The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated that minimally invasive surgery to treat spontaneous lobar intracerebral hemorrhage (ICH) improved functional outcomes. We aimed to explore current management trends for spontaneous lobar ICH in Canada to assess practice patterns and determine whether further randomized controlled trials are needed to clarify the role of surgical intervention.

Neurologists, neurosurgeons, physiatrists and trainees in these specialties were invited to complete a 16-question survey exploring three areas: (1) current management for spontaneous lobar ICH at their institution, (2) perceived influence of ENRICH on their practice and (3) perceived need for additional clinical trial data. Standard descriptive statistics were used to report categorical variables. The χ2 test was used to compare responses across specialties and career stages.

The survey was sent to 433 physicians, and 101 (23.3%) responded. Sixty-eight percent of participants reported that prior to publication of the ENRICH trial, spontaneous lobar ICH was primarily managed conservatively, with surgery reserved for life-threatening situations. Forty-three percent of participants did not foresee a significant increase in surgical intervention at their institution. Of neurosurgical respondents, 33% remained hesitant to offer surgical intervention beyond lifesaving operations. Only 5% reported routinely using specifically designed technologies to evacuate ICH. Seventy percent reported that another randomized controlled trial comparing nonsurgical to surgical management for spontaneous lobar ICH is needed.

There is significant practice variability in the management of spontaneous lobar ICH across Canadian institutions, stressing the need for additional clinical trial data to determine the role of surgical intervention.

This study aimed to explore relationships between parental stress, coping, and outcomes for parents of infants with CHD, via observational approach reflecting domains of the Parental Stress and Resilience in CHD (PSRCHD) model.

Fifty-five parents of 45 infants with CHD completed questionnaires with measures of parental stress, Problem-Focused Coping (PFC), Emotion-Focused Coping (EFC), Avoidant Coping (AC), mental health (symptoms of anxiety and symptoms of depression), post-traumatic growth (PTG) and quality of life (QoL). Demographic and infant clinical data were obtained.

Parental stress showed significant small to medium positive correlations with MH and PTG, but no significant correlations with QoL. EFC and AC showed significant small to medium positive correlations with MH, and medium negative correlations with parental QoL. EFC and PFC had significant small to medium correlations with PTG. PFC and AC had significant small to medium correlations with infant QoL. Hierarchical multiple regression analyses indicated that parental symptoms of anxiety, PTG, parental QoL, infant QoL were significantly predicted by models comprising of parental stress, coping styles, and clinical controls (adjusted R2 = 13.0–47.9%, p range < 0.001–.048), with results for parental symptoms of depression falling marginally above significance (adjusted R2 = 12.3%, p = .056).

Parental stress, coping styles, and length of hospital stay are related to psychological outcomes in parents of infants with CHD. Future research may use the PSRCHD framework to assess mechanisms underlying CHD parents’ stress and coping experiences and investigate longitudinal relationships between parental factors and parent and child outcomes.

Acute kidney injury is associated with worse outcomes after cardiac surgery. The haemodynamic goals to ameliorate kidney injury are not clear. Low post-operative renal perfusion pressure has been associated with acute kidney injury in adults. Inadequate oxygen delivery may also cause kidney injury. This study evaluates pressure and oximetric haemodynamics after paediatric cardiac surgery and their association with acute kidney injury.

Retrospective case–control study at a children’s hospital. Patients were < 6 months of age who underwent a Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery categories ≥ 3. Low renal perfusion pressure was time and depth below several tested thresholds. The primary outcome was serum creatine-defined acute kidney injury in the first 7 days.

Sixty-six patients (median age 8 days) were included. Acute kidney injury occurred in 36%. The time and depth of renal perfusion pressure < 42 mmHg in the first 24 hours was greater in acute kidney injury patients (94 versus 35 mmHg*minutes of low renal perfusion pressure/hour, p = 0.008). In the multivariable model, renal perfusion pressure < 42 mmHg was associated with acute kidney injury (aOR: 2.07, 95%CI: 1.25–3.82, p = 0.009). Mean arterial pressure, central venous pressure, and measures of inadequate oxygen delivery were not associated with acute kidney injury.

Periods of low renal perfusion pressure (<42 mmHg) in the first 24 post-operative hours are associated with acute kidney injury. Renal perfusion pressure is a potential modifiable target that may mitigate the impact of acute kidney injury after paediatric cardiac surgery.

This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.

In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.

Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.

Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.

Routine patient care data are increasingly used for biomedical research, but such “secondary use” data have known limitations, including their quality. When leveraging routine care data for observational research, developing audit protocols that can maximize informational return and minimize costs is paramount.

