violence. Larger proportions of participants aged 25–44 years (51.4%; 95% CI, 48.9–53.9%) or 16–24 years (48.4%, 95% CI, 46.1–50.6%) reported experiencing intimate partner violence than of participants aged 45 years or older (39.9%; 95% CI, 37.9–41.9%).

Conclusions: Intimate partner violence is widespread in Australia. Women are significantly more likely than men to experience any intimate partner violence, each type of violence, and multitype intimate partner violence. A comprehensive national prevention policy is needed, and clinicians should be helped with recognising and responding to intimate partner violence.

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  • 1 Queensland University of Technology, Brisbane, QLD
  • 2 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
  • 3 Safer Families Centre, the University of Melbourne, Melbourne, VIC
  • 4 Family Violence Prevention Centre, the Royal Women's Hospital, Melbourne, VIC
  • 5 McMaster University, Hamilton, Canada
  • 6 Curtin University, Perth, WA
  • 7 The University of Queensland, Brisbane, QLD
  • 8 Queensland Centre for Mental Health Research, Brisbane, QLD
  • 9 Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
  • 10 Child Health Research Centre, University of Queensland, Brisbane, QLD
  • 11 Centre for Mental Health Treatment Research and Education, Queensland Centre for Mental Health Research, Brisbane, QLD
  • 12 University of Edinburgh, Edinburgh, United Kingdom
  • 13 Institute of Child Protection Studies, Australian Catholic University, Melbourne, VIC
  • 14 Parenting and Family Support Centre, the University of Queensland, Brisbane, QLD
  • 15 QIMR Berghofer Medical Research Institute, Brisbane, QLD
  • 16 Australian Institute of Criminology, Canberra, ACT


Correspondence: b.mathews@qut.edu.au


Open access:

Open access publishing facilitated by Queensland University of Technology, as part of the Wiley – Queensland University of Technology agreement via the Council of Australian University Librarians.


Data Sharing:

Final data sets will be stored on the Australian Data Archive and made available in January 2026 after an embargo period.


Acknowledgements: 

This study was supported by the Australian Child Maltreatment Study (ACMS), funded by a National Health and Medical Research Council project grant (APP1158750) during 2019–2023, with further funding from the Department of the Prime Minister and Cabinet, and the Department of Social Services. The Australian Institute of Criminology provided funding to support the inclusion of survey items on intimate partner violence. The funding sources played no role in study design, data collection, analysis or interpretation, reporting or publication, except for the scholarly collaboration by one author (Timothy Cubitt). We acknowledge all survey participants, whose responses facilitated this research.

Competing interests:

No relevant disclosures.

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Antidepressant prescribing in Australian primary care: time to reevaluate

Katharine A Wallis, Anna King and Joanna Moncrieff
Med J Aust || doi: 10.5694/mja2.52645
Published online: 5 May 2025

Around one in seven Australians is now taking antidepressants (3.9 million people, 14%),1 and the prevalence of use is rising.2,3 Two antidepressants, sertraline and escitalopram, are now in the top ten drugs by defined daily dose per 1000 population per day.4 In Australia, women are prescribed antidepressants at 1.5 times the rate of men, and older people (aged ≥ 65 years) are twice as likely to be prescribed antidepressants as younger people (aged < 65 years).2,5 Around 26% of people aged 75 years or older are taking antidepressants.2 Most psychological distress or mental illness is managed in primary care, and antidepressant prescribing is overwhelmingly in primary care, with general practitioners prescribing 92% of antidepressants in Australia.1

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  • 1 University of Queensland, Brisbane, QLD
  • 2 University College London, London, United Kingdom


Correspondence: k.wallis@uq.edu.au


Open access:

Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.


Competing interests:

Katharine Wallis received funding from the Australian Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC) to lead the RELEASE (Redressing Long‐term Antidepressant Use) trial. Anna King is a member of the MRFF and NHMRC funded RELEASE trial Lived Experience Advisory Group. Joanna Moncrieff is a co‐investigator on the MRFF and NHMRC funded RELEASE trial, she has been a co‐investigator on a study of antidepressant discontinuation funded by the United Kingdom's National Institute for Health and care Research, she receives modest royalties from books about psychiatric drugs, and she is co‐chair of the Critical Psychiatry Network.

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The costs and benefits of a prison needle and syringe program in Australia, 2025–30: a modelling study

Farah Houdroge, Samantha Colledge‐Frisby, Nadine Kronfli, Rebecca J Winter, Joanne Carson, Mark Stoove and Nick Scott
Med J Aust || doi: 10.5694/mja2.52640
Published online: 21 April 2025

Abstract

Objectives: To estimate and compare the costs and benefits of introducing a prison needle and syringe program in all Australian prisons.

