Topics

Abstract

Objective: To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10‐year period.

Design, setting, participants: Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007–2016.

Main outcomes and measures: Temporal trends in population‐based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more).

Results: There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17–1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99–1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4–15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in‐hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths).

Conclusions: Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post‐discharge care, and support.

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1 Monash University, Melbourne, VIC
2 The Alfred Hospital, Melbourne, VIC
3 Victorian Spinal Cord Service, Austin Hospital, Melbourne, VIC
4 National Trauma Research Institute, Melbourne, VIC
5 Royal Melbourne Hospital, Melbourne, VIC
6 University of Melbourne, Melbourne, VIC
7 Royal Children's Hospital, Melbourne, VIC
8 Murdoch Children's Research Institute, Melbourne, VIC
9 Kolling Institute, University of Sydney, Sydney, NSW
10 Agency for Clinical Innovation, Sydney, NSW
11 Research Centre for Injury Studies, Flinders University, Adelaide, SA
12 Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, United Kingdom

Correspondence: ben.beck@monash.edu

Acknowledgements:

We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing Victorian State Trauma Registry data. We also thank Sue McLellan for her assistance with providing the data. The VSTR is funded by the Department of Health and Human Services, Victoria and the Transport Accident Commission. Ben Beck was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). Peter Cameron was supported by a National Health and Medical Research Council Practitioner Fellowship (545926). Warwick Teague's role as director of trauma services was supported by a grant from the Royal Children's Hospital Foundation. Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048).

Competing interests:

No relevant disclosures.

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Perspectives

Early success with room for improvement: influenza vaccination of young Australian children

Frank H Beard, Alexandra J Hendry and Kristine Macartney

Med J Aust 2019; 210 (11): . || doi: 10.5694/mja2.50141
Published online: 29 April 2019

Correction(s) for this article:

Erratum | Published online: 14 December 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Environment and public health

Immunisation providers should offer annual influenza vaccination for children aged 6 months to 5 years and report it to the Australian Immunisation Register

1 National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, NSW
2 University of Sydney, Sydney, NSW

Correspondence: Frank.Beard@health.nsw.gov.au

Competing interests:

No relevant disclosures.

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Perspectives

Qualified privilege legislation to support clinician quality assurance: balancing professional and public interests

Susannah Ahern, Ingrid Hopper and Erwin Loh

Med J Aust 2019; 210 (8): . || doi: 10.5694/mja2.50124
Published online: 22 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Health services administration

A review of the legislation may be warranted to assess the balance between professional and public interests

Patient health‐related datasets are protected by national and state‐based privacy laws which establish requirements for data security that safeguard identified patient information.1,2,3 Nevertheless, these data may potentially be accessed by third parties in accordance with the law — for example, in connection with freedom of information requests or legal proceedings — by statutory bodies such as the Australian Health Practitioner Regulatory Agency, or by jurisdictional health complaints commissions. Patient information from health service medical records is regularly used in medico‐legal proceedings, a recent significant example of which was the Bawa‐Garba case in the United Kingdom,4 discussed below.

Monash University, Melbourne, VIC

Correspondence: susannah.ahern@monash.edu

Competing interests:

No relevant disclosures.

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17. Australian Council for Safety and Quality in Health Care. National report on qualified privilege. Safety through action — improving patient safety in Australia. Third report to the Australian Health Ministers’ Conference, 19 July 2002. https://safetyandquality.gov.au/wp-content/uploads/2012/01/qual_priv1.pdf (viewed Jan 2019).

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Consensus statement

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

Scott Dunkley, Julie A Curtin, Anthony J Marren, Robert P Heavener, Simon McRae and Jennifer L Curnow

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50123
Published online: 15 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Hematologic diseases

Medical genetics

Abstract

Introduction: There have been significant advances in the understanding of the management of inherited bleeding disorders in pregnancy since the last Australian Haemophilia Centre Directors’ Organisation (AHCDO) consensus statement was published in 2009. This updated consensus statement provides practical information for clinicians managing pregnant women who have, or carry a gene for, inherited bleeding disorders, and their potentially affected infants. It represents the consensus opinion of all AHCDO members; where evidence was lacking, recommendations have been based on clinical experience and consensus opinion.

