ORCID Profile
0000-0002-1709-7174
Current Organisation
University of Queensland School of Medicine
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.AUCC.2015.05.001
Abstract: The objective of this study was to explore factors associated with the triage category assigned by the triage nurse for patients ultimately diagnosed with acute myocardial infarction. This was a retrospective analysis of 12 months of data, on adult emergency department patients ultimately diagnosed with acute myocardial infarction. Data were obtained from hospital databases and included patient demographics, patient clinical characteristics and nurses' experience. Of the 153 patients, 20% (95% CI: 14-27%) were given a lower urgency triage category than recommended by international guidelines. Compared to patients who were triaged Australasian Triage Category 1 or 2, patients with an Australasian Triage Category 3-5 were older (mean age 76 versus 68 years), more likely to be female (63% versus 32%), more likely to present without chest pain (93% versus 35%) and less likely to have a cardiac history (3.3% versus 17.9%). A slightly higher proportion of patients Australasian Triage Category 3-5 were triaged by an experienced nurse (50%) compared to patients categorised Australasian Triage Category 1-2 (35.2%) but this finding did not reach statistical significance. One in five presentations was given a lower urgency triage category than recommended by international guidelines, potentially leading to delays in medical treatment. The absence of chest pain was the defining characteristic in this group of patients, along with other factors identified by previous research such as being of female sex and elderly.
Publisher: Wiley
Date: 31-05-2017
Abstract: The Australasian College for Emergency Medicine requires 15 proctored examinations of the aorta for credentialing in ultrasonography for abdominal aortic aneurysm (AAA). Furthermore, at least three examinations need to be positive for an aneurysm. In the ED where AAA presentations are sporadic, what are the chances that an emergency physician (EP) will have the opportunity to demonstrate three AAAs in the next 12 months? The probability of an event occurring within a given time-frame can be modelled by the Poisson distribution. Central to the Poisson distribution is the infrequency of the event such as encountering an AAA in the ED. An EP working 30 clinical hours/week in our tertiary-referral hospital ED can be expected to encounter 15.6 (3.6 symptomatic + 12 asymptomatic) AAA in the next 12 months. The probability of seeing three or more cases during this time is 99.9%. Assuming a proctor can be found for half the cases, the probability of an EP performing proctored ultrasound examinations in at least three AAAs is 98%. This probability drops to 89% if a proctor can be found for only one-third of cases. For an EP to be almost 100% certain of meeting the credentialing requirements, he/she would need almost 10 proctored ultrasound cases of AAA to be available within his/her shifts during the year. The Poisson distribution has enabled us to model the probability of encountering a given number of AAA in the ED. Analysis such as this may help rationalise the numbers needed for credentialing.
Publisher: Wiley
Date: 16-03-2016
Abstract: The objective of this present study is to compare pain associated with the double-dorsal versus a single-volar subcutaneous injection in the provision of digital anaesthesia for finger injuries presenting to the ED. A randomised controlled trial from November 2012 to January 2014 at a single adult tertiary-referral hospital. ED patients with finger injuries requiring digital anaesthesia was randomised to either the double-dorsal or a single-volar subcutaneous injection technique. The primary outcome was patient reported injection pain measured on a 100 mm visual analogue scale with the assessor blinded to the injection technique. The secondary outcome was success of anaesthesia defined as ability to perform the assessment and treatment without further anaesthetic supplementation after 5 min. Eighty-six patients were enrolled. Median (IQR) age was 34 (24-47) years and 79% were men. The majority (66.3%) had distal phalanx injuries. Forty patients were randomised to the double-dorsal and 46 to a single-volar subcutaneous injection technique. The mean (standard deviation) pain score of the double-dorsal injection was 39.1 (24.2) and a single-volar injection was 37.3 (24.5) with a difference of 1.8 (95% CI -8.8 to 12.3). Digital anaesthesia was successful in 64.9% of the double-dorsal and 71.7% of the single-volar subcutaneous injections, a difference of 6.8% (95% CI -12.7 to 26.3). In ED patients with finger injuries requiring digital anaesthesia, both the double-dorsal or single-volar subcutaneous injection techniques have similar pain of injection and success rates of anaesthesia. Single-volar injection appears suitable alternative to the commonly performed double-dorsal injection in the ED.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Wiley
Date: 26-02-2018
Abstract: Gender equality and workforce ersity has recently been in the forefront of College discussions. Reasons for the difference between various groups may not be as they initially appeared. The results of comparing the outcome between two groups can sometimes be confounded and even reversed by an unrecognised third variable. This concept is known as Simpson's Paradox, and is illustrated here using a renowned case study on potential gender bias for acceptance to Graduate School at the University of California, Berkeley. The investigation showed that males were 1.8 times more likely to be admitted to Graduate School than females in 1973. Initially it appeared that women were discriminated against in the selection process. However, when admissions were re-examined at in idual Departments of the School, admission tended to be better for women than men in four of six Departments. This contradiction or paradox tells us that the association between admission and gender was dependent upon on Department. The confounding effect of Department was defined by two characteristics. Firstly, a strong association between Department and admission: some Departments admitted much smaller percentages of applicants than others. Secondly, a strong association between Department and gender: females tended to apply to Departments with lower admission rates. The explanation of differences between groups can be multifactorial. A search for possible confounders will assist in this understanding. This could apply whenever two groups initially appear to differ, but on closer analysis this difference is either unfounded, or even reversed by reference to a third, confounding variable.
