MJA
MJA

    Excessive PSA testing in general practice

    Justin J Coleman
    Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51208
    Published online: 6 September 2021

    The time for actively recommending the screening of asymptomatic men has passed

    There is little doubt that Australian doctors order too many prostate‐specific antigen (PSA) screening tests. The analysis by Franco and colleagues of electronic data for 142 000 Victorian general practice patients, published in this issue of the MJA, found that 46% of men aged 70–74 years had had at least two PSA tests during the preceding two years,1 despite Australian guidelines recommending against PSA screening of asymptomatic men in this age group.2 Indeed, the Royal Australian College of General Practitioners (RACGP) does not recommend PSA screening of most asymptomatic men of any age.3 Some testing might be justified (for example, screening of men at high risk, or prostate disease monitoring), but when Australian general practitioner registrars were asked to record specific reasons for ordering PSA tests, “asymptomatic screening” accounted for three‐quarters of requests.4

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      What is the role of general practice in the Chain of Survival for treating people with cardiac arrest?

      Siobhán Masterson and Tomás Barry
      Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51202
      Published online: 6 September 2021

      Patient survival is more likely when general practitioners and their staff are trained in resuscitation and equipped with defibrillators

      With increasing appreciation of the importance of post‐resuscitation care and long term patient outcomes, the Chain of Survival for patients with cardiac arrest has evolved.1 However, the first three links have not changed: early recognition and an emergency call for medical help; early cardiopulmonary resuscitation; and early defibrillation. If these steps are not immediately and sequentially activated, further links in the Chain of Survival have little or no impact on survival. The study by Haskins and colleagues2 reported in this issue of the MJA re‐affirms the importance of these three links, and provides direction on how they can be further strengthened in community general practice.


      • 1 HSE National Ambulance Service, Limerick, Ireland
      • 2 National University of Ireland Galway, Galway, Ireland
      • 3 UCD Centre for Emergency Medical Science, University College Dublin, Dublin, Ireland


      Competing interests:

      No relevant disclosures.

      • 1. Perkins GD, Graesner JT, Semeraro F, et al; European Resuscitation Council Guideline Collaborators. European Resuscitation Council guidelines 2021: executive summary. Resuscitation 2021; 161: 1–60.
      • 2. Haskins B, Nehme Z, Cameron PA, Smith K. Cardiac arrests in general practice clinics or witnessed by emergency medical services: a 20‐year retrospective study. Med J Aust 2021; 215: 222–227.
      • 3. Masterson S, McNally B, Cullinan J, et al. Out‐of-hospital cardiac arrest survival in international airports. Resuscitation 2018; 127: 58–62.
      • 4. Niegsch ML, Krarup NT, Clausen NE. The presence of resuscitation equipment and influencing factors at General Practitioners’ offices in Denmark: a cross‐sectional study. Resuscitation 2014; 85: 65–69.
      • 5. Masterson S, Wright P, Dowling J, et al. Out‐of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years’ experience. Emerg Med J 2011; 28: 437–438.
      • 6. Barry T, Headon M, Glynn R, et al. Ten years of cardiac arrest resuscitation in Irish general practice. Resuscitation 2018; 126: 43–48.
      • 7. Barry T, Headon M, Quinn M, et al. General practice and cardiac arrest community first response in Ireland. Resuscitation Plus 2021; 6: 100127.
      • 8. Bury G, Headon M, Dixon M, Egan M. Cardiac arrest in Irish general practice: an observational study from 426 general practices. Resuscitation 2009; 80: 1244–1247.
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        Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

        Lukoye Atwoli, Abdullah H Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard C Horton, Laurie Laybourn‐Langton, Carlos A Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J Rubin, Peush Sahni, Richard SW Smith, Nicholas J Talley, Sue Turale and Damián Vázquez
        Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51221
        Published online: 6 September 2021

        Wealthy nations must do much more, much faster

        The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we — the editors of health journals worldwide — call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.