Main recommendations: During pregnancy and delivery, women with inherited bleeding disorders may be exposed to haemostatic challenges. Women with inherited bleeding disorders, and their potentially affected infants, need specialised care during pregnancy, delivery, and postpartum, and should be managed by a multidisciplinary team that includes at a minimum an obstetrician, anaesthetist, paediatrician or neonatologist, and haematologist. Recommendations on management of pregnancy, labour, delivery, obstetric anaesthesia and postpartum care, including reducing and treating postpartum haemorrhage, are included. The management of infants known to have or be at risk of an inherited bleeding disorder is also covered.

Changes in management as a result of this statement: Key changes in this update include the addition of a summary of the expected physiological changes in coagulation factors and phenotypic severity of bleeding disorders in pregnancy; a flow chart for the recommended clinical management during pregnancy and delivery; guidance for the use of regional anaesthetic; and prophylactic treatment recommendations including concomitant tranexamic acid.

1 Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW
2 The Children's Hospital at Westmead, Sydney, NSW
3 Australian Haemophilia Centres Directors’ Organisation, Melbourne, VIC
4 Royal Prince Alfred Hospital, Sydney, NSW
5 Royal Adelaide Hospital, Adelaide, SA
6 Haemophilia Treatment Centre, Westmead Hospital, Sydney, NSW

Correspondence: scottmdunkley@gmail.com

Acknowledgements:

We are grateful to Steph P'ng, John Rowell, Tim Brighton, Huyen Tran and Ian Douglas for their helpful feedback and comments. We acknowledge Ruth Hadfield for medical writing and editing assistance.

Competing interests:

No relevant disclosures.

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36. Bolton‐Maggs PH, Chalmers EA, Collins PW, et al. A review of inherited platelet disorders with guidelines for their management on behalf of the UKHCDO. Br J Haematol 2006; 135: 603–633.
37. Haljamäe H. Thromboprophylaxis, coagulation disorders, and regional anaesthesia. Acta Anaesthesiol Scand 1996; 40(8 Pt 2): 1024–1040.
38. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28: 172–197.
39. Stedeford JC, Pittman JA. Von Willebrand's disease and neuroaxial anaesthesia. Anaesthesia 2000; 55: 1228–1229.
40. Curnow J, Pasalic L, Favaloro EJ. Treatment of von Willebrand Disease. Sem Thromb Hemost 2016; 42: 133–146.
41. Rodeghiero F. Von Willebrand disease: pathogenesis and management. Thromb Res 2013; 131 Suppl 1: S47–S50.
42. American Academy of Family Physicians. Advanced Life Support in Obstetrics (ALSO). http://www.aafp.org/cme/programs/also.html (viewed Mar 2019).
43. Babarinsa IA, Hayman RG, Draycott TJ. Secondary post‐partum haemorrhage: challenges in evidence‐based causes and management. Eur J Obstet Gynecol Reprod Biol 2011; 159: 255–260.
44. Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG 2001; 108: 927–930.
45. Begley CM, Gyte GM, Devane D, et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015; (3): CD007412.
46. James DK, Steer P, Weiner C, Gonik B. High risk pregnancy: management options. 4th ed. St Louis, MO: Elsevier Saunders, 2011: p. 1504.
47. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of postpartum haemorrhage (PPH). https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Management-of-Postpartum-Haemorrhage-(C-Obs-43)-Review-July-2017.pdf?ext=.pdf (viewed Nov 2018).
48. Demers C, Derzko C, David M, Douglas J. Gynaecological and obstetric management of women with inherited bleeding disorders. Int J Gynaecol Obstet 2006; 95: 75–87.
49. Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the healthy premature infant. Blood 1988; 72: 1651–1657.
50. Kulkarni R, Lusher J. Perinatal management of newborns with haemophilia. Br J Haematol 2001; 112: 264–274.
51. Kulkarni R, Lusher JM. Intracranial and extracranial hemorrhages in newborns with hemophilia: a review of the literature. J Pediatr Hematol Oncol 1999; 21: 289–295.
52. Veldman A, Josef J, Fischer D, Volk WR. A prospective pilot study of prophylactic treatment of preterm neonates with recombinant activated factor VII during the first 72 hours of life. Pediatr Crit Care Med 2006; 7: 34–39.
53. Australian Haemophilia Centre Directors’ Organisation. Guidelines for the treatment of inhibitors in haemophilia A and haemophilia B. Melbourne: AHCDO, 2010. http://www.ahcdo.org.au/documents/item/16 (viewed Nov 2018).
54. Australian Haemophilia Centre Directors’ Organisation and National Blood Authority, Australia. Guidelines for the management of haemophilia in Australia. Melbourne: AHCDO, 2016. https://www.blood.gov.au/system/files/HaemophiliaGuidelines-interactive-updated-260317v2.pdf (viewed Nov 2018).