Publisher: Wiley
Date: 02-08-2022
DOI: 10.5694/MJA2.51670
Publisher: Wiley
Date: 09-10-2020
DOI: 10.1111/JAN.14216
Abstract: To determine the association between time to first analgesic medication and emergency department length of stay (ED LOS). Retrospective cohort study. We conducted this study in a large, inner-city emergency department and included adult patients who presented with pain as a symptom and received analgesic medication(s). Study participants were identified from a random selection of 2,000 adult patients who presented between August-October 2018. The relationship between ED LOS and time to first analgesic medication was described using bivariate and multivariate linear regression. Of the 2,000 randomly selected patients presenting between August and October 2018, 727 (36.35%) had pain as a symptom on arrival, 423 (21.15%) had analgesic medication administered. The median time to first analgesic medication was in 62 (interquartile range: 36-105) minutes and median ED LOS was 218 (interquartile range: 160-317.5) minutes. After adjusting for the effects of sex, urgency of the presentation, emergency department location first seen by clinician, departure destination and workload metrics (average daily time to be seen and daily access block). Time to first analgesic medication was independently associated with ED LOS, contributing to 6.96% of the variance in the multivariate model. Providing analgesic medication faster to patients presenting in pain, in addition to previously demonstrated positive patient outcomes, may decrease their ED LOS. Reducing ED LOS through faster pain care, benefits the patient through faster pain relief and can benefit the department by reducing the total amount of care delivered in the emergency department. Reducing total care delivery frees up resources to improve the care to all emergency department patients.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 05-02-2018
Publisher: Cold Spring Harbor Laboratory
Date: 25-09-2023
Publisher: Cold Spring Harbor Laboratory
Date: 19-10-2022
DOI: 10.1101/2022.10.17.22280670
Abstract: Pain is the most common symptom experienced when presenting to the emergency department (ED). Estimates indicate over half of all patients will present in pain. EDs typically focus on care process measures, such as time to first analgesic medication. Process-based metrics remove the patient from their own experience. Unfortunately, when patient-reported measures of pain care are used in the ED for quality improvement or research, they vary widely and often lack validation. Previous work has demonstrated that a modified version of the American Pain Society – Patient Outcome Questionnaire – Revised Edition (APS-POQ-R) may provide an ideal patient-reported outcome measure for the adult ED population. However, previous work has left validation incomplete. In this multi-site, multistage research, we demonstrate the construct, convergent and ergent validity and the internal consistency of a modified version of the APS-POQ-R in adult patients presenting to two large, inner-city EDs with moderate to severe acute pain. After three stages of psychometric testing in 646 patients, we present a nine-question, three construct patient-reported outcome measure for moderate to severe pain in the adult emergency department, now known as the American Pain Society – Patient Outcome Questionnaire – Revised for the ED (APS-POQ-RED). This article presents the psychometric properties of a revised version of the APS-POQ-R for use in the adult ED. This shortened, ED-specific patient-reported outcome measure (APS-POQ-RED) seeks to provide a standardised, validated measure of patient-reported outcomes of acute pain care in the ED for quality and research purposes.
