David McD Taylor

• MBBS MD MPH DRCOG FACEM
• Director of emergency medicine research at Austin Health

Importance The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Objective To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of-hospital cardiac arrest improves survival at hospi...

Background: Medication-related problems (MRPs) occur across the continuum of emergency department (ED) care: they may contribute to ED presentation, occur in the ED/short-stay unit (SSU), at hospital admission, or shortly after discharge to the community. This project aimed to determine predictors for MRPs across the continuum of ED care and incorp...

Background Fixation of the coracoid during the Latarjet procedure can be performed with either unicortical or bicortical fixation. There is no clear evidence that the number of cortices fixed affects graft union, but in vitro studies suggest bicortical fixation is desirable. The primary aim of the study was to retrospectively review the coracoid un...

Objective: To describe the epidemiology, treatment and monitoring of treatment outcomes of patients presenting to the ED with hyperkalaemia. Methods: We undertook a retrospective observational study in a mixed adult/paediatric ED over five 3-month periods. Consecutive patients were included if they had an initial serum or blood gas potassium ≥6....

Objective We developed a clinical tool comprising patient risk factors for having an abnormal calcium (Ca), magnesium (Mg) or phosphate (PO4) level. We hypothesized that patients without a risk factor do not require testing. This study examined the tool's potential utility for rationalizing Ca, Mg and PO4 ordering in the emergency department (ED)....

Background The impact of substance use disorders (SUD) in an Asian population has not been fully explored. We aimed to assess the risk of mortality, accident and emergency (A&E) department attendances, and hospital admissions associated with SUD in a population-based cohort study. Method Patients diagnosed with SUD in public A&E departments from 2...

Introduction: The aim of this study was to describe the nature of regular medications taken by active comorbid scuba divers (having a declared medical comorbidity) and scuba divers and snorkellers who died following a diving incident. Methods: We undertook a retrospective, observational study from July to October, 2020. Data on 268 active comorb...

Objective To determine author and journal self-citation rates in a sample of original emergency medicine (EM) research articles. Methods We undertook a retrospective observational study of original research articles published in 2019 in the top six English language general EM journals. Data comprised the total numbers of articles, citations, autho...

Objective: To determine medications used by ED doctors to improve work and academic performance, and to manage stress and anxiety. Methods: We undertook an online, voluntary, anonymous survey of ACEM fellows and trainees. Results: One hundred and thirty-nine (46.5%) respondents used a medication under examination. Sleep aids included melatonin...

We previously reported the mean 4-year outcomes of anatomic total shoulder replacement using an all-polyethylene, pegged, hybrid-fixation (bone ingrowth and cement) glenoid component. In the present study, we report on that patient cohort after another 4 years of follow-up (mean, 101 months; range, 77 to 146 months). At that time, the median Americ...

Objective The aim of this study was to determine the types of medical misconduct, the practitioner, specialities and jurisdictions at risk, patient outcomes and the sanctions imposed.Methods This study was a retrospective case series of 822 adverse medical tribunal determinations in Australia, New Zealand, Canada (Ontario, Alberta), Pennsylvania (U...

Objective To determine patient knowledge of the nature of their pain management in the ED. Methods This was a planned sub‐study of data collected during a randomised, controlled trial of the nature of the informed consent process in a single ED. Patients aged ≥18 years, with a triage pain score of ≥4, were enrolled. Forty‐eight hours post‐ED disch...

Objective To assess patient satisfaction with laceration management, post‐ED care, cosmesis and complication rates. Methods We undertook a prospective observational study of adult patients with lacerations sutured in two EDs over a 4‐month period. ED data included participant demographics, laceration characteristics and management. A telephone sur...

Ethical oversight in the form of review boards and research ethics committees provide protection for research subjects as well as guidance for safe conduct of studies. As the number of collaborative emergency care research studies carried out in low- and middle-income countries increases, it is crucial to have a shared understanding of how ethics s...

Statistics can be used to describe data or make inferences about populations using samples. Median values (the 50th percentile) better represent central tendency of data samples than means (averages), particularly when data have extreme values. Errors resulting from use of inferential statistics when using classical hypothesis testing include type...