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        • 1 East African Medical Journal, Makhanda, South Africa
        • 2 Journal of Population, Health and Nutrition, UK
        • 3 Danish Medical Journal, Copenhagen, Denmark
        • 4 PLOS Medicine, San Francisco, CA, USA
        • 5 The BMJ, London, UK
        • 6 British Dental Journal, London, UK
        • 7 The Lancet, London, UK
        • 8 UK Health Alliance on Climate Change, London, UK
        • 9 Revista de Saúde Pública, São Paulo, Brazil
        • 10 International Journal of Nursing Studies, London, UK
        • 11 Canadian Medical Association Journal, Ottawa, Canada
        • 12 Pharmaceutical Journal, London, UK
        • 13 Dutch Journal of Medicine, Amsterdam, The Netherlands
        • 14 New England Journal of Medicine, Waltham, MA, USA
        • 15 National Medical Journal of India, New Delhi, India
        • 16 Medical Journal of Australia, Sydney, NSW, Australia
        • 17 International Nursing Review
        • 18 Pan American Journal of Public Health, Washington, DC, USA


        Competing interests:

        Fiona Godlee serves on the executive committee for the UK Health Alliance on Climate Change and is a Trustee of the Eden Project. Richard Smith is the chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet Commission on the Value of Death. A complete list of Nicholas Talley's disclosures is available at https://www.mja.com.au/journal/staff/editor-chief-professor-nick-talley

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          Public support for phasing out the sale of cigarettes in Australia

          Emily Brennan, Sarah Durkin, Michelle M Scollo, Maurice Swanson and Melanie Wakefield
          Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51224
          Published online: 30 August 2021

          As smoking rates continue to decline in some countries, including Australia,1 a goal once unthinkable is now being considered: phasing out the retail sale of combustible tobacco products.2,3 In 2009, 72% of Victorian adults and 57% of smokers felt it would be good if there came a time when cigarettes were no longer available for sale.4 In 2019, we assessed support among Victorian adults for phasing out retail sales, and canvassed their views on timeframes for doing so.

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          • 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC
          • 2 The University of Melbourne, Melbourne, VIC
          • 3 Australian Council on Smoking and Health (ACOSH), Perth, WA


          Acknowledgements: 

          The Victorian Smoking and Health survey was supported by Quit Victoria, with funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria. We acknowledge the contribution of Linda Hayes, Andrea Nathan and Emily Bain (Cancer Council Victoria) to the collection and analysis of the Victorian Smoking and Health Survey data.

          Competing interests:

          Emily Brennan, Sarah Durkin, Michelle Scollo and Melanie Wakefield received funding from VicHealth, the Victorian Department of Health and Human Services, and Cancer Council Victoria during the study.

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            The influence of the surveillance time interval on the risk of advanced neoplasia after non‐advanced adenoma removal

            Zaki Hamarneh, Charles Cock, Graeme P Young, Peter A Bampton, Robert Fraser, Fang LI Ang, Feruza Kholmurodova and Erin L Symonds
            Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51222
            Published online: 30 August 2021

            Abstract

            Objectives: To investigate the incidence of advanced neoplasia (colorectal cancer or advanced adenoma) at surveillance colonoscopy following removal of non‐advanced adenoma; to determine whether the time interval before surveillance colonoscopy influences the likelihood of advanced neoplasia.

            Design: Retrospective cohort study.

            Setting, participants: Patients enrolled in a South Australian surveillance colonoscopy program with findings of non‐advanced adenoma during 1999–2016 who subsequently underwent surveillance colonoscopy.

            Main outcome measures: Incidence of advanced neoplasia at follow‐up surveillance colonoscopy.

            Results: Advanced neoplasia was detected in 169 of 965 eligible surveillance colonoscopies (18%) for 904 unique patients (median age, 62.0 years; interquartile range [IQR], 54.0–69.0 years), of whom 570 were men (59.1%). The median interval between the initial and surveillance procedures was 5.2 years (IQR, 4.4–6.0 years; range, 2.0–14 years). Factors associated with increased risk of advanced neoplasia at follow‐up included age (per year: odds ratio [OR], 1.03; 95% CI, 1.01–1.05), prior history of adenoma (OR, 1.48; 95% CI, 1.01–2.15), two non‐advanced adenomas identified at baseline procedure (v one: OR, 1.74; 95% CI, 1.18–2.57), and time to surveillance colonoscopy (OR, 1.21; 95% CI, 1.08–1.37). The estimated incidence of advanced neoplasia was 19% five years after non‐advanced adenoma removal, and 30% at ten years.