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Editorials

Resilient health systems: preparing for climate disasters and other emergencies

Gerard J FitzGerald, Anthony Capon and Peter Aitken

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50115
Published online: 15 April 2019

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AUTHORS
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Topics

Emergency medicine

Environment and public health

Health services administration

A system that integrates all aspects of health care is essential for facing future challenges

After another Australian summer of record‐breaking temperatures, bushfires, floods and widespread drought, it is clear that our health systems should be strengthened to cope with the challenges of climate change. We must also reduce the carbon footprint of health care,1 and continue to advocate that Australia play its part in dealing with the fundamental causes of climate change. In May, the 21st biennial congress of the World Association for Disaster and Emergency Medicine (WADEM) will be hosted by Brisbane. The congress will bring together investigators and practitioners from around the world to discuss disaster health care, future risks, community vulnerabilities, and the strategies required by resilient health systems.

1 Queensland University of Technology, Brisbane, QLD
2 Sydney School of Public Health, University of Sydney, Sydney, NSW
3 Health Disaster Management Unit, Queensland Health, Brisbane, QLD

Correspondence: gj.fitzgerald@qut.edu.au

Competing interests:

No relevant disclosures.

1. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–e35.
2. Hanna EG, McIver LJ. Climate change: a brief overview of the science and health impacts for Australia. Med J Aust 2018; 208: 311–315. https://www.mja.com.au/journal/2018/208/7/climate-change-brief-overview-science-and-health-impacts-australia
3. Kishore N, Marqués D, Mahmud A, et al. Mortality in Puerto Rico after Hurricane Maria. N Engl J Med 2018; 379: 162–170.
4. Burns P, Douglas K, Hu W. Primary care in disasters: opportunity to address a hidden burden of health care. Med J Aust 2019; 210: 297–299.
5. Australian Institute of Health and Welfare. Emergency department care 2017–18: Australian hospital statistics (Cat. No. HSE 216; Health Services Series No. 89). Canberra: AIHW, 2018.

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Perspectives

Primary care in disasters: opportunity to address a hidden burden of health care

Penelope L Burns, Kirsty A Douglas and Wendy Hu

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50067
Published online: 15 April 2019

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Topics

General medicine

Emergency medicine

Environment and public health

Health services administration

General practitioners provide a flexible response to the changed needs of the disaster‐affected population

In Australia, “a land … of droughts and flooding rains,”1 disasters affect our lives annually, the majority of which are weather‐related.2 They are a part of the landscape, taking the form of cyclones, floods, bushfires, droughts and other phenomena. Cyclone Debbie, which hit northern Queensland in 2017, the Tathra bushfires, which affected the south coast of New South Wales in 2018, and the thunderstorm asthma event in Melbourne in 2016 are just a few recent examples. Such catastrophic events affect rural and urban communities and coastal and inland locations. No community in Australia is exempt, which is reflected in the recent shift in focus by national and international disaster management policy to prioritise improving local community capacity to respond and recover.3,4

1 Australian National University, Canberra, ACT
2 Western Sydney University, Sydney, NSW

Correspondence: Penelope.Burns@anu.edu.au

Acknowledgements:

We thank the Royal Australian College of General Practitioners Foundation for their support on some early work in this field.

