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Mohadeb J, Brueton-Campbell L, Doucet K, Reed A, Mitchell D, McColl T, Massarella C, Bigham B, Primiani N, Primavesi R, Kruse M, Souleymanov R, Klassen B, Brandt A, Dawson C, Gheorghica L, Prefontaine N, Crawford J, Kamabu S, Hrymak C, Leeies M. Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine. CAN J EMERG MED 2024:10.1007/s43678-024-00688-2. [PMID: 38703266 DOI: 10.1007/s43678-024-00688-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Sexual orientation and gender identity (SOGI)-diverse patients are marginalized and poorly cared for in the emergency department, yet well-designed educational interventions to meet this gap are lacking. We developed, implemented, and assessed a novel multi-modal SOGI curriculum on health and cultural humility for emergency medicine physician trainees. METHODS We conducted a prospective, single-arm evaluation of our educational intervention. A convenience sample of emergency medicine resident physicians (n = 21) participated in the facilitated curriculum including didactic and clinical simulation components. Participants completed a pre- and post-curriculum evaluation that assessed clinical skills, preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients. The content of the module was based on a scoping literature review and national needs assessment of Canadian emergency physicians, educators, and trainees along with expert collaborator and input from patient/community partners. The curriculum included a facilitated pre-brief, didactic presentation, clinical simulation modules, and a structured de-brief. Participant clinical skills were evaluated before and after the educational intervention. Our primary outcome was change in clinical preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients pre- and post-intervention. RESULTS Our patient-centered, targeted emergency medicine SOGI health and cultural humility training resulted in a significant improvement in resident self-rated clinical preparedness, attitudes, and knowledge in caring for SOGI-diverse patients. This training was valued by participants. CONCLUSION We have designed an effective, patient-centered curriculum in health and cultural humility for SOGI-diverse patients in EM. Other programs can consider using this model and developed resources in their jurisdictions to enhance provider capacities to care for this marginalized group.
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Affiliation(s)
- Juan Mohadeb
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Kris Doucet
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Anna Reed
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Devon Mitchell
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tamara McColl
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Carys Massarella
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Blair Bigham
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nadia Primiani
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Michael Kruse
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rusty Souleymanov
- Department of Social Work, University of Manitoba, Winnipeg, MB, Canada
| | - Ben Klassen
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Adam Brandt
- Investigaytors, Village Lab, Winnipeg, MB, Canada
| | | | | | | | | | - Seth Kamabu
- Investigaytors, Village Lab, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
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2
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Leeies M, Mohindra R, Hrymak C, McColl T, Ratana P, Hayward J, Davis P, Primavesi R, Archambault P, Meyer T, LeBlanc C, Sibley A, Mcilveen-Brown E, Henderson B, D'Cunha G, Bryan J, Grunau B. Enhanced sociodemographic variable collection in emergency departments. CAN J EMERG MED 2024:10.1007/s43678-024-00689-1. [PMID: 38691216 DOI: 10.1007/s43678-024-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Rohit Mohindra
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Tamara McColl
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rob Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Québec City, QC, Canada
| | - Tracy Meyer
- Department of Emergency Medicine, Dalhousie University, Saint John, NB, Canada
| | - Constance LeBlanc
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Aaron Sibley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- University of Prince Edward Island, Charlottetown, PE, Canada
| | - Emma Mcilveen-Brown
- Department of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Beth Henderson
- Health Records, Yukon Hospital Corporation, Whitehorse, YT, Canada
| | | | - Jennifer Bryan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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Wtorek P, Weiss MJ, Singh JM, Hrymak C, Chochinov A, Grunau B, Paunovic B, Shemie SD, Lalani J, Piggott B, Stempien J, Archambault P, Seleseh P, Fowler R, Leeies M. Beliefs of physician directors on the management of devastating brain injuries at the Canadian emergency department and intensive care unit interface: a national site-level survey. Can J Anaesth 2024:10.1007/s12630-024-02749-7. [PMID: 38570415 DOI: 10.1007/s12630-024-02749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI. METHODS We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians. RESULTS Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, n = 78), but 63% of these (n = 62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, n = 48) and believed that an ICU stay is required to improve confidence (99%, n = 97). Most (96%, n = 94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission. CONCLUSION In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation.
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Affiliation(s)
- Piotr Wtorek
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, JJ399-820 Sherbrook St., Ann Thomas Building, Winnipeg, MB, R3A 1R9, Canada.
| | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Quebec City, QC, Canada
| | - Jeffrey M Singh
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carmen Hrymak
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Alecs Chochinov
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Grunau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bojan Paunovic
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | | | | | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care, Université Laval, Laval, QC, Canada
| | - Parisa Seleseh
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Murdoch Leeies
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
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4
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Leeies M, Landry C, Blouw M, Butcher J, Hrymak CS, Vazquez-Grande G, Valiani S, Prakash V, Haddara WMR, Taneja R, Whittemore KG, MacRedmond RE, Paunovic BN, Downar J, Farrell CA, Murthy S, Haroon BA, DosSantos C, Balan M, Rochwerg B, D'Aragon F, Buss M, Burns KEA. Canadian Critical Care Society position statement on reconciliation, decolonization, and Indigenous engagement. Can J Anaesth 2024; 71:311-321. [PMID: 38332414 DOI: 10.1007/s12630-023-02682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Murdoch Leeies
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Department of Emergency Medicine, University of Manitoba, S203 Medical Services Bldg., 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada.
| | - Cameron Landry
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Marcus Blouw
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Joshua Butcher
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Carmen S Hrymak
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Sabira Valiani
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Varuna Prakash
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Wael M R Haddara
- Division of Critical Care Medicine, Western University, London, ON, Canada
- Critical Care Medicine Program, London Health Sciences Centre, London, ON, Canada
| | - Ravi Taneja
- Division of Critical Care Medicine, Western University, London, ON, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada
| | - Kathryn G Whittemore
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Critical Care, Regina General Hospital, Regina, SK, Canada
| | - Ruth E MacRedmond
- Critical Care Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
- Division of Critical Care Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bojan N Paunovic
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James Downar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada
| | - Catherine A Farrell
- Division of Pediatric Intensive Care, Centre hospitalier universitaire de Sainte-Justine, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Srinivas Murthy
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Babar A Haroon
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Claudia DosSantos
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Marko Balan
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mandy Buss
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
- Indigenous Physicians Association of Canada, Vancouver, BC, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of Critical Care, Department of Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, ON, Canada
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5
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Hrymak C, Lim R, Trivedi S, Alvarez A, Purdy E, Belisle S, Thull-Freedman J, Leeies M, Lang E, Chartier LB. An Exploration of the Interplay Between Well-being and Quality and Safety. CAN J EMERG MED 2024; 26:148-155. [PMID: 38421518 DOI: 10.1007/s43678-024-00653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Quality improvement and patient safety (QIPS) and clinician well-being work are interconnected and impact each other. Well-being is of increased importance in the current state of workforce shortages and high levels of burnout. The Canadian Association of Emergency Physicians (CAEP) Academic Symposium sought to understand the interplay between QIPS and clinician well-being and to provide practical recommendations to clinicians and institutions on ensuring that clinician well-being is integrated into QIPS efforts. METHODS A team of emergency physicians with expertise in well-being and QIPS performed a literature review, drafted goals and recommendations, and presented at the CAEP Academic Symposium in 2023 for feedback. Goals and recommendations were then further refined. RESULTS Three goals and recommendations were developed as follows: QIPS leaders and practitioners must (1) understand the potential intersection of well-being and QIPS, (2) consider a well-being lens for all QIPS work, and (3) incorporate QIPS methodology in efforts to improve clinician well-being. CONCLUSION QIPS and clinician well-being are often closely linked. By incorporating these recommendations, QIPS strategies can enhance clinician well-being.