Publisher: Cold Spring Harbor Laboratory
Date: 30-05-2022
DOI: 10.1101/2022.05.29.22275652
Abstract: Accurate, reliable and efficient measures of pain-related presentations are essential to evaluate and improve pain care in the ED. Estimates of pain prevalence on arrival to the emergency department (ED) vary depending on the methods used. Artificial intelligence (AI) approaches are likely to be the future for identifying patients in pain from electronic health records (EHR). However, we need a robust method to identify these patients before this can occur. This study aims to identify patients presenting in pain to the ED using binary classification and to describe the population, treatment and outcomes. This study employs a cross-sectional design using retrospective data routinely collected in the EHR at a single ED. A random s le of 10 000 patients was selected for inclusion over three years. Triage nursing assessment underwent binary classification by three expert clinicians. The prevalence of pain on arrival is the primary outcome. Patients with pain were compared to those without pain on arrival regarding demographics, treatment and outcomes. The prevalence of pain on arrival was 55.2% (95%CI 54.2% - 56.2%). Patients who presented in pain differed from those without pain in terms of age, country of birth, socioeconomic status, mode of arrival, urgency and discharge destination. The median time to first analgesic medication was 65min (IQR 38 – 114 min), and 45.6% (95% CI 44.3% - 46.9%) of patients arriving in pain received analgesic medication. The prevalence of pain on arrival compares well with previously reported figures using similar methods. Differences in the cohort presenting in pain compared to the population may represent differences in the prevalence or be an extension of previous bias seen in the documentation of pain. This work has set a rigorous methodology for identifying patients presenting with pain from the EHR. It will form the basis for future applications of AI to identify patients presenting in pain to the ED.
Publisher: Wiley
Date: 25-09-2023
Abstract: COVID‐19 greatly disrupted the provision of emergency care across the globe. ED service delivery was urgently redesigned as human and material resources were mobilised, and patients with respiratory symptoms were isolated. This study aimed to compare ED patient volume and flow metrics before and during the COVID‐19 pandemic. An observational study was conducted in two large urban EDs in Brisbane, Australia and Seoul, Republic of Korea. Patient volume and flow were quantified using ED presentation numbers and service times, respectively. Daily case numbers, waiting, treatment and admission delay times were compared between 2019 and 2020/2021 using time series plots. Outcomes were further classified by triage category and age group. Trends were examined alongside a timeline of health service and government policies. There were reductions in daily presentations for the least urgent triage categories during the early phase of the pandemic. The caseloads for the most urgent triage categories were unaffected. The trends were similar in both EDs. A reduction in waiting and admission delay times but not treatment times coincided with reduced presentations in Brisbane. This pattern gradually reversed as presentations returned to baseline. In Seoul, admission delay times returned to pre‐pandemic levels despite a persistent reduction in presentation numbers. Total daily presentations varied considerably according to government mandated social restrictions and testing requirements in both EDs. The reductions in waiting and admission delay times corresponded with improvements in hospital capacity.
Publisher: Cold Spring Harbor Laboratory
Date: 18-09-2020
DOI: 10.1101/2020.09.15.20194738
Abstract: 3. Pain is a common presenting complaint to the emergency department (ED), yet is often undertreated. When assessing the outcomes of pain care in the ED, process measures are commonly reported. Attempts to measure patient-reported outcomes existing in current ED literature. However, they are frequently unvalidated and lack standardization. The American Pain Societies – Patient Outcome Questionnaire-Revised edition (APS-POQ-R) has been identified as the most likely, pre-existing tool to be useful in the acute pain in the ED. However, this requires feasibility and construct validation before use. To assess the feasibility and construct validity of the APS-POQ-R in patients presenting to the adult emergency department with acute pain. This study is an initial psychometric evaluation of the constructs contained within the APS-POQ-R in adult patients presenting with moderate to severe acute pain to a large urban ED. The study is guided by the methods described in the initial development of the instrument. Two hundred adult patients were recruited and completed the APS-POQ-R. The APS-POQ-R demonstrated content validity in patients presenting with acute pain. Exploratory factor analysis demonstrated five subgroups. The tool demonstrated discriminatory ability based on patient urgency, and subscale measurement was associated with patient satisfaction with care. The APS-POQ-R has demonstrable construct validity in adult patients presenting with acute pain to the ED. Further psychometric analysis across multiple EDs is required before the APS-POQ-R can be recommended as a validated PROM for ED patients in pain.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.ANNEMERGMED.2014.01.023