Competing interests:

No relevant disclosures.

1. Mackellar D. My country and other poems. Ringwood: Viking, 1993.
2. Centre for Research on the Epidemiology of Disasters. Economic losses, poverty and disasters: 1998–2017. Brussels, Belgium: CRED, 2018. https://www.unisdr.org/we/inform/publications/61119 (viewed Feb 2019).
3. Australian Emergency Management Institute. National strategy for disaster resilience: community engagement framework. Handbook 6. Canberra: Commonwealth of Australia, 2013. https://www.emergency.nsw.gov.au/Documents/publications/National-Strategy-for-Disaster-Resilience-Community-Engagement-Framework.pdf (viewed Feb 2019).
4. Council of Australian Governments. National strategy for disaster resilience. Canberra: Commonwealth of Australia, 2011. https://archive.homeaffairs.gov.au/emergencymanagement/Documents/national-strategy-disaster-resilience.pdf (viewed Feb 2019).
5. Mitchell RD, Aitken P, Franklin RC. The physical health impacts of tropical cyclones. Annals ACTM 2014; 15: 2–8.
6. Steptoe A. The impact of natural disasters on myocardial infarction. Heart 2009; 95: 1972–1973.
7. Lee DC, Gupta VK, Carr BG, et al. Acute post‐disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy. BMJ Open Diabetes Res Care 2016; 4: e000248.
8. Fonseca VA, Smith H, Kuhadiya N, et al. Impact of a natural disaster on diabetes: exacerbation of disparities and long‐term consequences. Diabetes Care 2009; 32: 1632–1638.
9. Ng JM, Thorpe J, Walton C, et al. The effect of extensive flooding in Hull on the glycaemic control of diabetes patients. Diabet Med 2010; 1: 108.
10. Chan C, Elliott J, Troughton R, et al. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes. PLoS One 2013; 8: e68504.
11. Arrieta MI, Foreman RD, Crook ED, Icenogle ML. Providing continuity of care for chronic diseases in the aftermath of Katrina: from field experience to policy recommendations. Disaster Med Public Health Prep 2009; 3: 174–182.
12. Lin S, Gomez MI, Gensburg L, et al. Respiratory and cardiovascular hospitalizations after the World Trade Center disaster. Arch Environ Occup Health 2010; 65: 12–20.
13. World Health Organization. Thirteenth general programme of work, 2019–2030: report by the Director‐General. Geneva: WHO, 2018. https://www.who.int/about/what-we-do/gpw-thirteen-consultation/en/ (viewed Feb 2019).
14. Zhang Y, Beggs PJ, Bambrick H, et al. The MJA‐Lancet Countdown on health and climate change: Australian policy inaction threatens lives. Med J Aust 2018; 209: 474. https://www.mja.com.au/journal/2018/209/11/mja-lancet-countdown-health-and-climate-change-australian-policy-inaction
15. Healthpoint ANZ. Emergency response planning tool: emergency preparedness, response and recovery. Auckland: Healthpoint ANZ, 2014. https://www.racgp.org.au/running-a-practice/practice-management/managing-emergencies-and-pandemics/emergency-response-planning-tool (viewed Feb 2019).
16. Royal Australian College of General Practitioners. Managing emergencies in general practice. Melbourne: RACGP, 2017. https://www.racgp.org.au/running-a-practice/practice-management/managing-emergencies-and-pandemics (viewed Feb 2019).
17. Rural Doctors Association of Australian, Australian College of Rural and Remote Medicine. Position statement the role of the rural GP in disaster response and pre‐hospital care. Brisbane: RDAA, ACRRM; 2016. https://www.rdaa.com.au/documents/item/61 (viewed Feb 2019).
18. Australian Institute of Health and Welfare. Australia's Health 2018 (Cat. No. AUS 221; Australia's Health Series No. 16). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true (viewed Feb 2019).
19. Royal Australian College of General Practitioners. General practice health of the nation 2018. Melbourne: RACGP, 2018. https://www.racgp.org.au/general-practice-health-of-the-nation (viewed Feb 2019).
20. United Nations Office for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction, 2015–2030. Geneva: UNISDR, 2015. https://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf (viewed Feb 2019).