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Affiliation(s)
- Carmen Hrymak
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
| | - Rodrick Lim
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Sachin Trivedi
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Eve Purdy
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Sheena Belisle
- Departments of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine and Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucas B Chartier
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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6
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Leeies M, Kruse M, Weston B, Smith S, Primavesi R, Klassen B, Draenos C, Primiani N. Sexual orientation and gender identity advocacy in emergency medicine: a Canadian Association of Emergency Physicians position statement. CAN J EMERG MED 2024; 26:78-81. [PMID: 38240958 DOI: 10.1007/s43678-023-00644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024]
Affiliation(s)
| | | | - Brock Weston
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Sheila Smith
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Ben Klassen
- Community Based Research Centre, Vancouver, BC, Canada
| | - Chris Draenos
- Community Based Research Centre, Vancouver, BC, Canada
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Leeies M, Caslake E, Massarella C. Just the facts: transgender and gender diverse identities in emergency medicine. CAN J EMERG MED 2024; 26:10-14. [PMID: 37721696 DOI: 10.1007/s43678-023-00583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ellie Caslake
- Department of Equity, Access & Participation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carys Massarella
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Leeies M, Collister D, Christie E, Doucette K, Hrymak C, Lee TH, Sutha K, Ho J. Sexual and gender minority relevant policies in Canadian and United States organ and tissue donation and transplantation systems: An opportunity to improve equity and safety. Am J Transplant 2024; 24:11-19. [PMID: 37659606 DOI: 10.1016/j.ajt.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
Current policies in organ and tissue donation and transplantation (OTDT) systems in Canada and the United States unnecessarily restrict access to donation for sexual and gender minorities (SGMs) and pose safety risks to transplant recipients. We compare SGM-relevant policies between the Canadian and United States systems. Policy domains include the risk assessment of living and deceased organ and tissue donors, physical examination considerations, viral testing recommendations, and informed consent and communication. Identified gaps between current evidence and existing OTDT policies along with differences in SGM-relevant policies between systems, represent an opportunity for improvement. Specific recommendations for OTDT system policy revisions to achieve these goals include the development of behavior-based, gender-neutral risk assessment criteria, a reduction in current SGM no-sexual contact period requirements pending development of inclusive criteria, and destigmatization of sexual contact with people living with human immunodeficiency virus. OTDT systems should avoid rectal examinations to screen for evidence of receptive anal sex without consent and mandate routine nucleic acid amplification test screening for all donors. Transplant recipients must receive enhanced risk-to-benefit discussions regarding decisions to accept or decline an offer of an organ classified as increased risk. These recommendations will expand the donor pool, enhance equity for SGM people, and improve safety and outcomes for transplant recipients.
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Affiliation(s)
- Murdoch Leeies
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, Manitoba, Canada.
| | - David Collister
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Emily Christie
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Doucette
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Hrymak
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ken Sutha
- Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie Ho
- Transplant Manitoba, Adult Kidney Program, Shared Health Manitoba, Winnipeg, Manitoba, Canada; Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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9
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Ismath M, Black H, Hrymak C, Rosychuk RJ, Archambault P, Fok PT, Audet T, Dufault B, Hohl C, Leeies M. Characterizing intubation practices in response to the COVID-19 pandemic: a survey of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) sites. BMC Emerg Med 2023; 23:139. [PMID: 38001415 PMCID: PMC10675858 DOI: 10.1186/s12873-023-00911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The risk of occupational exposure during endotracheal intubation has required the global Emergency Medicine (EM), Anesthesia, and Critical Care communities to institute new COVID- protected intubation guidelines, checklists, and protocols. This survey aimed to deepen the understanding of the changes in intubation practices across Canada by evaluating the pre-COVID-19, early-COVID-19, and present-day periods, elucidating facilitators and barriers to implementation, and understanding provider impressions of the effectiveness and safety of the changes made. METHODS We conducted an electronic, self-administered, cross-sectional survey of EM physician site leads within the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) to characterize and compare airway management practices in the pre-COVID-19, early-COVID-19, and present-day periods. Ethics approval for this study was obtained from the University of Manitoba Health Research Ethics Board. The electronic platform SurveyMonkey ( www.surveymonkey.com ) was used to collect and store survey tool responses. Categorical item responses, including the primary outcome, are reported as numbers and proportions. Variations in intubation practices over time were evaluated through mixed-effects logistic regression models. RESULTS Invitations were sent to 33 emergency department (ED) physician site leads in the CCEDRRN. We collected 27 survey responses, 4 were excluded, and 23 analysed. Responses were collected in English (87%) and French (13%), from across Canada and included mainly physicians practicing in mainly Academic and tertiary sites (83%). All respondents reported that the intubation protocols used in their EDs changed in response to the COVID-19 pandemic (100%, n = 23, 95% CI 0.86-1.00). CONCLUSIONS This study provides a novel summary of changes to airway management practices in response to the evolving COVID-19 pandemic in Canada. Information from this study could help inform a consensus on safe and effective emergent intubation of persons with communicable respiratory infections in the future.
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Affiliation(s)
- Muzeen Ismath
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Holly Black
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Department of Anesthesiology and Intensive Care, Université Laval, Québec, QC, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thomas Audet
- Department of Internal Medicine, Université Laval, Québec, QC, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Corinne Hohl
- Deparment of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Rady Faculty of Health Sciences, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Cruz-Kan K, Dufault B, Fesehaye L, Kornelsen J, Hrymak C, Zubert S, Ratana P, Leeies M. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. CAN J EMERG MED 2023; 25:617-626. [PMID: 37389771 DOI: 10.1007/s43678-023-00533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. METHODS We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. RESULTS A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. CONCLUSIONS Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.