Abstract: We assess the sensitivity and specificity of xanthochromia as adjudicated by visual inspection and spectrophotometry at predicting the presence of cerebral aneurysm in patients with suspected subarachnoid hemorrhage who have a normal computed tomography (CT) head scan result. A systematic review was performed. MEDLINE and EMBASE databases were searched. Relevant studies with clinical data on the diagnostic accuracy of visual inspection or spectrophotometry were considered. Patients who had a normal CT head scan result followed by a lumbar puncture were included in this review. Sensitivities, specificities, and heterogeneity (I(2)) were calculated. Subgroup analyses were performed to explore reasons for the heterogeneity. There were major methodological limitations in the studies found. Twenty-two relevant articles were heterogeneous in regard to time to lumbar puncture, spectrophotometry methods, and follow-up of patients not undergoing cerebral angiography. Twelve of the 22 studies selected patients on the basis of a cerebral aneurysm or subarachnoid hemorrhage on imaging, or a positive lumbar puncture result. These studies were excluded from our initial analysis, which included only patients with clinically suspected subarachnoid hemorrhage. In this initial analysis, pooled estimates of sensitivity and specificity for spectrophotometry were 87% (95% confidence interval [CI] 71% to 96% I(2)=26%) and 86% (95% CI 84% to 88% I(2)=96%), respectively. For visual inspection, pooled sensitivity and specificity were 83% (95% CI 59% to 96% I(2)=52%) and 96% (95% CI 93% to 97% I(2)=76%), respectively. Sensitivity estimates are difficult to interpret without knowing time to lumbar puncture. The heterogeneity in the underlying studies, combined with significant overlap in pooled confidence limits, makes it impossible to provide a definite conclusion about the diagnostic accuracy of spectrophotometry versus visual inspection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000520548
Abstract: b i Background and Aim: /i /b Migraine headache is commonly diagnosed in emergency departments (ED). There is relatively little real-world information about the epidemiology, investigation, management, adherence to therapeutic guidelines and disposition of patients treated in ED with a final diagnosis of migraine. The primary aim of the current study is to get a snapshot of assessment and management patterns of acute migraine presentations to the different settings of EDs with a view to raise awareness. b i Methods: /i /b This is a planned sub-study of a prospective study conducted in 67 health services in 10 countries including Australia, New Zealand, Southeast Asia, Europe, and the UK investigating the epidemiology and outcome of adult patients presenting to ED with nontraumatic headache. Outcomes of interest for this study are demographics, clinical features (including severity), patterns of investigation, treatment, disposition, and outcome of patients diagnosed as having migraine as their final ED diagnosis. b i Results: /i /b The cohort comprises 1,101 patients with a mean age of 39 years (SD ± 13.5 73.7% [811]) were female. Most patients had had migraine diagnosed previously (77.7%). Neuroimaging was performed in 25.9% with a very low diagnostic yield or significant findings (0.07%). Treatment of mild migraine was in accordance with current guidelines, but few patients with moderate or severe symptoms received recommended treatment. Paracetamol (46.3%) and nonsteroidal anti-inflammatory drugs (42.7%) were the most commonly prescribed agents. Metoclopramide (22.8%), ondansetron (19.2%), chlorpromazine (12.8%), and prochlorperazine (12.8%) were also used. b i Conclusions: /i /b This study suggests that therapeutic practices are not congruent with current guidelines, especially for patients with severe symptoms. Efforts to improve and sustain compliance with existing management best practices are required.
Publisher: BMJ
Date: 20-12-2019
DOI: 10.1136/EMERMED-2018-207876
Abstract: Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians’ decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent in idual face-to-face or telephone interviews. Content analysis was performed whereby transcripts were examined and coded independently by two co-investigators, who then jointly agreed on the influencing factors. Six categories of influencing factors were identified. Patient interaction was at the forefront of the identified factors. This shared decision-making process incorporated ‘what the patient wants’ but may be biased by how the clinician communicates the benefits and harms of the diagnostic options to the patient. Patient risk profile, practice evidence and guidelines were also important. Other influencing factors included experiential factors of the clinician, consultation with colleagues and external influences where practice location and work processes impose constraints on test ordering external to the preferences of the clinician or patient. The six categories were organised within a conceptual framework comprising four components: the context, the evidence, the experience and the decision. When clinicians are faced with a diagnostic challenge, such as the workup of a patient with suspected SAH, there are a number of influencing factors that can result in a variation in approach. These need to be considered in approaches to improve the appropriateness and consistency of medical care.
No related grants have been discovered for Kevin Chu.