The specialty of Emergency Medicine continues to expand and mature worldwide. As a relatively new specialty, the body of research that underpins patient management in the emergency department (ED) setting needs to be expanded for optimum patient care. Research in the ED, however, is complicated by a number of issues including limited time and resou...

Presenting research at a conference is an opportunity to disseminate the findings, network with other researchers, and to develop your academic track record. Although every conference will have some local differences, there are common approaches to presenting your research in the best manner. This will differ depending on whether it is an oral or a...

Objective: To determine if ED research reflects patient expectations. Method: A cross-sectional ED patient survey. Results: Three hundred and nine (98.1%, 95% confidence interval [CI] 95.7-99.2) of 315 patients believed that ED research was important. Two hundred and twelve (68.4%, 95% CI 62.9-73.5) would welcome involvement, only 26 (8.4%, 95...

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each...

Objective: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. Methods: We undertook a prospecti...

Objective: The utility of calcium, magnesium and phosphate measurement in the ED is limited. We aimed to determine clinical risk variables for abnormal levels of these electrolytes in order to inform the development of an ordering guideline. Methods: We performed a retrospective, observational study of patients who presented to a tertiary referr...

The proliferation of computer 3D simulation and computer-generated guides is aimed at minimizing perforation of the glenoid vault by glenoid pegs in shoulder arthroplasty, based on assumptions that perforation leads to worse outcomes by component loosening and potential failure. We evaluated outcomes of glenoid peg perforation testing the assumptio...

Background Behavioural emergencies (BEs) are complex situations in the emergency department (ED) setting. Treatment decisions always must be made within a limited time and are based on incomplete patient data. As a result of the urgency and complexity, patients often are exposed to increased risk of harm. Aim The aim of this paper is to describe t...

Objective: To describe the incidence, nature and risk factors for adverse events (AEs) among patients who received parenteral sedation for acute agitation in an emergency department (ED) setting. Methods: We undertook a prospective observational study and a clinical trial of parenteral sedation for the management of acute agitation. We included...

Objective To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4) tests change ED patient management. Methods We undertook a retrospective observational study in an Australian tertiary referral ED. We enrolled adult patients (aged ≥18 years) who presented between 1 January and 30 June 2017 and who had a serum Ca, Mg or PO4 tes...

Background: We aimed to determine the barriers to optimal management of psychiatric patients in the emergency department (ED). Methods: We undertook an observational study in a tertiary referral ED with a 24h acute psychiatric nursing service (February to April, 2017). Following patient discharge, the attending psychiatric nurse completed a vali...

Little is known about the effects of the ‘cold calling’ technique (telephone contact without prior warning) for patient follow up in ED research. Recently, we undertook a prospective, observational pain management study. Patients were cold called 48 h post‐discharge and surveyed regarding their pain management satisfaction. We made contact with 778...

Objective: To determine the nature and extent of misappropriation of medications and equipment from the ED. Methods: We undertook a retrospective audit of medications procured and administered, and equipment replaced, in 2016, within a tertiary referral ED. Medication procurement and administration data were obtained from our MERLIN® pharmacy sy...

Objective The completeness of ED medical record documentation is often suboptimal. We aimed to determine the variables associated with documentation completeness in a large, tertiary referral ED. Methods We audited 1200 randomly selected medical records of patients who presented with either abdominal pain, cardiac chest pain, shortness of breath o...

Objective There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension. We aim to study current resuscitation practices in EDs in Australia and New Zealand (the Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Departmen...

Purpose To determine if a regimen of restricted fluids and early vasopressor compared to usual care is feasible for initial resuscitation of hypotension due to suspected sepsis. Methods A prospective, randomised, open-label, clinical trial of a restricted fluid resuscitation regimen in the first 6 h among patients in the emergency department (ED)...

Objective: To determine the prevalence, predictors, and characteristics of health-related internet searches by adult emergency department (ED) patients; to examine the effect of searching on the doctor-patient relationship and treatment compliance. Design: A multi-centre, observational, cross-sectional study; a purpose-designed 51-item survey, i...

Historically, acetylcysteine has been delivered at a fixed dose and duration of 300 mg/kg over 20 hours to nearly every patient deemed to be at any risk for hepatotoxicity following acetaminophen overdose. We investigated a 12-hour treatment regimen for selected low-risk patients. This was a multicenter, open-label, cluster-controlled trial at six...