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Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lula Fesehaye
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Jodi Kornelsen
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Shelly Zubert
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
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11
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Leeies M, Ho J, Wilson LC, Lalani J, James L, Carta T, Gruber J, Shemie SD, Hrymak C. Sociodemographic Variables in Canadian Organ Donation Organizations: A Health Information Survey. Transplant Direct 2023; 9:e1494. [PMID: 37305650 PMCID: PMC10256411 DOI: 10.1097/txd.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023] Open
Abstract
Health systems must collect equity-relevant sociodemographic variables to measure and mitigate health inequities. The specific variables collected by organ donation organizations (ODOs) across Canada, variable definitions, and processes of the collection are not defined. We undertook a national health information survey of all ODOs in Canada. These results will inform the development of a standard national dataset of equity-relevant sociodemographic variables. Methods We conducted an electronic, self-administered cross-sectional survey of all ODOs in Canada from November 2021 to January 2022. We targeted key knowledge holders familiar with the data collection processes within each Canadian ODO known to Canadian Blood Services. Categorical item responses are presented as numbers and proportions. Results We achieved a 100% response rate from 10 Canadian ODOs. Most data were collected by organ donation coordinators. Only 2 of 10 ODOs reported using scripts explaining why sociodemographic data are being collected or incorporated training in cultural sensitivity for any given variable. A lack of cultural sensitivity training was endorsed by 50% of respondents as a barrier to the collection of sociodemographic variables by ODOs, whereas 40% of respondents identified a lack of training in sociodemographic variable collection as a significant barrier. Conclusions Few programs routinely collect sufficient data to examine health inequities with an intersectional lens. Most data collection occurs midway through the ODO interaction, creating a missed opportunity to better understand differences in social identities of patients who register their intention to donate in advance or who decline the donation. National standardization of equity-relevant data collection definitions and processes of the collection is needed.
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Affiliation(s)
- Murdoch Leeies
- Section of Critical Care, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
| | - Julie Ho
- Department of Internal Medicine and Immunology, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Adult Kidney Program, Winnipeg, MB, Canada
| | | | | | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Tricia Carta
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
| | - Jackie Gruber
- British Columbia Institute of Technology, Vancouver, BC, Canada
| | - Sam D. Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care Medicine, Montreal Children’s Hospital, McGill University Health Centre and Research Institute, McGill University, Montreal, QC, Canada
| | - Carmen Hrymak
- Section of Critical Care, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
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12
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Hrymak H, Hrymak C, Ratana P, Leeies M. Legal issues pertaining to the collection of sociodemographic data in emergency departments. Acad Emerg Med 2023; 30:760-764. [PMID: 36869627 DOI: 10.1111/acem.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Haley Hrymak
- Peter A. Allard School of Law, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Leeies M, Valiani S, Prakash V, Haddara WMR, Taneja R, Whittemore KG, Hrymak CS, Vazquez-Grande G, Paunovic BN, MacRedmond RE, Downar J, Farrell CA, Murthy S, Haroon BA, DosSantos C, Waechter J, Rochwerg B, D'Aragon F, Burns KEA. Canadian Critical Care Society position statement on Equity, Diversity, Decolonization, and Inclusion. Can J Anaesth 2023; 70:942-949. [PMID: 37231230 DOI: 10.1007/s12630-023-02448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Murdoch Leeies
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Department of Emergency Medicine, University of Manitoba, S203 Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
| | - Sabira Valiani
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Varuna Prakash
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Wael M R Haddara
- Division of Critical Care Medicine, Western University, London, ON, Canada
- Critical Care Medicine Program, London Health Sciences Centre, London, ON, Canada
| | - Ravi Taneja
- Division of Critical Care Medicine, Western University, London, ON, Canada
- Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada
| | - Kathryn G Whittemore
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Critical Care, Regina General Hospital, Regina, SK, Canada
| | - Carmen S Hrymak
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Emergency Medicine, University of Manitoba, S203 Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | | | - Bojan N Paunovic
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth E MacRedmond
- Critical Care Medicine, St. Paul's Hospital, Vancouver, BC, Canada
- Division of Critical Care Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - James Downar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada
| | - Catherine A Farrell
- Division of Pediatric Intensive Care, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Srinivas Murthy
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Babar A Haroon
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Claudia DosSantos
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jason Waechter
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Division of Critical Care, Department of Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, ON, Canada
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14
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Leeies M, Christie E, Collister D. Sexual orientation and gender identity in organ and tissue donation and transplantation. Nat Rev Nephrol 2023; 19:357-358. [PMID: 37041414 DOI: 10.1038/s41581-023-00711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Murdoch Leeies
- Transplant Manitoba, Gift of Life Program, Winnipeg, Manitoba, Canada.
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
- Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Emily Christie
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David Collister
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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15
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Leeies M, Rosychuk RJ, Ismath M, Xu K, Archambault P, Fok PT, Audet T, Jelic T, Hayward J, Daoust R, Chandra K, Davis P, Yan JW, Hau JP, Welsford M, Brooks SC, Hohl CM. Intubation practices and outcomes for patients with suspected or confirmed COVID-19: a national observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). CAN J EMERG MED 2023; 25:335-343. [PMID: 37017802 PMCID: PMC10075161 DOI: 10.1007/s43678-023-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Intubation practices changed during the COVID-19 pandemic to protect healthcare workers from transmission of disease. Our objectives were to describe intubation characteristics and outcomes for patients tested for SARS CoV-2 infection. We compared outcomes between patients testing SARS COV-2 positive with those testing negative. METHODS We conducted a health records review using the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. We included consecutive eligible patients who presented to one of 47 EDs across Canada between March 1, 2020 and June 20, 2021, were tested for SARS-CoV-2 and intubated in the ED. The primary outcome was the proportion of patients experiencing a post-intubation adverse event during the ED stay. Secondary outcomes included first-pass success, intubation practices, and hospital mortality. We used descriptive statistics to summarize variables with subgroup differences examined using t tests, z tests, or chi-squared tests where appropriate with 95% CIs. RESULTS Of 1720 patients with suspected COVID-19 who were intubated in the ED during the study period, 337 (19.6%) tested SARS-CoV-2 positive and 1383 (80.4%) SARS-CoV-2 negative. SARS-CoV-2 positive patients presented to hospital with lower oxygen levels than SARS-CoV-2 negative patients (mean pulse oximeter SaO2 86 vs 94%, p < 0.001). In total, 8.5% of patients experienced an adverse event post-intubation. More patients in the SARS-CoV-2 positive subgroup experienced post-intubation hypoxemia (4.5 vs 2.2%, p = 0.019). In-hospital mortality was greater for patients who experienced intubation-related adverse events (43.2 vs 33.2%, p = 0.018). There was no significant difference in adverse event-associated mortality by SARS-CoV-2 status. First-pass success was achieved in 92.4% of all intubations, with no difference by SARS-CoV-2 status. CONCLUSIONS During the COVID-19 pandemic, we observed a low risk of adverse events associated with intubation, even though hypoxemia was common in patients with confirmed SARS-CoV-2. We observed high rates of first-pass success and low rates of inability to intubate. The limited number of adverse events precluded multivariate adjustments. Study findings should reassure emergency medicine practitioners that system modifications made to intubation processes in response to the COVID-19 pandemic do not appear to be associated with worse outcomes compared to pre-COVID-19 practices.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Rady Faculty of Health Sciences, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Muzeen Ismath
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ke Xu
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine and Department of Anesthesiology and Intensive Care, Université Laval, Québec, QC, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thomas Audet
- Department of Internal Medicine, Université Laval, Québec, QC, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Raoul Daoust
- Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie University, Saint John, NB, Canada
| | - Phil Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University and Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Shemie SD, Wilson LC, Hornby L, Basmaji J, Baker AJ, Bensimon CM, Chandler JA, Chassé M, Dawson R, Dhanani S, Mooney OT, Sarti AJ, Simpson C, Teitelbaum J, Torrance S, Boyd JG, Brennan J, Brewster H, Carignan R, Dawe KJ, Doig CJ, Elliott-Pohl K, Gofton TE, Hartwick M, Healey A, Honarmand K, Hornby K, Isac G, Kanji A, Kawchuk J, Klowak JA, Kramer AH, Kromm J, LeBlanc AE, Lee-Ameduri K, Lee LA, Leeies M, Lewis A, Manara A, Matheson S, McKinnon NKA, Murphy N, Briard JN, Pope TM, Sekhon MS, Shanker JJS, Singh G, Singh J, Slessarev M, Soliman K, Sutherland S, Weiss MJ, Shaul RZ, Zuckier LS, Zorko DJ, Rochwerg B. A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline. Can J Anaesth 2023; 70:483-557. [PMID: 37131020 PMCID: PMC10203028 DOI: 10.1007/s12630-023-02431-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 05/04/2023] Open
Abstract
This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.