            Conclusions: Increasing the surveillance colonoscopy interval beyond five years after removal of non‐advanced adenoma increases the risk of detection of advanced neoplasia at follow‐up colonoscopy.

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            • 1 Flinders Medical Centre, Adelaide, SA
            • 2 Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA
            • 3 Royal Adelaide Hospital, Adelaide, SA
            • 4 Flinders University, Adelaide, SA
            • 5 College of Medicine and Public Health, Flinders University, Adelaide, SA
            • 6 Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA


            Correspondence: erin.symonds@sa.gov.au
            Acknowledgements: 

            The study was funded by the Flinders Foundation (Adelaide). Feruza Kholmurodova was supported by a grant provided by the Cancer Council SA Beat Cancer Project.

            Competing interests:

            No relevant disclosures.

            • 1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359–386.
            • 2. Cole SR, Tucker GR, Osborne JM, et al. Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust 2013; 198: 327–330. https://www.mja.com.au/journal/2013/198/6/shift‐earlier‐stage‐diagnosis‐consequence‐national‐bowel‐cancer‐screening
            • 3. Hewitson P, Glasziou P, Irwig L, et al. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007; CD001216.
            • 4. Wiegering A, Ackermann S, Riegel J, et al. Improved survival of patients with colon cancer detected by screening colonoscopy. Int J Colorectal Dis 2016; 31: 1039–1045.
            • 5. Citarda F, Tomaselli G, Capocaccia R, et al; Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 2001; 48: 812–815.
            • 6. Kahi CJ, Imperiale TF, Juliar BE, Rex DK. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol 2009; 7: 770–775.
            • 7. Barclay K, Leggett B, Macrae F, et al; Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Updated 25 Mar 2019. Colonoscopic surveillance after polypectomy. https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/Colonoscopy_surveillance/Colonoscopic_surveillance_after_polypectomy (viewed Jan 2021).
            • 8. Atkin WS, Morson BC, Cuzick J. Long‐term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992; 326: 658–662.
            • 9. Cottet V, Jooste V, Fournel I, et al. Long‐term risk of colorectal cancer after adenoma removal: a population‐based cohort study. Gut 2012; 61: 1180–1186.
            • 10. Cancer Council Australia Colonoscopy Surveillance Working Party. Management of epithelial polyps: colonoscopic surveillance after polypectomy. In: Clinical practice guidelines for surveillance colonoscopy in adenoma follow‐up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease. Dec 2011. https://gastros.com.au/wp‐content/uploads/2017/11/cpgcs.pdf (viewed Jan 2021).
            • 11. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi‐Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844–857.
            • 12. Hassan C, Quintero E, Dumonceau JM, et al; European Society of Gastrointestinal Endoscopy. Post‐polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 842–851.
            • 13. Dubé C, Yakubu M, McCurdy BR, et al. Risk of advanced adenoma, colorectal cancer, and colorectal cancer mortality in people with low‐risk adenomas at baseline colonoscopy: a systematic review and meta‐analysis. Am J Gastroenterol 2017; 112: 1790–1801.
            • 14. Rutter MD, East J, Rees CJ, et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post‐polypectomy and post‐colorectal cancer resection surveillance guidelines. Gut 2020; 69: 201–223.
            • 15. Good NM, Macrae FA, Young GP, et al. Ideal colonoscopic surveillance intervals to reduce incidence of advanced adenoma and colorectal cancer. J Gastroenterol Hepatol 2015; 30: 1147–1154.
            • 16. Bampton PA, Sandford JJ, Young GP. Applying evidence‐based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia. Med J Aust 2002; 176: 155–157. https://www.mja.com.au/journal/2002/176/4/applying‐evidence‐based‐guidelines‐improves‐use‐colonoscopy‐resources‐patients
            • 17. Jenkins M, Lee‐Bates B, Ait Quakrim D, et al; Cancer Council Australia Colorectal Cancer Guidelines Working Party. Colorectal cancer risk according to family history. Updated 30 Oct 2018. https://wiki.cancer.org.au/australia/Clinical_question:Family_history_and_CRC_risk (viewed Jan 2021).
            • 18. Snover DC, Ahnen D, Burt R, Odze RD. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman FT, Carneiro F, Hruban RH, Theise N, editors. WHO classification of tumours of the digestive system. 4th edition. Lyon: International Agency for Research on Cancer (IARC), 2010; pp. 160–165.
            • 19. Anderson JC, Baron JA, Ahnen DJ, et al. Factors associated with shorter colonoscopy surveillance intervals for patients with low‐risk colorectal adenomas and effects on outcome. Gastroenterology 2017; 152: 1933–1943.e5.
            • 20. Xu M, Wang S, Cao H, et al. Low rate of advanced adenoma formation during a 5‐year colonoscopy surveillance period after adequate polypectomy of non‐advanced adenoma. Colorectal Dis 2016; 18: 179–186.
            • 21. Chung SJ, Kim YS, Yang SY, et al. Five‐year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. Gut 2011; 60: 1537–1543.
            • 22. Lieberman D, Sullivan BA, Hauser ER, et al. Baseline colonoscopy findings associated with 10‐year outcomes in a screening cohort undergoing colonoscopy surveillance. Gastroenterology 2020; 158: 862–874.e8.
            • 23. Hartstein JD, Vemulapalli KC, Rex DK. The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. Gastrointest Endosc. 2020; 91: 614–621.e6.
            • 24. Sneh Arbib O, Zemser V, Leibovici Weissman Y, et al. Risk of advanced lesions at the first follow‐up colonoscopy after polypectomy of diminutive versus small adenomatous polyps of low‐grade dysplasia. Gastrointest Endosc 2017; 86: 713–721.e2.
            • 25. Chiu HM, Lee YC, Tu CH, et al. Effects of metabolic syndrome and findings from baseline colonoscopies on occurrence of colorectal neoplasms. Clin Gastroenterol Hepatol 2015; 13: 1134–1142.e8.
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              Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data