Objective To retrospectively assess the accuracy and inter‐rater reliability of the aortic dissection detection risk score (ADD‐RS). Methods Single‐centre, observational, diagnostic accuracy study undertaken in a university‐affiliated, tertiary hospital ED. Results Two hundred patients were enrolled. Five patients were diagnosed with acute aortic...

We aimed to determine whether the outpatient management of ED patients with asthma adheres to Australia's Asthma Consensus Guidelines. Adult patients, under treatment for asthma, were administered a validated questionnaire. Data on their outpatient management were collected and analysed descriptively. Of 51 patients, 14 smoked and 35 did not underg...

Objective: To assess the accuracy of medication information sources available for adult patients presenting to the ED, compared to a best possible medication history (BPMH). Methods: This prospective observational study was undertaken in the ED of a major tertiary-referral teaching hospital. A convenience sample of consecutive adult patients tak...

Introduction To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method We undertook a prospective cohort study in a tertiary referral emergency department (February–May 201...

Objectives: Mind and Body Practice (MBP) use (e.g., chiropractic, acupuncture, meditation) among Emergency Department (ED) patients is largely unknown. We aimed to determine the period prevalence, nature of MBP use, and perceptions of MBP among adult ED patients. Design and setting: We undertook a cross-sectional survey of a convenience sample o...

Background We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. Methods We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February–May, 2016). Patients aged ≥18 years who devel...

Background Guidelines recommend an initial intravenous (IV) fluid bolus of 30 ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack of evidence from clinical trials to support this. Accumulating observational data suggest harm associated with the injudicious use of fluids in sepsis. There is currently equipoi...

Background: The combination of midazolam and droperidol has proven superior to droperidol or olanzapine monotherapy in the management of acute agitation in emergency departments (EDs). Objective: This is the first economic analysis to evaluate the cost-benefit and cost effectiveness of the midazolam-droperidol combination compared with droperido...

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing a...

Objective: The aim of this study was to determine patient satisfaction with procedural sedation as a function of nature of the procedure and depth of sedation. Method: We undertook a prospective observational study of adult patients who received procedural sedation in two EDs (20?month period). The level of sedation was determined by an investig...

Objective: Although ED patients presenting with supraventricular tachycardia (SVT) are commonly investigated, the value of these investigations has been questioned. We aimed to determine the frequency and utility of investigations in patients with SVT. Methods: We undertook an explicit retrospective medical record audit of patients with SVT who...

Objective: The proportion of adults in Australia meeting or exceeding the national guidelines for physical activity has remained relatively static over the past 10 years. The research objective was to measure self-reported physical activity and sedentary behaviour among ED patients in accordance with Australia's current physical activity and seden...

Objective: While complementary medicine use among ED paediatric patients is common, the use of alternative therapies (ATs; physical or spiritual therapies) is unknown. We aimed to determine the 12 month period prevalence and nature of AT use among paediatric patients and parent perceptions of AT use. Methods: We undertook a cross-sectional surve...

Objective To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). Methods We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Austra...

Study objective: We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. Methods: We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and...

Emergency care needs to be underpinned by the highest quality evidence. However, research involving critically ill patients in the emergency setting has unique ethical, logistical and regulatory issues. Informed consent is a well-established principle in conventional research. In this article, we discuss informed consent as it pertains to the diffi...

This perspective article summarises the experience of conducting a multicentre research project. We describe expected and unexpected hurdles we experienced as well as suggesting possible solutions for researchers embarking on multicentre studies.

Background: Little is known about the use of sedation drugs for the management of acute agitation in Hong Kong's Accident and Emergency Departments (AEDs) and how it compares with Australasian practice. Objective: The aim of this study was to determine drug preferences, clinicians' perceived confidence in management, barriers/gaps in training an...

Objectives: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and by <4 [0-10 scale]) and determine the effect on patient satisfaction. Methods: We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The i...

To determine the prevalence and nature of off-label and unlicenced (off-label/unlicenced) medicine administration to paediatric ED patients. We undertook a retrospective, observational study in six EDs (July 2011 to June 2012, inclusive). Patients, aged 0-17 years, who were administered a medicine in the ED were included. At each site, 50 eligible...