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Perspectives

The importance of public health genomics for ensuring health security for Australia

Deborah A Williamson, Martyn D Kirk, Vitali Sintchenko and Benjamin P Howden

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50063
Published online: 15 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Health services administration

Coordination is required to future‐proof Australia's capacity and leadership in public health genomics

Infectious diseases are an ever‐present risk to society, particularly because of globalisation and the threat of antimicrobial‐resistant organisms. Recently, a World Health Organization (WHO) team conducted a joint external evaluation of Australia's core capacities under the International Health Regulations. The evaluation gave Australia a high scorecard in all areas relevant to protecting health from emerging infectious disease threats.1 However, an area that the evaluation team highlighted for critical improvement was the integration of whole genome sequencing‐based surveillance into existing communicable diseases control systems in the Australian setting.1 While Australia scored highly for laboratory testing of priority diseases, the team recommended “integration of laboratory testing data with epidemiological data particularly in the context of whole genome sequencing”.1

1 University of Melbourne, Melbourne, VIC
2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
3 University of Sydney, Sydney, NSW

Correspondence: deborah.williamson@unimelb.edu.au

Competing interests:

No relevant disclosures

1. World Health Organization. Joint external evaluation of IHR core capacities of Australia: mission report, 24 November ‐ 1 December 2017. Geneva: WHO, 2018. http://apps.who.int/iris/handle/10665/272362 (viewed Feb 2019).
2. Gardy JL, Loman NJ. Towards a genomics‐informed, real‐time, global pathogen surveillance system. Nat Rev Genet 2018; 19: 9–20.
3. Australian Government Department of Health. National Framework for Communicable Disease Control Canberra: Commonwealth of Australia, 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-frame-communic-disease-control.htm (viewed Feb 2019).
4. Australian Government Department of Health. National Health Genomics Policy Framework 2018‐2021. http://www.health.gov.au/internet/main/publishing.nsf/Content/national-health-genomics-policy-framework-2018-2021 (viewed Feb 2018).
5. Allard MW, Strain E, Melka D, et al. Practical value of food pathogen traceability through building a whole‐genome sequencing network and database. J Clin Microbiol 2016; 54: 1975–1983.
6. Kwong JC, Stafford R, Strain E, et al. Sharing is caring: international sharing of data enhances genomic surveillance of Listeria monocytogenes. Clin Infect Dis 2016; 63: 846–848.
7. Grant K, Jenkins C, Arnold C, et al. Implementing pathogen genomics: a case study. London: Public Health England, 2018. https://www.gov.uk/government/publications/implementing-pathogen-genomics-a-case-study (viewed Feb 2018).
8. Dallman TJ, Byrne L, Ashton PM, et al. Whole‐genome sequencing for national surveillance of Shiga toxin‐producing Escherichia coli O157. Clin Infect Dis 2015; 61: 305–312.
9. Baker KS, Dallman TJ, Field N, et al. Genomic epidemiology of Shigella in the United Kingdom shows transmission of pathogen sublineages and determinants of antimicrobial resistance. Sci Rep 2018; 8: 7389.
10. Neuert S, Nair S, Day MR, et al. Prediction of phenotypic antimicrobial resistance profiles from whole genome sequences of non‐typhoidal Salmonella enterica. Front Microbiol 2018; 9: 592.
11. Williamson D, Howden B, Stinear T. Mycobacterium chimaera spread from heating and cooling units in heart surgery. N Engl J Med 2017; 376: 600–602.
12. Vasant BR, Stafford RJ, Jennison AV, et al. Mild Illness during outbreak of Shiga toxin‐producing Escherichia coli O157 infections associated with agricultural show, Australia. Emerg Infect Dis 2017; 23: 1686–1689.
13. Gurjav U, Outhred AC, Jelfs P, et al. Whole genome sequencing demonstrates limited transmission within identified Mycobacterium tuberculosis clusters in New South Wales, Australia. PLOS One 2016; 11: e0163612.
14. Kwong JC, Mercoulia K, Tomita T, et al. Prospective whole‐genome sequencing enhances national surveillance of Listeria monocytogenes. J Clin Microbiol 2016; 54: 333–342.
15. Kwong JC, Lane CR, Romanes F, et al. Translating genomics into practice for real‐time surveillance and response to carbapenemase‐producing Enterobacteriaceae: evidence from a complex multi‐institutional KPC outbreak. PeerJ 2018; 6: e4210.