              Louise A Keogh, Lyle C Gurrin and Patricia Moore
              Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51217
              Published online: 30 August 2021

              It is difficult to estimate the abortion rate in Australia, as most states do not routinely report abortion data, and published national data have been incomplete.1 Consequently, some clinicians and academics have been accused of inflating reported rates for political reasons.2 National data have not been published in the peer‐reviewed literature since 2005.3 However, “abortion with operating room procedure” (65 451 procedures) was reported to be the third most frequent surgical procedure in Victorian hospitals during January 2014 ‒ December 2016.4 Prompted by this report, we sought to provide an updated estimate of the national abortion rate for women in Australia. Our study was approved by the University of Melbourne Human Research Ethics Committee (2021‐21757‐16379‐2).

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              • 1 Centre for Health Equity, University of Melbourne, Melbourne, VIC
              • 2 Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
              • 3 Royal Women’s Hospital, Melbourne, VIC


              Correspondence: l.keogh@unimelb.edu.au
              Competing interests:

              No relevant disclosures.

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                Prescribing of direct‐acting antiviral therapy by general practitioners for people with hepatitis C in an unrestricted treatment program

                Fergus Stafford, Gregory J Dore, Shawn Clackett, Marianne Martinello, Gail V Matthews, Jason Grebely, Anne C Balcomb and Behzad Hajarizadeh
                Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51204
                Published online: 23 August 2021

                In Australia, highly effective direct‐acting antiviral (DAA) therapy has been available for people with chronic hepatitis C through the Pharmaceutical Benefits Scheme (PBS) since March 2016. All clinicians, including general practitioners, have prescribing authority.1 In many countries, DAA prescribing is restricted to specific medical specialties,2 creating barriers to treatment by disrupting the cascade of care and limiting access for those unable or unwilling to attend specialist services.3 In this study, we characterised DAA prescribing by GPs in the Australian model of DAA access.

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                • 1 The Kirby Institute, UNSW Sydney, Sydney, NSW
                • 2 Centre for Population Health, NSW Health, Sydney, NSW
                • 3 76 Prince Medical, Orange, NSW


                Acknowledgements: 

                The Kirby Institute is funded by the Australian Department of Health and Ageing. Gregory Dore, Gail Matthews and Marianne Martinello were supported by National Health and Medical Research Council (NHMRC) fellowships. Jason Grebely was supported by an NHMRC Investigator grant.

