The lactate ≥2 mmol/L threshold-based LqSOFA score performs better than qSOFA alone in identifying risk of adverse outcomes in ED patients with suspected sepsis.

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Objectives There is a lack of consensus for the management of otitis externa. In addition to looking at seasonal trends surrounding otitis externa, this article also reviews a collection of local and international guidelines on the management of this condition. Design Retrospective case audit of clinician‐diagnosed otitis externa at the Hedland Health Campus over 18 months. Review of 2007‐2017 evidence‐based guidelines relevant to area of practice. Setting Hedland Health Campus Emergency Department in the remote Pilbara region of Western Australia. Participants Two‐hundred‐thirty‐six otitis externa cases in 193 individuals were seen by our service. Main outcome measured Number of otitis externa presentations each month. Result Nine guidelines were reviewed, which varied widely in recommendations. An overrepresentative proportion of patients identified as either Aboriginal or Torres Strait Islander. There was a strong positive correlation between the monthly rainfall and otitis externa, moderate correlation between higher monthly minimum temperatures and no correlation with maximum temperature. Given the variety of guidelines available, it was difficult to assess whether prescribing was always consistent with guidelines. Conclusion This research makes evidence‐based suggestions for Australian practitioners. Patients should be treated with oral analgesia, ear toileting and targeted topical therapy. There is no evidence for swabs, ear wicks and oral antibiotics. The authors hypothesise that re‐presentation rates might be in part attributable to freshwater pseudomonal infection.

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Introduction: The objective of this study was to explore the demographic characteristics, disease specifics and outcomes of adult patients with suspected sepsis presenting to a remote Australian emergency department (ED). A retrospective, Rural and Remote Health rrh.org.au

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Aim: Establish the incidence, burden and characteristics of paediatric safeguarding concerns in rural Australian emergency department practice. Methods: Retrospective cohort study of burns, injury and poisoning presentations across 16 months involving 1472 paediatric cases. Results: Five per cent of presentations had confirmed safeguarding concern. These were highest during the 2200-0600 staffing period. Mean age was 7.7 years, 43.8% were female. Multivariable regression models show age 2-6 years (odds ratio (OR), 3.27; 95% confidence interval (CI), 1.35-7.93); delayed presentation (OR, 2.3; 95% CI, 1.47-3.59); and police accompaniment (OR, 9.46; 95% CI, 2.61-34.26) are associated with increased safeguarding concerns. Most concerns (91.8%) related to injuries, largely musculoskeletal, wounds and head injuries. Thermal burns were more common than chemical and electrical. Conclusion: Children aged 2-6 are at higher risk for harm than previously recognised and children aged 0-2 years were over-represented in staff-suspected concerns. Those accompanied by police had significant association with confirmed safeguarding concerns which were undersuspected by staff or assumed to have been already reported. In rural practice, 'unreasonable delay' was found to be a better measure of concern than a discrete time value. Transient family arrangements, unsecured accommodation, geographical isolation, cultural safety and unique home environments must be taken into when completing injury assessments. For regional health services to successfully identify children at risk, interagency collaboration, staff education and local patterns of concern should be targeted. Rostering changes should increase after-hours assessment capacity by specialty paediatric staff.