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Affiliation(s)
- Sam D Shemie
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
- McGill University, Montreal, QC, Canada.
- MUHC Research Institute, Montreal, QC, Canada.
- Canadian Blood Services, Ottawa, ON, Canada.
| | | | | | | | - Andrew J Baker
- Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Sonny Dhanani
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Owen T Mooney
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Aimee J Sarti
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christy Simpson
- Canadian Blood Services, Ottawa, ON, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Jeanne Teitelbaum
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | | | - J Gordon Boyd
- Kingston General Hospital, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | | | | | | | - Kirk J Dawe
- Eastern Health, St. John's, NL, Canada
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher J Doig
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Michael Hartwick
- University of Ottawa, Ottawa, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Andrew Healey
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
- William Osler Health System, Brampton, ON, Canada
| | - Kimia Honarmand
- Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | | | - George Isac
- University of British Columbia, Vancouver, BC, Canada
| | - Aly Kanji
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | - Joann Kawchuk
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | - Andreas H Kramer
- University of Calgary, Calgary, AB, Canada
- Southern Alberta Organ & Tissue Donation Program, Calgary, AB, Canada
| | - Julie Kromm
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | - Allana E LeBlanc
- University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
- Canadian Association of Critical Care Nurses, London, ON, Canada
| | - Katarina Lee-Ameduri
- University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Laurie A Lee
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - Murdoch Leeies
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- Canadian Critical Care Society, Markham, ON, Canada
| | - Ariane Lewis
- NYU Langone Medical Center, New York City, NY, USA
| | | | | | - Nicole K A McKinnon
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Peter Gilgan Center for Research and Learning, Toronto, ON, Canada
| | | | | | - Thaddeus M Pope
- University of Ottawa, Ottawa, ON, Canada
- Mitchell Hamline School of Law, Saint Paul, MN, USA
- Queensland University of Technology, Brisbane, Qld, Australia
- Albany Medical College, Albany, NY, USA
- University of Minnesota Center for Bioethics, Minneapolis, MN, USA
| | - Mypinder S Sekhon
- University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Gurmeet Singh
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Singh
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Marat Slessarev
- Western University, London, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Karim Soliman
- Queen's University, Kingston, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- Lakeridge Health, Oshawa, ON, Canada
| | | | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- CHU de Québec - Université Laval, Quebec City, QC, Canada
- Université Laval, Quebec City, QC, Canada
| | - Randi Zlotnik Shaul
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Lionel S Zuckier
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - David J Zorko
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bram Rochwerg
- McMaster University, Hamilton, ON, Canada
- Canadian Critical Care Society, Markham, ON, Canada
- Canadian Critical Care Trials Group, Markham, ON, Canada
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Leeies M, Collister D, Ho J, Trachtenberg A, Gruber J, Weiss MJ, Chandler JA, Mooney O, Carta T, Klassen B, Draenos C, Sutha K, Randell S, Strang M, Partain B, Whitley CT, Cuvelier S, MacKenzie LJ, Shemie SD, Hrymak C. Inequities in organ and tissue donation and transplantation for sexual orientation and gender identity diverse people: A scoping review. Am J Transplant 2023:S1600-6135(23)00359-3. [PMID: 36997028 DOI: 10.1016/j.ajt.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Sexual orientation and gender identity (SOGI) diverse populations experience discrimination in organ and tissue donation and transplantation (OTDT) systems globally. We assembled a multidisciplinary group of clinical experts as well as SOGI-diverse patient and public partners and conducted a scoping review including citations on the experiences of SOGI-diverse persons in OTDT systems globally to identify and explore the inequities that exist with regards to living and deceased OTDT. Using scoping review methods, we conducted a systematic literature search of relevant electronic databases from 1970-2021 including a grey literature search. We identified and screened 2402 references and included 87 unique publications. Two researchers independently coded data in included publications in duplicate. We conducted a best-fit framework synthesis paired with an inductive thematic analysis to identify synthesized benefits, harms, inequities, justification of inequities, recommendations to mitigate inequities, laws and regulations, as well as knowledge and implementation gaps regarding SOGI-diverse identities in OTDT systems. We identified numerous harms and inequities for SOGI-diverse populations in OTDT systems. There were no published benefits of SOGI-diverse identities in OTDT systems. We summarized recommendations for the promotion of equity for SOGI-diverse populations and identified gaps that can serve as targets for action moving forward.
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18
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Hall T, Leeies M, Funk D, Hrymak C, Siddiqui F, Black H, Webster K, Tkach J, Waskin M, Dufault B, Kowalski S. Emergency airway management in a tertiary trauma centre (AIRMAN): a one-year prospective longitudinal study. Can J Anaesth 2023; 70:351-358. [PMID: 36670315 PMCID: PMC9857903 DOI: 10.1007/s12630-022-02390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/08/2022] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Emergency airway management can be associated with a range of complications including long-term neurologic injury and death. We studied the first-pass success rate with emergency airway management in a tertiary care trauma centre. Secondary outcomes were to identify factors associated with first-pass success and factors associated with adverse events peri-intubation. METHODS We performed a single-centre, prospective, observational study of patients ≥ 17 yr old who were intubated in the emergency department (ED), surgical intensive care unit (SICU), medical intensive care unit (MICU), and inpatient wards at our institution. Ethics approval was obtained from the local research ethics board. RESULTS In a seven-month period, there were 416 emergency intubations and a first-pass success rate of 73.1%. The first-pass success rates were 57.5% on the ward, 66.1% in the intensive care units (ICUs) and 84.3% in the ED. Equipment also varied by location; videolaryngoscopy use was 65.1% in the ED and only 10.6% on wards. A multivariate regression model using the least absolute shrinkage and selection algorithm (LASSO) showed that the odds ratios for factors associated with two or more intubation attempts were location (wards, 1.23; MICU, 1.24; SICU, 1.19; reference group, ED), physiologic instability (1.19), an anatomically difficult airway (1.05), hypoxemia (1.98), lack of neuromuscular blocker use (2.28), and intubator inexperience (1.41). CONCLUSIONS First-pass success rates varied widely between locations within the hospital and were less than those published from similar institutions, except for the ED. We are revamping ICU protocols to improve the first-pass success rate.