                Competing interests:

                Gregory Dore is a consultant/advisor and has received research grants from Gilead, AbbVie, Merck, Bristol‐Myers Squibb, and Cepheid. Jason Grebely is a consultant/advisor and has received research grants from Gilead, AbbVie, Hologic, Indivior, Merck, and Cepheid. Gail Matthews has received research funding, advisory board payments, and speaker payments from Gilead, and research funding and speaker payments from Janssen.

                • 1. Hajarizadeh B, Grebely J, Matthews GV, et al. Uptake of direct‐acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25: 640–648.
                • 2. Marshall AD, Cunningham EB, Nielsen S, et al; International Network on Hepatitis in Substance Users (INHSU). Restrictions for reimbursement of interferon‐free direct‐acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol 2018; 3: 125–133.
                • 3. Radley A, Robinson E, Aspinall EJ, et al. A systematic review and meta‐analysis of community and primary‐care‐based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Serv Res 2019; 19: 765.
                • 4. Iranpour N, Dore GJ, Martinello M, et al. Estimated uptake of hepatitis C direct‐acting antiviral treatment among individuals with HIV co‐infection in Australia: a retrospective cohort study. Sex Health 2020; 17: 223–230.
                • 5. Australian Department of Health. General practice workforce providing primary care services in Australia. Updated 17 June 2020. https://hwd.health.gov.au/resources/data/gp‐primarycare.html (viewed June 2021).
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                  Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening

                  Naomi Noguchi, Michael L Marinovich, Elizabeth J Wylie, Helen G Lund and Nehmat Houssami
                  Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51216
                  Published online: 23 August 2021

                  Abstract

                  Objectives: To estimate rates of screen‐detected and interval breast cancers, stratified by risk factor, to inform discussions of risk‐stratified population screening.

                  Design: Retrospective population‐based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data.

                  Setting, participants: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 ‒ 30 June 2017.

                  Main outcome measures: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor.

                  Results: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67‒70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2‒10.1) cancers per 10 000 women‐years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk‐relevant benign conditions (P = 0.012), hormone‐replacement therapy (P = 0.002), and self‐reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone‐replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40‒49 years.

                  Conclusions: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk‐relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self‐reported breast‐related symptoms, and women using hormone‐replacement therapy. Our findings could inform the evaluation of risk‐based screening.

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                  • 1 The University of Sydney, Sydney, NSW
                  • 2 Curtin University, Perth, WA
                  • 3 BreastScreen WA, Perth, WA
                  • 4 Royal Perth Hospital, Perth, WA
                  • 5 Sydney School of Public Health, University of Sydney, Sydney, NSW


                  Correspondence: naomi.noguchi@sydney.edu.au
                  Acknowledgements: 

                  Nehmat Houssami is supported by the National Breast Cancer Foundation (NBCF) Chair in Breast Cancer Prevention program (EC‐21‐001) and by a National Health and Medical Research Council Investigator (Leader) grant (1194410). Michael Marinovich is supported by a National Breast Cancer Foundation Investigator Initiated Research Scheme grant (IIRS‐20‐011). We thank Sonia El‐Zaemey and Kim Kee Ooi (BreastScreen WA) for extracting and cleaning the data for our analysis.

                  Competing interests:

                  No relevant disclosures.

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                    Medico‐legal risks associated with fragmented care in general practice

                    Jack Marjot, Georgie Haysom and Penny Browne
                    Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51205
                    Published online: 23 August 2021

                    Fragmented patient care can lead to missed diagnoses, inappropriate prescribing and failure of preventive medicine

                    “Continuity of care” refers to the holistic management of a patient by a single practitioner, or a well integrated network of practitioners in close communication. The definition of fragmented care is not established, but here we consider it to be three or more different general practitioners managing the same underlying condition or presenting complaint.


                    • Avant Mutual, Sydney, NSW


                    Competing interests:

                    No relevant disclosures.