Study design: Stochastic compartmental modelling study.

Setting: All Australian prisons, 1 January 2010 to 31 December 2030.

Intervention: Introduction of a prison needle and syringe program in all Australian prisons during 1 January 2025 – 1 January 2027, with the aim of covering 50% of people who inject drugs in prison by 1 January 2030.

Main outcome measures: Projected new hepatitis C virus (HCV) infections and hospitalisations with injection‐related bacterial and fungal infections in prisons, with and without the needle and syringe program; costs of the program; savings in treatment costs for HCV and injection‐related bacterial and fungal infections; benefit–cost ratio of the program.

Results: In the base scenario (no prison needle and syringe program), the projected number of new HCV infections during 2025–2030 was 2932 (uncertainty interval [UI], 2394–3507) and the projected number of hospitalisations with injection‐related bacterial and fungal infections was 3110 (UI, 2596–3654). With the prison needle and syringe program, it was projected that 894 (UI 880–912) new HCV infections (30%; UI, 26–37%) and 522 (UI, 509–532) hospitalisations with injection‐related bacterial and fungal infections (17%; UI, 15–20%) would be averted; the incidence of new HCV infections would be reduced from 3.1 (UI, 2.5–3.7) to 1.3 (UI, 1.0–1.7) per 100 person‐years among people who inject drugs in prison. The estimated cost of the program was $12.2 million (UI, $7.6–22.2 million), and the saved care costs for HCV and injection‐related infections were $31.7 million (UI, $29.3–34.6 million), yielding a benefit–cost ratio of 2.6 (UI, 1.4–4.1). The benefit–cost ratio was also greater than one for scenarios in which the assumptions and base values for several parameters were varied.

Conclusions: Each dollar spent on a needle and syringe program in Australian prisons could save $2.60 in treatment costs for HCV and other injection‐related infections.

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  • 1 The Burnet Institute, Melbourne, VIC
  • 2 National Drug Research Institute, Perth, WA
  • 3 McGill University Health Centre, Montreal, Canada
  • 4 Centre for Outcomes Research and Evaluation Research, Institute of the McGill University Health Centre, Montreal, Canada
  • 5 St Vincent's Hospital Melbourne, Melbourne, VIC
  • 6 The Kirby Institute, University of New South Wales, Sydney, NSW
  • 7 Monash University, Melbourne, VIC



Data Sharing:

This study did not generate original data.


Acknowledgements: 

We thank the SToP‐C study group (Supporting Information) for contributing data for some model parameters.

Competing interests:

Nadine Kronfli has received research funding from Gilead Sciences, AbbVie, and ViiV Healthcare, advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and AbbVie, and speaker fees from Gilead Sciences, AbbVie, and Merck, all unrelated to this study. Mark Stoové has received investigator‐initiated research funding from Gilead Sciences and AbbVie and consultant fees from Gilead Sciences for activities unrelated to this study. Rebecca Winter has received investigator‐initiated research funding from Gilead Sciences unrelated to this study.

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Geographic remoteness‐based differences in in‐hospital mortality among people admitted to NSW public hospitals with heart failure, 2002–21: a retrospective observational cohort study

Imants Rubenis, Gregory Harvey, Karice Hyun, Vincent Chow, Leonard Kritharides, Andrew P Sindone, David B Brieger and Austin CC Ng
Med J Aust 2025; 222 (7): . || doi: 10.5694/mja2.52635
Published online: 21 April 2025

Abstract

Objective: To examine associations between remoteness of region of residence and in‐hospital mortality for people admitted to hospital with heart failure in New South Wales during 2002–21.

Study design: Retrospective observational cohort study; analysis of New South Wales Admitted Patient Data Collection data.

Setting, participants: Adult (16 years or older) NSW residents admitted with heart failure to NSW public hospitals, 1 January 2002 – 30 September 2021. Only first admissions with heart failure during the study period were included.

Main outcome measures: In‐hospital mortality, by remoteness of residence (Australian Statistical Geography Standard), adjusted for age (with respect to median), sex, socio‐economic status (Index of Relative Socioeconomic Advantage and Disadvantage [IRSAD], with respect to median), other diagnoses, hospital length of stay, and calendar year of admission (by 4‐year group).