Objective To evaluate the effect of changes to the pre-hospital management of patients with supraventricular tachycardia (SVT) following intervention with a revised Clinical Practice Guideline (CPG). The major CPG revisions were removal of verapamil, addition of adenosine and an emphasis on Valsalva manoeuvre.Method We undertook a retrospective cas...

Objective: The present study examined patient demographics, characteristics and the effectiveness of current prehospital supraventricular tachycardia (SVT) management by ambulance paramedics in Victoria, Australia. Method: We conducted a retrospective study of all Victorian patients attended by paramedics between 14 February 2012 and 13 February...

Objectives This study sought to determine the most effective technique for Valsalva Manoeuvre (VM) and Human Dive Reflex Manoeuvre (HDR) generation of vagal tone. Methods We conducted a repeated-measures trial of healthy adult volunteers from a university campus, aged 18–56 years, in sinus rhythm. Participants were randomised to VM (in supine or Tr...

To evaluate the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea. A feasibility study (with historical controls) undertaken at the Northern Hospital ED in Melbourne, Australia, involving people presenting to ED triage with pain (VAS 0-10) and/or nausea (Morrow Index 1-6) between Ja...

There is limited evidence regarding clinical research priorities in emergency medicine outside of some special interest groups. The ACEM Clinical Trials Group undertook a consensus meeting with the aim of developing a reproducible weighting matrix for assessing clinical research priorities. A session at the ACEM annual scientific meeting was dedica...

To determine the clinical research priorities of Fellows of the Australasian College for Emergency Medicine (ACEM) in order to inform the strategic research agenda specific to multicentre clinical research. An anonymous survey of all ACEM Fellows (FACEMs) listed on the ACEM researcher database was conducted between January and March 2013. Of 108 FA...

The study aims to evaluate the impact of a nurse-initiated analgesia pathway (NIAP) intervention for paediatric patients in the ED. We undertook a pre- and post-intervention trial in a large, tertiary referral, mixed ED. The intervention comprised development and implementation of a comprehensive NIA Standing Order. In addition to paracetamol, whic...

The study aims to determine if obesity (body mass index ≥30.0 kg/m(2) ) adversely affects the patients' ED experience in terms of flow variables and rates of assistance, investigation and procedure. This was a prospective, analytical, observational study in a large tertiary referral ED. Consecutive patients, presenting during data collection period...

Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT – either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this...

Background: Patients with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of AV nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents o...

Under- or overdosing of N-acetylcysteine (NAC), when used to treat paracetamol toxicity, is associated with significant morbidity and mortality. This study evaluated the effect of a weight-based dosing chart (WBDC) introduced to decrease NAC prescription errors. We undertook a pre- and post-intervention trial in a single ED. The intervention (the N...

Objective: Anterior chest thrusts (with the subject sitting or standing and thrusts applied to the lower sternum) are recommended by the Australian Resuscitation Council as part of the sequence for clearing upper airway obstruction by a foreign body. Lateral chest thrusts (with the victim lying on their side) are no longer recommended due to a lac...

Objectives: The objective was to determine, among emergency department (ED) patients, the factors associated with a high level of satisfaction with pain management. Methods: This was a prospective cohort study in a single ED. Consecutive adult patients, with triage pain scores of ≥4 (numerical rating scale=0 to 10), were enrolled. Variables exam...

In this series we address key topics for clinicians who conduct research as part of their work in the ED. Multicentre research is conducted to enrol larger numbers of participants and improve the validity and generalisability of the findings. Little has been published outlining the practical mechanics of multicentre research in the ED. This article...

The emergency department (ED) is commonly the first point of care for patients with acute behavioral issues from the community. Routinely, clinical management involves the use of benzodiazepine and/or antipsychotic drugs, when initial de-escalation strategies fail. There is currently scant literature available to inform the clinical management and...

Study objective: Parenteral benzodiazepines or antipsychotics are often used to manage acute agitation in emergency department (ED) settings in which alternative strategies have failed or are not feasible. There are scant data comparing parenteral medication regimens. We aim to determine the efficacy and safety of intravenous droperidol or olanzap...

In this series we address key topics for clinicians who conduct research as part of their work in the ED. Analysis of research data does not represent the completion of a project as the findings need to be communicated to clinicians and other researchers in the field. In this section, we describe how to write up clinical research data for publicati...