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Research

The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Nasir Wabe, Ling Li, Robert Lindeman, Ruth Yimsung, Maria R Dahm, Kate Clezy, Susan McLennan, Johanna Westbrook and Andrew Georgiou

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50049
Published online: 8 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Health services administration

General medicine

Abstract

Objective: To determine whether rapid polymerase chain reaction (PCR) testing for influenza and respiratory syncytial viruses (RSV) in emergency departments (EDs) is associated with better patient and laboratory outcomes than standard multiplex PCR testing.

Design, setting: A before‐and‐after study in four metropolitan EDs in New South Wales.

Participants: 1491 consecutive patients tested by standard multiplex PCR during July–December 2016, and 2250 tested by rapid PCR during July–December 2017.

Main outcome measures: Hospital admissions; ED length of stay (LOS); test turnaround time; patient receiving test result before leaving the ED; ordering of other laboratory tests.

Results: Compared with those tested by standard PCR, fewer patients tested by rapid PCR were admitted to hospital (73.3% v 77.7%; P < 0.001) and more received their test results before leaving the ED (67.4% v 1.3%; P < 0.001); the median test turnaround time was also shorter (2.4 h [IQR, 1.6–3.9 h] v 26.7 h [IQR, 21.2–37.8 h]). The proportion of patients admitted to hospital was also lower in the rapid PCR group for both children under 18 (50.6% v 66.6%; P < 0.001) and patients over 60 years of age (84.3% v 91.8%; P < 0.001). Significantly fewer blood culture, blood gas, sputum culture, and respiratory bacterial and viral serology tests were ordered for patients tested by rapid PCR. ED LOS was similar for the rapid (7.4 h; IQR, 5.0–12.9 h) and standard PCR groups (6.5 h; IQR, 4.2–11.9 h; P = 0.27).

Conclusion: Rapid PCR testing of ED patients for influenza virus and RSV was associated with better outcomes on a range of indicators, suggesting benefits for patients and the health care system. A formal cost–benefit analysis should be undertaken.

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1 Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
2 NSW Health Pathology, Sydney, NSW
3 Prince of Wales Hospital, Sydney, NSW
4 Sydney Medical School, University of Sydney, Sydney, NSW

Correspondence: nasir.wabe@mq.edu.au

Acknowledgements:

The project was part of a partnership project funded by a National Health and Medical Research Council of Australia Partnership Project Grant (APP1111925), in partnership with NSW Health Pathology and the Australian Commission on Safety and Quality in Healthcare.23

Competing interests:

No relevant disclosures.