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Affiliation(s)
- Thomas Hall
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Murdoch Leeies
- Department of Emergency Medicine, Section of Critical Care, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Duane Funk
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Critical Care, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Section of Critical Care, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Faisal Siddiqui
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Critical Care, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Holly Black
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kim Webster
- Health Sciences Centre, Winnipeg, MB, Canada
| | - Jenn Tkach
- Health Sciences Centre, Winnipeg, MB, Canada
| | - Matt Waskin
- Health Sciences Centre, Winnipeg, MB, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Health Care Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Kowalski
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Critical Care, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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19
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Bola R, Sutherland J, Murphy RA, Leeies M, Grant L, Hayward J, Archambault P, Graves L, Rose T, Hohl C. Patient-reported health outcomes of SARS-CoV-2-tested patients presenting to emergency departments: a propensity score-matched prospective cohort study. Public Health 2023; 215:1-11. [PMID: 36587446 PMCID: PMC9712064 DOI: 10.1016/j.puhe.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE This study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients controlling for seasonal effects. STUDY DESIGN This was a retrospective cohort study. METHODS This study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2-negative controls for every SARS-CoV-2-positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. RESULTS We included 1170 SARS-CoV-2-positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (β = -7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (β = -5.4; 95% CI: -6.3, -4.5). CONCLUSION Physical health, assessed by PCS, was similar between matched SARS-CoV-2-positive and SARS-CoV-2-negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.
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Affiliation(s)
- R Bola
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - R A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - M Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada; Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - L Grant
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada; Emergency Department, Jewish General Hospital, Montreal, QC, Canada
| | - J Hayward
- Department of Emergency Medicine, University of Alberta, AB, Canada
| | - P Archambault
- Université Laval, Department of Family Medicine and Emergency Medicine, QC, Canada
| | - L Graves
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - T Rose
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - C Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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20
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Black H, Hall T, Hrymak C, Funk D, Siddiqui F, Sokal J, Satoudian J, Foster K, Kowalski S, Dufault B, Leeies M. A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic. CAN J EMERG MED 2023; 25:123-133. [PMID: 36542309 PMCID: PMC9768405 DOI: 10.1007/s43678-022-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba's largest tertiary hospital. During this study, a natural experiment emerged when a standardized "COVID-Protected Rapid Sequence Intubation Protocol" was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a "COVID-Protected Rapid Sequence Intubation Protocol" impact first-pass success or other intubation-related outcomes? METHODS A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack-Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days. RESULTS Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% (n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% (n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack-Lehane view favoring the protocol (p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol (p = 0.0172). CONCLUSION A "COVID-Protected Protocol" implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events.
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Affiliation(s)
- Holly Black
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Thomas Hall
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Carmen Hrymak
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Duane Funk
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Faisal Siddiqui
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - John Sokal
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Jaime Satoudian
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Kendra Foster
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Stephen Kowalski
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Brenden Dufault
- George & Fay Yee Center for Healthcare Innovation, Winnipeg, MB Canada
| | - Murdoch Leeies
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
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21
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Leeies M, Grunau B, Askin N, Fesehaye L, Kornelsen J, McColl T, Ratana P, Gruber J, Hrymak H, Hrymak C. Equity-relevant sociodemographic variable collection in emergency medicine: A systematic review, qualitative evidence synthesis, and recommendations for practice. Acad Emerg Med 2022. [PMID: 36398908 DOI: 10.1111/acem.14629] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective was to conduct a systematic review and qualitative evidence synthesis (QES) to identify best practices, benefits, harms, facilitators, and barriers to the routine collection of sociodemographic variables in emergency departments (EDs). METHODS This work is a systematic review and QES. We conducted a comprehensive search of Medline (Ovid), CINAHL (Ebsco), Cochrane Central (OVID), EMBASE (Ovid), and the multidisciplinary Web of Science Core database using peer-reviewed search strategies, complemented by a gray literature search. We included citations containing perspectives on routine sociodemographic variable collection in EDs and recommendations on definitions or processes of collection or benefits, harms, facilitators, or barriers related to the routine collection of sociodemographic variables in EDs. We conducted this systematic review and QES adhering to the Joanna Briggs Institute guidelines. Two reviewers independently selected included studies and extracted data. We conducted a best-fit framework synthesis and paired inductive thematic analysis of the included studies. We generated recommendations based on the QES. RESULTS We included 21 unique reports that enrolled 10,454 patients or respondents in our systematic review and QES. Publication dates of included studies ranged from 2011 to 2021. Included citations were published in Australia, Canada, and the United States. We synthesized 11 benefits, 14 potential harms, 15 barriers, and 19 facilitators and identified 14 best practice recommendations from included citations. CONCLUSIONS Health systems should routinely collect sociodemographic variables in EDs guided by recommendations that minimize harms and maximize benefits and consider relevant barriers and facilitators. Our recommendations can serve as a guide for the equity-focused reformation of emergency medicine health information systems.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Health Sciences Centre Emergency Department, Shared Health, Winnipeg, Manitoba, Canada.,Winnipeg Regional Health Authority, Emergency Medicine Program, Winnipeg, Manitoba, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Askin
- Winnipeg Regional Health Authority Virtual Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lula Fesehaye
- Health Sciences Centre Emergency Department, Shared Health, Winnipeg, Manitoba, Canada
| | - Jodi Kornelsen
- Health Sciences Centre Emergency Department, Shared Health, Winnipeg, Manitoba, Canada
| | - Tamara McColl
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Winnipeg Regional Health Authority, Emergency Medicine Program, Winnipeg, Manitoba, Canada.,St. Boniface Hospital Emergency Department, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Winnipeg Regional Health Authority, Emergency Medicine Program, Winnipeg, Manitoba, Canada.,St. Boniface Hospital Emergency Department, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Jackie Gruber
- Respect, Diversity and Inclusion Department, British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| | - Haley Hrymak
- Peter A. Allard School of Law, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Health Sciences Centre Emergency Department, Shared Health, Winnipeg, Manitoba, Canada.,Winnipeg Regional Health Authority, Emergency Medicine Program, Winnipeg, Manitoba, Canada
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22
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Rimmer E, Garland A, Kumar A, Doucette S, Houston BL, Menard CE, Leeies M, Turgeon AF, Mahmud S, Houston DS, Zarychanski R. White blood cell count trajectory and mortality in septic shock: a historical cohort study. Can J Anaesth 2022; 69:1230-1239. [PMID: 35902458 PMCID: PMC9334545 DOI: 10.1007/s12630-022-02282-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Septic shock is associated with a mortality of 20-40%. The white blood cell count (WBC) at hospital admission correlates with prognosis in septic shock. Here, we explore whether the trajectory of WBC after admission provides further information about outcomes. We aimed to identify groups of patients with different WBC trajectories and the association of WBC trajectory with mortality. METHODS We included adult patients with septic shock in two academic intensive care units (ICU) in Winnipeg, MB, Canada between 2006 and 2012. We used group-based trajectory analysis to group patients according to their WBC patterns over the first seven days in the ICU. Our primary analysis was the association of WBC trajectory group on 30-day mortality using multivariable Cox proportional hazards regression. RESULTS We included 917 patients with septic shock. The final model identified seven distinct WBC trajectories. The rising WBC trajectory was independently associated with increased mortality (hazard ratio, 3.41; 95% confidence interval, 1.86 to 6.26; P < 0.001) compared with the stable WBC trajectory. CONCLUSION In patients with septic shock, distinct and clinically relevant groups can be identified by analyzing WBC trajectories. A rising WBC trajectory was associated with higher mortality.
