The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition.METHODS: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females(71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger(M=37.05, SD=13.23) than the whole ED population(M=46.17 SD=20.50)(P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous(IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates(42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used.CONCLUSION: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

Presenting patterns of dermatology conditions to an Australian emergency department

BACKGROUND: Approximately 5%–8% of emergency department(ED) presentations are due to a dermatological condition.This study aimed to identify and characterise patients with skin conditions presenting to a busy ED.METHODS: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed.Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations.A prospective survey was conducted on low priority triage(triage 4 and 5) patients identifying reasons presenting to the ED.RESULTS: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016.Of the dermatology presentations, 41.5% were female and had an average age of 47.The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer.Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology.Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED.CONCLUSION: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology.This data may help ED clinicians decide on the discharge disposition of these patients.There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.