1. Chen Y, Kirk MD. Incidence of acute respiratory infections in Australia. Epidemiol Infect 2014; 142: 1355–1361.
2. Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390: 946–958.
3. Varghese BM, Dent E, Chilver M, et al. Epidemiology of viral respiratory infections in Australian working‐age adults (20–64 years): 2010–2013. Epidemiol Infect 2018; 146: 619–626.
4. Mahony JB. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev 2008; 21: 716–747.
5. Mahony J, Chong S, Merante F, et al. Development of a respiratory virus panel test for detection of twenty human respiratory viruses by use of multiplex PCR and a fluid microbead‐based assay. J Clin Microbiol 2007; 45: 2965–2970.
6. Rogers BB, Shankar P, Jerris RC, et al. Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med 2015; 139: 636–641.
7. Rappo U, Schuetz AN, Jenkins SG, et al. Impact of early detection of respiratory viruses by multiplex PCR assay on clinical outcomes in adult patients. J Clin Microbiol 2016; 54: 2096–2103.
8. Bureau of Health Information. Healthcare observer: hospital data. http://www.bhi.nsw.gov.au/Healthcare_Observer (viewed June 2018).
9. Li L, Georgiou A, Vecellio E, et al. The effect of laboratory testing on emergency department length of stay: a multihospital longitudinal study applying a cross‐classified random‐effect modeling approach. Acad Emerg Med 2015; 22: 38–46.
10. Linehan E, Brennan M, O'Rourke S, et al. Impact of introduction of Xpert flu assay for influenza PCR testing on obstetric patients: a quality improvement project. J Matern Fetal Neonatal Med 2018; 31: 1016–1020.
11. Li‐Kim‐Moy J, Dastouri F, Rashid H, et al. Utility of early influenza diagnosis through point‐of‐care testing in children presenting to an emergency department. J Paediatr Child Health 2016; 52: 422–429.
12. Ko F, Drews SJ. The impact of commercial rapid respiratory virus diagnostic tests on patient outcomes and health system utilization. Expert Rev Mol Diagn 2017; 17: 917–931.
13. Soto M, Sampietro‐Colom L, Vilella A, et al. Economic impact of a new rapid PCR assay for detecting influenza virus in an emergency department and hospitalized patients. PLoS One 2016; 11: e0146620.
14. St John A, Price CP. Economic evidence and point‐of‐care testing. Clin Biochem Rev 2013; 34: 61–74.
15. Mills JM, Harper J, Broomfield D, Templeton KE. Rapid testing for respiratory syncytial virus in a paediatric emergency department: benefits for infection control and bed management. J Hosp Infect 2011; 77: 248–251.
16. Hawkins RC. Laboratory turnaround time. Clin Biochem Rev 2007; 28: 179–194.
17. Jeong HW, Heo JY, Park JS, Kim WJ. Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department. PLoS One 2014; 9: e110978.
18. Doan Q, Enarson P, Kissoon N, et al. Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database Syst Rev 2014; CD006452.
19. Poehling KA, Zhu Y, Tang YW, Edwards K. Accuracy and impact of a point‐of‐care rapid influenza test in young children with respiratory illnesses. Arch Pediatr Adolesc Med 2006; 160: 713–718.
20. Blaschke AJ, Shapiro DJ, Pavia AT, et al. A national study of the impact of rapid influenza testing on clinical care in the emergency department. J Pediatric Infect Dis Soc 2014; 3: 112–118.
21. Nitsch‐Osuch A, Stefanska I, Kuchar E, et al. Influence of rapid influenza test on clinical management of children younger than five with febrile respiratory tract infections. Adv Exp Med Biol 2013; 755: 237–241.
22. Eccles M, Grimshaw J, Campbell M, Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 2003; 12: 47–52.
23. Dahm MR, Georgiou A, Westbrook JI, et al. Delivering safe and effective test‐result communication, management and follow‐up: a mixed‐methods study protocol. BMJ Open 2018; 8: e020235.

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Traumatic spinal cord injury in Victoria, 2007–2016

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Early success with room for improvement: influenza vaccination of young Australian children

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Qualified privilege legislation to support clinician quality assurance: balancing professional and public interests

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Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

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Resilient health systems: preparing for climate disasters and other emergencies

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Primary care in disasters: opportunity to address a hidden burden of health care

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The importance of public health genomics for ensuring health security for Australia

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The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

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Diagnosis of Mycobacterium ulcerans disease: be alert to the possibility of negative initial PCR results

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Family planning, antenatal and post partum care in multiple sclerosis: a review and update

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Traumatic spinal cord injury in Victoria, 2007–2016

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Early success with room for improvement: influenza vaccination of young Australian children

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Qualified privilege legislation to support clinician quality assurance: balancing professional and public interests

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Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

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Resilient health systems: preparing for climate disasters and other emergencies

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Primary care in disasters: opportunity to address a hidden burden of health care

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The importance of public health genomics for ensuring health security for Australia

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The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

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Diagnosis of Mycobacterium ulcerans disease: be alert to the possibility of negative initial PCR results

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Family planning, antenatal and post partum care in multiple sclerosis: a review and update

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