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Affiliation(s)
- Emily Rimmer
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, Section of Medical Oncology/Hematology, University of Manitoba, Winnipeg, MB, Canada.
- Department of Medical Oncology and Haematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada.
| | - Allan Garland
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anand Kumar
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Steve Doucette
- Capital District Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Brett L Houston
- Department of Internal Medicine, Section of Medical Oncology/Hematology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Chantalle E Menard
- Department of Internal Medicine, Section of Medical Oncology/Hematology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Murdoch Leeies
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Salah Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Donald S Houston
- Department of Internal Medicine, Section of Medical Oncology/Hematology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Ryan Zarychanski
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Medical Oncology/Hematology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
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23
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Hohl CM, Rosychuk RJ, Hau JP, Hayward J, Landes M, Yan JW, Ting DK, Welsford M, Archambault PM, Mercier E, Chandra K, Davis P, Vaillancourt S, Leeies M, Small S, Morrison LJ. Correction to: Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). CAN J EMERG MED 2022; 24:461-462. [PMID: 35451805 PMCID: PMC9026034 DOI: 10.1007/s43678-022-00314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Megan Landes
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Justin W Yan
- Division of Emergency Medicine, London Health Sciences Centre, London, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daniel K Ting
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Levis, QC, Canada
| | - Eric Mercier
- Centre de Recherche, CHU de Québec, Université Laval, Quebec, QC, Canada.,VITAM (Centre de recherche en santé durable), Quebec, QC, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada.,Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Samuel Vaillancourt
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.,Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Serena Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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24
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Hohl CM, Rosychuk RJ, Hau JP, Hayward J, Landes M, Yan JW, Ting DK, Welsford M, Archambault PM, Mercier E, Chandra K, Davis P, Vaillancourt S, Leeies M, Small S, Morrison LJ. Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). CAN J EMERG MED 2022; 24:397-407. [PMID: 35362857 PMCID: PMC8972682 DOI: 10.1007/s43678-022-00275-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Background Treatment for coronavirus disease 2019 (COVID-19) evolved between pandemic waves. Our objective was to compare treatments, acute care utilization, and outcomes of COVID-19 patients presenting to emergency departments (ED) across pandemic waves. Methods This observational study enrolled consecutive eligible COVID-19 patients presenting to 46 EDs participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 1 and December 31, 2020. We collected data by retrospective chart review. Our primary outcome was in-hospital mortality. Secondary outcomes included treatments, hospital and ICU admissions, ED revisits and readmissions. Logistic regression modeling assessed the impact of pandemic wave on outcomes. Results We enrolled 9,967 patients in 8 provinces, 3,336 from the first and 6,631 from the second wave. Patients in the second wave were younger, fewer met criteria for severe COVID-19, and more were discharged from the ED. Adjusted for patient characteristics and disease severity, steroid use increased (odds ratio [OR] 7.4; 95% confidence interval [CI] 6.2–8.9), and invasive mechanical ventilation decreased (OR 0.5; 95% CI 0.4–0.7) in the second wave compared to the first. After adjusting for differences in patient characteristics and disease severity, the odds of hospitalization (OR 0.7; 95% CI 0.6–0.8) and critical care admission (OR 0.7; 95% CI 0.6–0.9) decreased, while mortality remained unchanged (OR 0.7; 95% CI 0.5–1.1). Interpretation In patients presenting to cute care facilities, we observed rapid uptake of evidence-based therapies and less use of experimental therapies in the second wave. We observed increased rates of ED discharges and lower hospital and critical care resource use over time. Substantial reductions in mechanical ventilation were not associated with increasing mortality. Advances in treatment strategies created health system efficiencies without compromising patient outcomes. Trial registration Clinicaltrials.gov, NCT04702945. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00275-3.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Megan Landes
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Justin W Yan
- Division of Emergency Medicine, London Health Sciences Centre, London, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daniel K Ting
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Levis, QC, Canada
| | - Eric Mercier
- Centre de Recherche, CHU de Québec, Université Laval, Quebec, QC, Canada.,VITAM (Centre de recherche en santé durable), Quebec, QC, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada.,Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Samuel Vaillancourt
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.,Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Serena Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Hohl CM, Rosychuk RJ, Archambault PM, O'Sullivan F, Leeies M, Mercier É, Clark G, Innes GD, Brooks SC, Hayward J, Ho V, Jelic T, Welsford M, Sivilotti MLA, Morrison LJ, Perry JJ. The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study. CMAJ Open 2022; 10:E90-E99. [PMID: 35135824 PMCID: PMC9259439 DOI: 10.9778/cmajo.20210243] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to develop and validate a clinical score to predict emergency department and in-hospital mortality among consecutive nonpalliative patients with COVID-19; in this study, we define palliative patients as those who do not want resuscitative measures, such as intubation, intensive care unit care or cardiopulmonary resuscitation. METHODS This derivation and validation study used observational cohort data recruited from 46 hospitals in 8 Canadian provinces participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included adult (age ≥ 18 yr) nonpalliative patients with confirmed COVID-19 who presented to the emergency department of a participating site between Mar. 1, 2020, and Jan. 31, 2021. We randomly assigned hospitals to derivation or validation, and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting emergency department and in-hospital mortality in a validation cohort. RESULTS Of 8761 eligible patients, 618 (7.0%) died. The CCEDRRN COVID-19 Mortality Score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support. The area under the curve was 0.92 (95% confidence interval [CI] 0.90-0.93) in derivation and 0.92 (95% CI 0.90-0.93) in validation. The score had excellent calibration. These results suggest that scores of 6 or less would categorize patients as being at low risk for in-hospital death, with a negative predictive value of 99.9%. Patients in the low-risk group had an in-hospital mortality rate of 0.1%. Patients with a score of 15 or higher had an observed mortality rate of 81.0%. INTERPRETATION The CCEDRRN COVID-19 Mortality Score is a simple score that can be used for level-of-care discussions with patients and in situations of critical care resource constraints to accurately predict death using variables available on emergency department arrival. The score was derived and validated mostly in unvaccinated patients, and before variants of concern were circulating widely and newer treatment regimens implemented in Canada. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04702945.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont.
