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ObjectiveTo compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress.MethodsWe conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay.Results708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care −1.0, IQR −3.0 to 0.0 vs CPAP −3.5, IQR −5.2 to −2.0), median difference −2.0 (95% CI −2.5 to −1.6); and RR (usual care −4.0, IQR −9.0 to 0.0 min-1 vs CPAP −8.0, IQR −14.0 to −4.0 min-1), median difference −4.0 (95% CI −5.0 to −4.0) min-1. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI −0.17 to 0.90).ConclusionsThe use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay.Trial registration numberACTRN12615001180505.

IntroductionMild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%–20% of individuals experience mTBI symptoms beyond this ‘typical’ recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers.Objective(1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories; (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS.Methods and analysisThe Concussion Recovery Study (CREST) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18–65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II, participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors.Ethics and disseminationHuman Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberACTRN12619001226190.

Recent behavioural and event-related potential (ERP) studies reported cross-modal links in spatial attention between vision, audition and touch. Such links could reflect differences in hemispheric-activation levels associated with spatial attention to one side, or more abstract spatial reference-frames mediating selectivity across modalities. To distinguish these hypotheses, ERPs were recorded to lateral tactile stimuli, plus visual (experiment 1) or auditory stimuli (experiment 2), while participants attended to the left or right hand to detect infrequent tactile targets, and ignored other modalities. In separate blocks, hands were either in a crossed or uncrossed posture. With uncrossed hands, visual stimuli on the tactually attended side elicited enhanced N1 and P2 components at occipital sites, and an enhanced negativity at midline electrodes, reflecting cross-modal links in spatial attention from touch to vision. Auditory stimuli at tactually attended locations elicited an enhanced negativity overlapping with the N1 component, reflecting cross-modal links from touch to audition. An analogous pattern of results arose for crossed hands, with tactile attention enhancing auditory or visual responses on the side where the attended hand now lay (i.e. in the opposite visual or auditory hemifield to that enhanced by attending the same hand when uncrossed). This suggests that cross-modal attentional links are not determined by hemispheric projections, but by common external locations. Unexpectedly, somatosensory ERPs were strongly affected by hand posture in both experiments, with attentional effects delayed and smaller for crossed hands. This may reflect the combined influence of anatomical and external spatial codes within the tactile modality, while cross-modal links depend only on the latter codes.