ORCID Profile
0000-0002-6245-672X
Current Organisations
St George Hospital
,
Australasian College for Emergency Medicine
,
Instituto di Ricerca Pediatrica Città della Speranza
,
University of New South Wales - Randwick Campus
,
University of New South Wales
,
University of Sydney
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Publications
Ptprj is a candidate for the mouse colon-cancer susceptibility locus Scc1 and is frequently deleted in human cancers
Publisher: Springer Science and Business Media LLC
Date: 24-06-2002
DOI: 10.1038/NG903
The HEART score to identify emergency department patients suspected of an acute coronary syndrome who can be removed from cardiac monitoring: A retrospective chart review
Publisher: Wiley
Date: 23-06-2021
Abstract: Continuous cardiac monitoring has been recommended for ED patients being evaluated for possible acute coronary syndrome (ACS) due to concern for arrhythmia, although evidence suggests this risk is low. Indiscriminate use of monitored beds restricts access for other critically unwell patients and contributes to overcrowding. The objective of the present study was to determine if a low/intermediate‐risk HEART score identified patients at very low risk for a clinically important arrhythmia who could be removed from cardiac monitoring. This was a single centre, retrospective, cohort study of consecutive ED patients in a tertiary referral hospital evaluated for possible ACS from July to August 2017. Patients with ST‐elevation myocardial infarction or an arrhythmia at presentation which would mandate monitoring were excluded. Data was obtained by medical chart review. The primary outcome was the occurrence of an arrhythmia requiring treatment while in ED. Inter‐rater reliability for data extraction demonstrated very strong agreement (kappa 0.87, 95% confidence interval 0.83–0.91). There were 653 participants included with 83 (12.7%) having a final diagnosis of ACS. Three (0.5%) clinically important arrhythmias occurred. There were no cases of ventricular tachycardia, ventricular fibrillation or cardiac arrest. Five hundred and forty (82.7%) participants were low/intermediate‐risk HEART score and one (0.2%) clinically important arrhythmia occurred (this was supraventricular tachycardia treated by a valsalva manoeuvre). Among ED patients presenting with a possible ACS, a low/intermediate‐risk HEART score identified those at very low risk for having a clinically important arrhythmia while in ED.
Position of the abdominal seat belt sign and its predictive utility for abdominal trauma
Publisher: Wiley
Date: 16-10-2018
Abstract: In a motor vehicle crash, compressive forces from the lap component of the seat belt may produce an abdominal abrasion/contusion known as the 'seat belt sign', and is associated with abdominal and lumbar injuries. Previous research has not taken into account the position of this sign in relation to the anterior superior iliac spine (ASIS). Our aim was to demonstrate an association between the seat belt sign position in relation to ASIS and the presence of abdominal/lumbar injury. A mixed prospective and retrospective observational study of patients involved in a motor vehicle crash was conducted. The presence of a seat belt sign was recorded as above ASIS, at/below ASIS, or none. Injury data were extracted from discharge summaries, radiology reports and operation reports. Proportions of patients with injuries were compared across the three groups. Four hundred and sixty-four participants were enrolled. For participants with a seat belt sign above ASIS, compared to those with no seat belt sign, the positive likelihood ratio for a seat belt related injury was 4.2 (95% CI 2.6-6.8). When the seat belt sign was at/below the level of ASIS the positive likelihood ratio was 1.5 (95% CI 0.4-5.7). The seat belt sign is associated with abdominal and lumbar injury however, the location is important. This association is strong when the seat belt sign is above ASIS, but when the sign is at/below the ASIS the injury rate is similar to participants with no seat belt sign. Routine imaging of the abdomen may be appropriate only for those with a seat belt sign above ASIS.
Assessing the validity of two-dimensional carotid ultrasound to detect the presence and absence of a pulse
Publisher: Elsevier BV
Date: 12-2020
Neurologic outcomes following the introduction of a policy for using soft cervical collars in suspected traumatic cervical spine injury: A retrospective chart review
Publisher: Wiley
Date: 09-10-2020
The incidence of airway haemorrhage in manual versus mechanical cardiopulmonary resuscitation
Publisher: BMJ
Date: 25-11-2020
DOI: 10.1136/EMERMED-2019-208568
Abstract: The aim of this study was to compare the incidence of airway haemorrhage between participants who received manual cardiopulmonary resuscitation (CPR) and those who had received mechanical CPR using the LUCAS device. A retrospective cohort study was conducted by means of a medical chart review. All non-traumatic cardiac arrest patients that presented to the ED, from May 2014 to February 2018, were recruited. The groups were stratified according to those who had the majority of CPR performed using the LUCAS and those who had the majority of CPR performed manually. The primary outcome was the proportion of participants with airway haemorrhage, defined as blood observed in the endotracheal tube, pharynx, trachea or mouth, and documented in the doctor or nursing notes. Logistic regression analysis was performed to adjust for confounders. 12 of 54 (22%) participants in the majority LUCAS CPR group had airway haemorrhage, compared with 20 of 215 (9%) participants in the majority manual CPR group, a difference of 13% (95% CI 3% to 26%, p=0.02). The unadjusted odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.8 (95% CI 1.3 to 6.1). After adjusting for confounders, the odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.5 (95% CI 1.1 to 5.7). The LUCAS mechanical CPR device is associated with a higher incidence of airway haemorrhage compared with manual CPR. Limitations in the study design mean this conclusion is not robust.
Effect of an intervention for patients 65 years and older with blunt chest injury: Patient and health service outcomes
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.INJURY.2022.04.024
Abstract: Blunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury. ChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes. There were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites. Implementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery. ANZCTR: ACTRN12618001548224, approved 17/09/2018.
Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department
Publisher: Wiley
Date: 02-05-2019
Related Organisations
Related Funding Activities
No related grants have been discovered for Stephen Asha.