| | - Rhonda J Rosychuk
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Patrick M Archambault
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Murdoch Leeies
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Éric Mercier
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Gregory Clark
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Grant D Innes
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Steven C Brooks
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Jake Hayward
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Vi Ho
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Tomislav Jelic
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Michelle Welsford
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Marco L A Sivilotti
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Laurie J Morrison
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
| | - Jeffrey J Perry
- Department of Emergency Medicine (Hohl, O'Sullivan, Ho), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Hohl, O'Sullivan, Ho), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Québec, Que.; Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches (Archambault), Lévis, Que.; Department of Emergency Medicine (Leeies, Jelic) and Section of Critical Care Medicine (Leeies), Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Centre de recherche (Mercier), CHU de Québec, Université Laval; VITAM (Centre de recherche en santé durable) (Mercier), Québec, Que.; Department of Emergency Medicine (Clark), McGill University, Montréal, Que.; Department of Emergency Medicine and Community Health Sciences (Innes), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Brooks, Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine (Hayward), University of Alberta, Edmonton, Alta.; Division of Emergency Medicine (Welsford), McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Kingston Health Sciences Centre (Sivilotti), Kingston, Ont.; Emergency Services (Morrison), Sunnybrook Health Sciences Centre; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Perry), University of Ottawa; Ottawa Hospital Research Institute (Perry), Ottawa, Ont
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Leeies M, Gershengorn HB, Charbonney E, Kumar A, Fergusson DA, Turgeon AF, Garland A, Houston DS, Houston B, Rimmer E, Jacobsohn E, Murthy S, Fowler R, Balshaw R, Zarychanski R. Epidemiology of intravenous immune globulin in septic shock: a retrospective cohort analysis of the Premier Healthcare Database. Can J Anaesth 2021; 68:1641-1650. [PMID: 34378167 DOI: 10.1007/s12630-021-02081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Intravenous immune globulin (IVIG) may improve survival in people with septic shock. Current utilization patterns of IVIG are unknown. We sought to characterize adult patients with septic shock requiring vasopressors who received IVIG, describes IVIG regimens, and evaluate determinants of IVIG use in patients with septic shock. METHODS We conducted a retrospective database study of adult patients with septic shock admitted to US hospitals in the Premier Healthcare Database (from July 2010 to June 2013). We described the proportion of patients with septic shock receiving IVIG, examined IVIG regimens across sites and employed random-effects multivariable regression techniques to identify predictors of IVIG use. RESULTS Intravenous immune globulin was administered to 0.3% (n = 685) of patients with septic shock; with a median [interquartile range (IQR)] dose of 1 [0.5-1.8] g·kg-1 for a median [IQR] of 1 [1-2] day. Receipt of IVIG was less likely for Black patients (odds ratio [OR], 0.54; 95% confidence interval [CI] 0.41 to 0.72) and patients without private insurance (Medicare OR, 0.73; 95% CI 0.59 to 0.90; Medicaid OR, 0.41; 95% CI 0.30 to 0.57) and more likely for patients with immunocompromise (OR, 6.83; 95% CI 5.47 to 8.53), necrotizing fasciitis (OR, 9.78; 95% CI 6.97 to 13.72), and toxic shock (OR, 56.9; 95% CI 38.7 to 83.7). CONCLUSIONS Intravenous immune globulin is used infrequently across the US in patients with septic shock. Regimens of IVIG in septic shock may be less intensive than those associated with a survival benefit in meta-analyses. Observed infrequent use supports apparent clinical equipoise, perhaps secondary to limitations of the primary literature. A clinical trial evaluating the role of IVIG in septic shock is needed.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmanuel Charbonney
- Department of Medicine, Critical Care, Université de Montréal, Montreal, QC, Canada
| | - Anand Kumar
- Section of Critical Care Medicine, Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Dean A Fergusson
- Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Adjunct Scientist, Canadian Blood Services, Ottawa, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Unit (Trauma - Emergency - Critical Care Medicine),, Québec City, QC, Canada
| | - Allan Garland
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Donald S Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Brett Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Emily Rimmer
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Eric Jacobsohn
- Section of Critical Care Medicine, Department of Anesthesiology, University of Manitoba, Winnipeg, MB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert Balshaw
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Ryan Zarychanski
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
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Alcock S, Batoo D, Ande SR, Grierson R, Essig M, Martin D, Trivedi A, Sinha N, Leeies M, Zeiler FA, Shankar JJS. Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study. BMJ Open 2021; 11:e047305. [PMID: 34108167 PMCID: PMC8191612 DOI: 10.1136/bmjopen-2020-047305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Severe traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI. METHODS AND ANALYSIS The Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients. ETHICS AND DISSEMINATION This study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study. TRIAL REGISTRATION NUMBER NCT04318665.
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Affiliation(s)
- Susan Alcock
- Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Divjeet Batoo
- Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Sudharsana Rao Ande
- Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Rob Grierson
- Department of Emergency Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Marco Essig
- Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Douglas Martin
- Department of Emergency Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Anurag Trivedi
- Section of Neurology, Department of Internal Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Namita Sinha
- Section of Neuropathology, Department of Pathology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine & Section of Critical Care Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Department of Human Anatomy and Cell Science, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jai Jai Shiva Shankar
- Department of Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Department of Human Anatomy and Cell Science, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
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Leeies M, Gershengorn HB, Charbonney E, Kumar A, Fergusson D, Turgeon AF, Cowan J, Paunovic B, Embil J, Garland A, Houston DS, Houston B, Rimmer E, Siddiqui F, Cameron B, Murthy S, Marshall JC, Fowler R, Zarychanski R. Intravenous immune globulin in septic shock: a Canadian national survey of critical care medicine and infectious disease specialist physicians. Can J Anaesth 2021; 68:782-790. [PMID: 33598888 DOI: 10.1007/s12630-021-01941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock. METHODS We conducted a cross-sectional survey of critical care and infectious diseases physicians across Canada. We summarized categorical item responses as counts and proportions. We developed a multivariable logistic regression model to identify physician-level predictors of IVIG use in septic shock. RESULTS Our survey was disseminated to 674 eligible respondents with a final response rate of 60%. Most (91%) respondents reported having prescribed IVIG to patients with septic shock at least once, 86% for septic shock due to necrotizing fasciitis, 52% for other bacterial toxin-mediated causes of septic shock, and 5% for undifferentiated septic shock. The majority of respondents expressed uncertainty regarding the impact of IVIG on mortality (97%) and safety (95%) in septic shock. Respondents were willing to participate in further IVIG research with 98% stating they would consider enrolling their patients into a trial of IVIG in septic shock. Familiarity with published evidence was the single greatest predictor of IVIG use in septic shock (odds ratio, 10.2; 95% confidence interval, 3.4 to 30.5; P < 0.001). CONCLUSIONS Most Canadian critical care and infectious diseases specialist physicians reported previous experience using IVIG in septic shock. Respondents identified inadequacy of existing research as the greatest barrier to routine use of IVIG in septic shock. Most respondents support the need for further studies on IVIG in septic shock, and would consider enrolling their own patients into a trial of IVIG in septic shock.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
- School of Medicine, Miami, FL, USA
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmanuel Charbonney
