Alice Rogan

Objectives To explore the unique impact the first COVID‐19 national lockdown in New Zealand (NZ) had on the utility of computed tomography (CT)‐head scanning in patients presenting to the ED with head injuries. Methods Retrospective observational study of CT‐head use in head‐injured patients presenting to the ED during the 2020 COVID‐19 lockdown compared to the corresponding time period in 2019. Results During the lockdown period in 2020, the total number of ED presentations reduced by 30.3% (95% confidence interval [CI] 28.8–31.6) from 13 477 to 9403. The total number of head injury presentations also reduced by 32% (95% CI 27–36.7) from 523 to 356. The proportion of head‐injured patients remained similar (3.9% [ n = 523] in 2019 vs 3.8% [ n = 356] in 2020). Of the head injured patients, 185 (51.9%, 95% CI 44.5–59.4) had CT‐head scans performed in 2020 compared to 269 (51.4%, 95% CI 45.2–57.5) in 2019; a reduction of 31.2% (95% CI 24.5–37.9). The proportion of patients who had a CT‐head scan remained similar (51.4% [95% CI 45.2–57.5] in 2019 vs 51.9% [95% CI 44.5–59.4] in 2020). There were no significant differences in the proportion of CT‐head scans with acute traumatic pathology (13.0% [95% CI 8.7–17.3] in 2019 vs 12.4% [95% CI 7.4–17.5] in 2020, P = 0.86). Conclusions During the first COVID‐19 lockdown in NZ, the total number of patients presenting to the ED decreased by one third. Reassuringly, the proportion of patients who presented with head injuries, had a CT‐head scan performed, and had positive CT‐head findings remained the same as the previous year.

Aim To explore factors influencing fever management practices and antipyretic use among New Zealand Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). Methods Cross‐sectional survey of doctors and nurses across 11 New Zealand EDs. The questionnaire examined eight of 12 TDF domains, based on a generic questionnaire validated to assess TDF‐based determinants of health‐care professional behaviour. Relevant domains were identified by the frequency of beliefs; the presence of conflicting beliefs within a domain; and the likely strength of impact of a belief on paediatric fever management in the ED. Results About 602 participants (243 doctors, 353 nurses and 6 unknown) completed the survey (response rate 47.5%). Over half (351/591, 59.6%, 95% confidence interval (CI) 55.5–63.5%) knew the content of clinical practice guidelines regarding antipyretic use in febrile children (TDF Domain Knowledge), or had been trained to ensure antipyretics are given to febrile children only if they appear distressed (347/592, 58.6%, 95% CI 54.5–62.6%) (Skills). Over 40% (246/590, 95% CI 37.7–45.8%) aim to reduce the fever before discharge (Goals). Most (444/591, 75.1%, 95% CI 71.4–78.6%) participants felt capable of explaining appropriate antipyretic use to parents/care givers (Beliefs about Capabilities). Only a minority (155/584, 26.5%, 95% CI 23.0–30.3%) thought that they can ensure antipyretics are given to febrile children only if they appear distressed when the ED is busy (Environmental Context and Resources). Conclusions Using the TDF, we identified factors influencing fever management practices and antipyretic use in the ED. These factors can guide the design of targeted, theory‐informed knowledge translation strategies.