For more than a decade, the Latin America and East Africa regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium have been auditing the observational data drawn from participating human immunodeficiency virus clinics. Since our earliest audits, where external auditors used paper forms to record audit findings from paper medical records, we have streamlined our protocols to obtain more efficient and informative audits that keep up with advancing technology while reducing travel obligations and associated costs.

We present five key lessons learned from conducting data audits of secondary-use data from resource-limited settings for more than 10 years and share eight recommendations for other consortia looking to implement data quality initiatives.

After completing multiple audit cycles in both the Latin America and East Africa regions of the IeDEA consortium, we have established a rich reference for data quality in our cohorts, as well as large, audited analytical datasets that can be used to answer important clinical questions with confidence. By sharing our audit processes and how they have been adapted over time, we hope that others can develop protocols informed by our lessons learned from more than a decade of experience in these large, diverse cohorts.

Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear.

To describe the emergency department presentation patterns of a help-seeking youth mental health cohort.

Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12–30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other).

During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86–0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086–1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation.

Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.

The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described.

Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3–5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter.

Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar.

In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.

Uncomplicated acute alcohol intoxication (UAAI) requiring medical management is common at some mass gathering events. Most of the mass gathering literature reporting on medical management involving UAAI are single case studies. The common clinical practice for UAAI at mass gatherings reported in the literature involves intravenous fluids and antiemetics. However, emergency department evidence suggests that administration of intravenous fluids does not enhance patient outcomes, and in some cases extends emergency department length of stay and costs.

Using a retrospective cohort design of routinely collected data over a nine-year period (2010-2013 and 2016-2020), this study was set at an annual end-of-year ‘schoolies’ youth mass gathering event. The primary study aim was to determine the intravenous fluid management practices of UAAI at this event. Secondary study outcomes included patient demographic, clinical characteristics, and patient outcomes. Data were analyzed using time series and descriptive statistics. Ethical approval was obtained.

In total, 378 patients were identified with UAAI at the event over the nine-year period. The median patient age was 17 years (IQR: 17-18), with 47.2% (n=179) being male. Overall, the median length of stay was 74 minutes (IQR: 40 – 144). Only 7.9% (n=30) patients received intravenous cannulation and 6.3% (n=24) patients received intravenous fluids. Proportionately, the use of intravenous fluids for the management of UAAI decreased over the study years [2010, 28.6%; 2011, 32.1%; 2012, 15.6%; 2013, 6.3%; 2016, 2.6%; 2017, 0%; 2018, 1.8%; 2019, 0%; 2020, 0%].

Some mass gathering events have a higher incidence of UAAI presentations. This is particularly true for those mass gathering events with young adults and at music festivals. Knowledge translation from the emergency department context regarding UAAI clinical management could be applied to the mass gathering event setting. This clinical management should include a conservative approach to the management of UAAI.

New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.

Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.

Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.

This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.

Case Study

.

.

The occurrence of disasters and mass casualty incidents (MCIs) is on the rise, thus training and rehearsal for disaster response remain paramount. Virtual reality (VR) platforms have previously been shown to be well-received, engaging, and immersive for disaster training. The primary objective of this study was to ascertain if a human actor-based VR MCI scenario could elicit a sympathetic response, as measured by heart rate variability (HRV), in medical doctors and trainees compared to a baseline state.

A simulation was filmed with students, residents, and surgeons on a GoPro 360 camera. Subjects (n=35) were recruited to sufficiently power (1-b=0.8) a Wilcoxon matched-pairs test and Welch’s t-test. Subjects watched the simulation on an Oculus Quest headset while having HRV recorded. Multivariate logistic regression was performed to identify factors associated with increased odds of significant sympathetic activation. Statistical significance was established at p<0.05.

Thirty-five subjects were enrolled and included three trauma surgeons, three emergency medicine (EM) attendings, eight EM residents, six surgery residents, and 15 medical students. A significant decrease in HRV was observed across all groups in the MCI (median 20 ms IQR 16.2, 31.4 ms) compared to baseline (33.2 ms IQR 27.2, 44.1 ms; p<0.0001). Sympathetic activation was most pronounced in students, then attendings, then residents. There was no significant difference in the fold-difference of sympathetic activation of EM physicians (-48.5% +/- 32.1%) versus surgeons (-49.5% +/- 25.2%; p=0.57). In all groups, SNS activation occurred independently of heart rate, age, sex, number of years in practice, first responder experience, or prior MCI response.

Live-actor VR MCI simulation elicited a strong sympathetic response from students, residents, and attending physicians. By recruiting and disinhibiting essential neural pathways via controlled SNS activation, VR MCI training has the potential to enhance the encoding and consolidation of disaster training in a low-cost and reproducible manner.