- Department of Medicine, Critical Care, Université de Montréal, Montreal, QC, Canada
| | - Anand Kumar
- Department of Medical Microbiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Dean Fergusson
- Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - Juthaporn Cowan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bojan Paunovic
- Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John Embil
- Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Allan Garland
- Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Donald S Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Brett Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Emily Rimmer
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Faisal Siddiqui
- Department of Anesthesiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Bill Cameron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan Zarychanski
- Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
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Leeies M, Gershengorn HB, Charbonney E, Kumar A, Fergusson D, Turgeon AF, Cowan J, Paunovic B, Embil J, Houston DS, Houston B, Rimmer E, Siddiqui F, Cameron B, Murthy S, Marshall JC, Fowler R, Zarychanski R. Correction to: Intravenous immune globulin in septic shock: a Canadian national survey of critical care medicine and infectious disease specialist physicians. Can J Anaesth 2021; 68:1310-1311. [PMID: 33694127 DOI: 10.1007/s12630-021-01964-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
- School of Medicine, Miami, FL, USA
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmanuel Charbonney
- Department of Medicine, Critical Care, Université de Montréal, Montreal, QC, Canada
| | - Anand Kumar
- Department of Medical Microbiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Dean Fergusson
- Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, QC, Canada
| | - Juthaporn Cowan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bojan Paunovic
- Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John Embil
- Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Donald S Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Brett Houston
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Emily Rimmer
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
| | - Faisal Siddiqui
- Department of Anesthesiology, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Bill Cameron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan Zarychanski
- Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada
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Leeies M, Flynn E, Turgeon AF, Paunovic B, Loewen H, Rabbani R, Abou-Setta AM, Ferguson ND, Zarychanski R. High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Syst Rev 2017; 6:202. [PMID: 29037221 PMCID: PMC5644261 DOI: 10.1186/s13643-017-0593-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We performed a systematic review and meta-analysis to evaluate the efficacy and safety of high-flow oxygen via nasal cannulae (HFNC) compared to non-invasive ventilation (NIV) and/or standard oxygen in patients with acute, hypoxemic respiratory failure. METHODS We reviewed randomized controlled trials from CENTRAL, EMBASE, MEDLINE, Scopus and the International Clinical Trials Registry Platform (inception to February 2016), conference proceedings, and relevant article reference lists. Two reviewers independently screened and extracted trial-level data from trials investigating HFNC in patients with acute, hypoxemic respiratory failure. Internal validity was assessed in duplicate using the Cochrane Risk of Bias tool. The strength of evidence was assessed in duplicate using the Grading of Recommendations Assessment, Development and Evaluation framework. Our primary outcome was mortality. Secondary outcomes included dyspnea, PaO2:FiO2 ratio, PaCO2, and pH. Safety outcomes included respiratory arrest, intubation, delirium, and skin breakdown. RESULTS From 2023 screened citations, we identified seven trials (1771 patients) meeting inclusion criteria. All trials were at high risk of bias due to lack of blinding. There was no evidence for a mortality difference in patients receiving HFNC vs. NIV and/or standard oxygen (RR 1.01, 95% CI 0.69 to 1.48, I 2 = 63%, five trials, 1629 patients). In subgroup analyses of HFNC compared to NIV or standard oxygen individually, mortality differences were not observed. Measures of patient tolerability were heterogeneous. The PaO2:FiO2 ratio at 6-12 h was significantly lower in patients receiving oxygen via HFNC compared to NIV or standard oxygen for hypoxemic respiratory failure (MD - 53.34, 95% CI - 71.95 to - 34.72, I 2 = 61%, 1143 patients). There were no differences in pH, PaCO2, or rates of intubation or cardio-respiratory arrest. Delirium and skin breakdown were infrequently reported in included trials. CONCLUSIONS In patients with acute hypoxemic respiratory failure HFNC was not associated with a difference in mortality compared to NIV or standard oxygen. Secondary outcomes including dyspnea, tolerance, and safety were not systematically reported. Residual heterogeneity and variable reporting of secondary outcomes limit the conclusions that can be made in this review. Prospective trials designed to evaluate the efficacy and safety of HFNC in patients with acute hypoxemic respiratory failure are required.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, JJ399-700 William Avenue, Ann Thomas Building, Winnipeg, MB, R3E0Z3, Canada. .,Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eric Flynn
- Department of Emergency Medicine, University of Manitoba, JJ399-700 William Avenue, Ann Thomas Building, Winnipeg, MB, R3E0Z3, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Québec City, Québec, Canada
| | - Bojan Paunovic
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Hal Loewen
- Neil John Mclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Rasheda Rabbani
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Niall D Ferguson
- Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, Toronto General Research Institute, Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada.,Departments of Medicine and Physiology, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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31
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Leeies M, Weldon E. STEMI stymie: metastatic cancer and cardiac tamponade presenting as inferior STEMI. Ann Emerg Med 2011; 57:221-4. [PMID: 21353908 DOI: 10.1016/j.annemergmed.2010.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 08/02/2010] [Accepted: 08/06/2010] [Indexed: 10/18/2022]
Abstract
The combination of chest pain and isolated ST-segment elevation on an ECG immediately suggests the diagnosis of myocardial infarction. However, given the potential for complications associated with reperfusion strategies, clinicians must maintain a high index of suspicion for ST-segment elevation myocardial infarction mimics, including pericardial disease, in their assessment of these patients. Here we report a case that illustrates a rare presentation in which a patient with isolated inferior ST-segment elevation and acute chest pain suggestive of ST-segment elevation myocardial infarction was ultimately diagnosed with cardiac tamponade as the first presentation of an occult malignancy. This case supports the rationale for the use of bedside ultrasonography as a diagnostic modality to include in the evaluation of select cardiac patients and all pulseless electrical activity arrest patients in the emergency department.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
BACKGROUND Self-medication has been proposed as an explanation for the high rates of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders; however, knowledge of self-medication in PTSD is scarce. We describe the prevalence and correlates of self-medication in PTSD in the general population. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (N=34,653; response rate: 70.2%), a nationally representative survey of mental illness in community-dwelling adults. Self-medication was assessed separately for alcohol and drugs. Prevalence rates were determined for self-medication among individuals with DSM-IV PTSD. Regression analyses determined associations between self-medication and a variety of correlates, including sociodemographic factors, comorbid mental disorders, suicide attempts, and quality of life. RESULTS Approximately 20% of individuals with PTSD used substances in an attempt to relieve their symptoms. Men were significantly more likely than women to engage in self-medication behavior. In adjusted models, using illicit drugs or misusing prescription medications to control PTSD symptoms was associated with a substantially higher likelihood of dysthymia and borderline personality disorder. After controlling for mental disorder comorbidity, self-medication was independently associated with higher odds of suicide attempts (adjusted odds ratio=2.46; 95% confidence interval 1.53-3.97) and lower mental health-related quality of life. CONCLUSIONS Self-medication is a common behavior among people with PTSD in the community, yet has potentially hazardous consequences. Health care practitioners should assess reasons for substance use among people with PTSD to identify a subgroup with higher psychiatric morbidity.
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Affiliation(s)
- Murdoch Leeies
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
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