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                      The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study

                      Laila F Ibrahim, Doris Tham, Vimuthi Chong, Mark Corden, Simon Craig, Paul Buntine, Shefali Jani, Michael Zhang, Shane George, Amit Kochar, Sharon O’Brien, Karen Robins‐Browne, Shidan Tosif, Andrew Daley, Sarah McNab, Nigel W Crawford, Catherine Wilson and Franz E Babl
                      Med J Aust 2021; 215 (5): . || doi: 10.5694/mja2.51207
                      Published online: 16 August 2021

                      Abstract

                      Objectives: To examine the epidemiological and clinical characteristics of SARS‐CoV‐2‐positive children in Australia during 2020.

                      Design, setting: Multicentre retrospective study in 16 hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network; eleven in Victoria, five in four other Australian states.

                      Participants: Children aged 0‒17 years who presented to hospital‐based COVID‐19 testing clinics, hospital wards, or emergency departments during 1 February ‒ 30 September 2020 and who were positive for SARS‐CoV‐2.

                      Main outcome measures: Epidemiological and clinical characteristics of children positive for SARS‐CoV‐2.

                      Results: A total of 393 SARS‐CoV‐2‐positive children (181 girls, 46%) presented to the participating hospitals (426 presentations, including 131 to emergency departments [31%]), the first on 3 February 2020. Thirty‐three children presented more than once (8%), including two who were transferred to participating tertiary centres (0.5%). The median age of the children was 5.3 years (IQR, 1.9‒12.0 years; range, 10 days to 17.9 years). Hospital admissions followed 51 of 426 presentations (12%; 44 children), including 17 patients who were managed remotely by hospital in the home. Only 16 of the 426 presentations led to hospital medical interventions (4%). Two children (0.5%) were diagnosed with the paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS).

                      Conclusion: The clinical course for most SARS‐CoV‐2‐positive children who presented to Australian hospitals was mild, and did not require medical intervention.

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                      • 1 Murdoch Children’s Research Institute, Melbourne, VIC
                      • 2 University of Melbourne, Melbourne, VIC
                      • 3 Western Health, Melbourne, VIC
                      • 4 Austin Hospital, Melbourne, VIC
                      • 5 Northern Hospital Epping, Melbourne, VIC
                      • 6 Monash Health, Melbourne, VIC
                      • 7 Monash University, Melbourne, VIC
                      • 8 Eastern Health, Melbourne, VIC
                      • 9 Box Hill Hospital, Melbourne, VIC
                      • 10 The Children’s Hospital at Westmead, Sydney, NSW
                      • 11 The University of Sydney, Sydney, NSW
                      • 12 John Hunter Hospital, Newcastle, NSW
                      • 13 Gold Coast University Hospital, Gold Coast, QLD
                      • 14 The University of Queensland Child Health Research Centre, Brisbane, QLD
                      • 15 Women’s and Children’s Hospital, Adelaide, SA
                      • 16 Perth Children’s Hospital, Perth, WA
                      • 17 Curtin University, Perth, WA
                      • 18 University Hospital Geelong, Geelong, VIC


                      Correspondence: Laila.Ibrahim@mcri.edu.au
                      Acknowledgements: 

                      This study was unfunded, but was supported by a National Health and Medical Research Council (NHMRC) Centre of Research Excellence grant for paediatric emergency medicine (GNT1171228) and the Victorian Government Infrastructure Support Program. The participation of Franz Babl was partly funded by an NHMRC Practitioner Fellowship (GNT1124466) and by the Royal Children’s Hospital Foundation. Laila Ibrahim was supported by a Clinician‐Scientist Fellowship from the Murdoch Children’s Research Institute.

                      We acknowledge the staff who assisted with data retrieval: Visakan Krishnananthan and Caoimhe Basquille (emergency medicine, Eastern Health); Rebecca Gormley (Sunshine Hospital, Western Health); Gaby Nieva (Women’s and Children’s Hospital, Adelaide); and Rebecca Hughes (Royal Children’s Hospital Melbourne).

                      Competing interests:

                      No relevant disclosures.

                      • 1. Lavezzo E, Franchin E, Ciavarella C, et al; Imperial College COVID‐19 Response Team. Suppression of a SARS‐CoV‐2 outbreak in the Italian municipality of Vo’. Nature 2020; 584: 425–429.
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