To interrogate the National Coroners Information System (NCIS) to determine the recurrent themes among coroners' recommendations that aimed to increase the safety of ED care. This was a retrospective analysis of NCIS closed cases, from Queensland, New South Wales, Tasmania, Victoria, Australian Capital Territory, South Australia and North Territory...

We aimed to compare the precipitants of acute decompensated heart failure (ADHF) among patients admitted with diagnoses inclusive of ADHF (community patients) and patients admitted without ADHF but who developed it during their stay (hospital patients). This was a prospective, analytical, observational study undertaken in the Austin Hospital, a maj...

Study objective: Parenteral benzodiazepines or antipsychotics are often used to manage acute agitation in emergency department (ED) settings in which alternative strategies have failed or are not feasible. There are scant data comparing parenteral medication regimens. We aim to determine the efficacy and safety of intravenous droperidol or olanzapi...

The human dive reflex (HDR), a physiological phenomenon similar to the bradycardia reflex used by marine mammals during prolonged submersion, can be employed in managing paroxysmal supraventricular tachycardia (PSVT). This review aims to identify a standardised HDR technique for haemodynamically stable PSVT, to determine the effectiveness of the HD...

AimTo compare the costs of midazolam and droperidol for the management of acute agitation in the emergency department (ED).MethodA decision analysis model was used to undertake a cost-minimisation analysis of resource utilisation in the ED of a Melbourne hospital. Data from acutely agitated patients who received midazolam (n = 74) or droperidol (n...

To evaluate the effects on temperature and outcome at hospital discharge of a pre-hospital rapid infusion of large volume, ice-cold intravenous Hartmann's solution in patients with out-of-hospital cardiac arrest and an initial cardiac rhythm of asystole or pulseless electrical activity. Prospective, randomized, controlled clinical trial. Pre-hospit...

Purpose: To evaluate the impact on clinical outcomes by providing acupuncture as an option for acute pain management in the emergency department (ED) of a major metropolitan hospital in Melbourne, Australia. Methods: Adult patients (aged 18+ years) with acute pain attending the ED were initially assessed by medical staff and/or acupuncture staff fo...

Clinical researchers in acute emergency settings are commonly faced with the difficulty of satisfying the conventional ethical requirement of obtaining informed consent, whilst ensuring a representative group of patients is recruited into studies. We discuss our own experience in addressing institutional ethical requirements to obtain informed cons...

Aim To investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting). Method A retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control...

Nursing home-acquired infections may differ from general community-acquired infections in bacteriology and antibiotic resistance. However, there are currently limited data on this topic in the Australian setting. To compare bacterial isolates and antibiotic resistance patterns, from pathology specimens of nursing home and community patients, and to...

Objective: We aimed to determine the epidemiology of chemical eye exposures reported to the Victorian Poisons Information Centre, Australia. Methods: This was a prospective case series comprising consecutive calls to the Victorian Poisons Information Centre that related to chemical eye exposures (January 2009-2010). Data included patient demogra...

Pain is the most common reason that patients present to an emergency department (ED) and is often inadequately managed. Evidence suggests that acupuncture is effective for pain relief, yet it is rarely practiced in the ED. The current study aims to assess the efficacy of acupuncture for providing effective analgesia to patients presenting with acut...

We aimed to compare the relative efficacy of tropisetron and metoclopramide in treating nausea/vomiting in undifferentiated ED patients. We undertook a randomized, double-blinded, clinical trial. Adult patients requiring treatment for nausea/vomiting were randomly assigned to either tropisetron (5 mg) or metoclopramide (10 mg), by i.v. bolus. The p...

The aim of the present study was to describe procedural sedation practices undertaken in a spectrum of Australian EDs. Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and us...

To determine the nature, incidence and risk factors for sedation-related events during ED procedural sedation, with particular focus on the drugs administered. Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedur...

To determine factors associated with failure to successfully complete a procedure during sedation in the ED. Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure and the success or failure of the procedure was r...

Background Despite the lack of supporting evidence, olanzapine intramuscular (IM) injection continues to be used via the unapproved intravenous (IV) route for the management of acute agitation in the emergency setting.AimTo report the management of acute agitation using IV olanzapine via 4 representative cases in the emergency department (ED).Clini...