Results: We included 154 853 admissions with heart failure; 99 687 people lived in metropolitan areas (64.4%), 41 953 in inner regional areas (27.1%), and 13 213 in outer regional/remote/very remote areas (8.5%). The median age at admission was 80.3 years (interquartile range [IQR], 71.2–86.8 years), and 78 591 patients were men (50.8%). The median IRSAD score was highest for people from metropolitan areas (metropolitan: 1000; IQR, 940–1064; inner regional: 934; IQR, 924–981; outer regional/remote/very remote areas: 930; IQR, 905–936). During 2002–21, 9621 people (6.2%) died in hospital; the proportion was 8.0% in 2002, 4.9% in 2021. In‐hospital all‐cause mortality was lower during 2018–21 than during 2002–2005 (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.49–0.56); the decline was similar for all three remoteness categories. Compared with people from metropolitan areas, the odds of in‐hospital death during 2002–21 were higher for people from inner regional (aOR, 1.12; 95% CI, 1.07–1.17) or outer regional/remote/very remote areas (aOR, 1.35; 95% CI, 1.25–1.45).

Conclusion: In‐hospital mortality during heart failure admissions to public hospitals declined across NSW during 2002–21. However, it was higher among people living in regional and remote areas than for people from metropolitan areas. The reasons for the difference in in‐hospital mortality should be investigated.

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  • 1 Concord Repatriation General Hospital, Sydney, NSW
  • 2 The University of Sydney, Sydney, NSW
  • 3 ANZAC Research Institute, Sydney, NSW


Correspondence: imants.rubenis@sydney.edu.au


Open access:

Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.


Data Sharing:

The NSW Population and Health Services Research Ethics Committee (PHSREC) prohibits authors from making the minimal data set publicly available. Interested researchers may contact the ethics coordinator (ethics@cancerinstitute.org.au) to seek permission to access the data; data will then be made available upon request to interested researchers who receive approval from the NSW PHSREC.


Competing interests:

No relevant disclosures.

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Early cardiovascular collapse after envenoming by snakes in Australia, 2005–2020: an observational study (ASP‐31)

Geoffrey K Isbister, Katherine Z Isoardi, Angela L Chiew, Shane Jenkins and Nicholas A Buckley
Med J Aust 2025; 222 (6): . || doi: 10.5694/mja2.52622
Published online: 7 April 2025

Abstract

Objectives: To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.

Study design: Observational study; analysis of prospectively collected demographic and clinical data.

Setting, participants: People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 – 30 June 2020.

Main outcome measures: Time from snakebite to collapse; post‐collapse complications (cardiac arrest, seizures, death).

Results: Of 1259 envenomed people, 157 (12%) collapsed within 24 hours of the snakebite; venom‐induced consumption coagulopathy (VICC) was determined in all 156 people for whom coagulation testing could be performed. The exact time between bite and collapse was known for 149 people (median, 20 min; interquartile range, 15–30 min; range, 5–115 min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (Pseudonaja spp.) envenoming was the leading cause of collapse (103 cases, 66%). Forty‐two collapses (27%) were followed by cardiac arrest, 49 (31%) by seizures (33 without cardiac arrest), and five by apnoea; collapse was associated with hypotension in all 24 people whose blood pressure could be measured at or close to the time of collapse. Twenty‐five people who collapsed died (16%), and seven of the envenomed people who did not collapse (0.6%; difference: 15 percentage points; 95% confidence interval, 8–21 percentage points). The deaths of 21 of the 25 people who collapsed were immediately associated with the cardiac arrest that followed the collapse; three people who did not have cardiac arrests died later of intracranial haemorrhage, and one of hyperthermia. The proportion of people who had collapsed before reaching hospital was larger for people who died of post‐collapse cardiac arrest (13 of 21, 62%) than for those who survived (6 of 21, 28%).

Conclusion: Collapse after Australian snake envenoming almost always occurred within 60 minutes of the bite, was always accompanied by VICC, and most frequently followed brown snake bites. Poorer outcomes, including cardiac arrest, seizures, and death, were more frequent for people who collapsed than for those who did not. Outcomes for people who collapsed before medical care arrived were poorer than for those who collapsed in hospital or in an ambulance.

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  • 1 The University of Sydney, Sydney, NSW
  • 2 The University of Newcastle, Newcastle, NSW
  • 3 NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW
  • 4 Princess Alexandra Hospital, Brisbane, QLD
  • 5 The University of Queensland, Brisbane, QLD
  • 6 Prince of Wales Hospital and Community Health Services, Sydney, NSW



Open access:

Open access publishing facilitated by The University of Newcastle, as part of the Wiley – the University of Newcastle agreement via the Council of Australian University Librarians.


Acknowledgements: 

We acknowledge Kylie Tape (University of Newcastle) for data collection and data entry for the Australian Snakebite Project.

Competing interests:

No relevant disclosures.

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