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Lung T, Lex JR, Pincus D, Gatley J, Wasserstein D, Paterson JM, Ravi B. MRI use leading up to total knee arthroplasty: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2621-2628. [PMID: 38727817 DOI: 10.1007/s00590-024-03940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/27/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Demand for total knee arthroplasty (TKA) is increasing as it remains the gold-standard treatment for end-stage osteoarthritis (OA) of the knee. Magnetic resonance imaging (MRI) scans of the knee are not indicated for diagnosing knee OA and represent a possible delay to orthopaedic surgeon referral and unnecessary expenditure. The purpose of this study was to determine the proportion of patients who underwent an MRI in the two years prior to their primary TKA for OA and determine patient and physician associations with increased MRI usage. METHODS This is a population-based cohort study using administrative data from Ontario, Canada. All patients over 40 years old who underwent their first primary TKA between April 1, 2008, and March 31, 2019, were included. Statistical analyses were performed using SAS and included the Cochran-Armitage test for trend of MRI prior to surgery. A predictive multivariable regression model was used to determine features correlated to receiving an MRI. RESULTS There were 194,989 eligible first-time TKA recipients, of which 38,244 (19.6%) received an MRI in the two years prior to their surgery. The majority of these (69.6%) were ordered by primary care physicians. Patients who received an MRI were younger, had fewer comorbidities and were more affluent than patients who did not (p < 0.001). MRI use prior to TKA increased from 2008 to 2018 (p < 0.001). CONCLUSION Despite MRIs rarely being indicated for the work-up of end-stage OA, nearly one in five patients have an MRI in the two years prior to their TKA. This may be increasing healthcare expenditure and surgical wait-times.
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Affiliation(s)
- Tiffany Lung
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Johnathan R Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 43 Wellesley St E, Room 315, Toronto, ON, M4Y 1H1, Canada.
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Batomen B, Macpherson A, Lewis J, Howard A, Ruth Saunders N, Richmond S, Anne Harris M, Saskin R, Zagorski B, Macarthur C, Fuselli P, Rothman L. Vulnerable road user injury trends following the COVID-19 pandemic in Toronto, Canada: An interrupted time series analysis. JOURNAL OF SAFETY RESEARCH 2024; 89:152-159. [PMID: 38858038 DOI: 10.1016/j.jsr.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic altered traffic patterns worldwide, potentially impacting pedestrian and bicyclists safety in urban areas. In Toronto, Canada, work from home policies, bicycle network expansion, and quiet streets were implemented to support walking and cycling. We examined pedestrian and bicyclist injury trends from 2012 to 2022, utilizing police-reported killed or severely injured (KSI), emergency department (ED) visits and hospitalization data. METHODS We used an interrupted time series design, with injury counts aggregated quarterly. We fit a negative binomial regression using a Bayesian modeling approach to data prior to the pandemic that included a secular time trend, quarterly seasonal indicator variables, and autoregressive terms. The differences between observed and expected injury counts based on pre-pandemic trends with 95% credible intervals (CIs) were computed. RESULTS There were 38% fewer pedestrian KSI (95%CI: 19%, 52%), 35% fewer ED visits (95%CI: 28%, 42%), and 19% fewer hospitalizations (95%CI: 2%, 32%) since the beginning of the COVID-19 pandemic. A reduction of 35% (95%CI: 7%, 54%) in KSI bicyclist injuries was observed, but However, ED visits and hospitalizations from bicycle-motor vehicle collisions were compatible with pre-pandemic trends. In contrast, for bicycle injuries not involving motor vehicles, large increases were observed for both ED visits, 73% (95% CI: 49%, 103%) and for hospitalization 108% (95% CI: 38%, 208%). CONCLUSION New road safety interventions during the pandemic may have improved road safety for vulnerable road users with respect to collisions with motor vehicles; however, further investigation into the risk factors for bicycle injuries not involving motor vehicles is required.
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Affiliation(s)
- Brice Batomen
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Alison Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Ontario, Canada
| | - Jeremy Lewis
- School of Occupational and Public Health Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Andrew Howard
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Sarah Richmond
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
| | - M Anne Harris
- School of Occupational and Public Health Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | | | | | - Linda Rothman
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; School of Occupational and Public Health Toronto Metropolitan University, Toronto, Ontario, Canada
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Paleczny S, Osagie N, Sethi J. Validity and reliability International Classification of Diseases-10 codes for all forms of injury: A systematic review. PLoS One 2024; 19:e0298411. [PMID: 38421992 PMCID: PMC10903801 DOI: 10.1371/journal.pone.0298411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Intentional and unintentional injuries are a leading cause of death and disability globally. International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes are used to classify injuries in administrative health data and are widely used for health care planning and delivery, research, and policy. However, a systematic review of their overall validity and reliability has not yet been done. OBJECTIVE To conduct a systematic review of the validity and reliability of external cause injury ICD-10 codes. METHODS MEDLINE, EMBASE, COCHRANE, and SCOPUS were searched (inception to April 2023) for validity and/or reliability studies of ICD-10 external cause injury codes in all countries for all ages. We examined all available data for external cause injuries and injuries related to specific body regions. Validity was defined by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Reliability was defined by inter-rater reliability (IRR), measured by Krippendorff's alpha, Cohen's Kappa, and/or Fleiss' kappa. RESULTS Twenty-seven published studies from 2006 to 2023 were included. Across all injuries, the mean outcome values and ranges were sensitivity: 61.6% (35.5%-96.0%), specificity: 91.6% (85.8%-100%), PPV: 74.9% (58.6%-96.5%), NPV: 80.2% (44.6%-94.4%), Cohen's kappa: 0.672 (0.480-0.928), Krippendorff's alpha: 0.453, and Fleiss' kappa: 0.630. Poisoning and hand and wrist injuries had higher mean sensitivity (84.4% and 96.0%, respectively), while self-harm and spinal cord injuries were lower (35.5% and 36.4%, respectively). Transport and pedestrian injuries and hand and wrist injuries had high PPVs (96.5% and 92.0%, respectively). Specificity and NPV were generally high, except for abuse (NPV 44.6%). CONCLUSIONS AND SIGNIFICANCE The validity and reliability of ICD-10 external cause injury codes vary based on the injury types coded and the outcomes examined, and overall, they only perform moderately well. Future work, potentially utilizing artificial intelligence, may improve the validity and reliability of ICD codes used to document injuries.
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Affiliation(s)
- Sarah Paleczny
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nosakhare Osagie
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jai Sethi
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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4
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Thorogood NP, Noonan VK, Chen X, Fallah N, Humphreys S, Dea N, Kwon BK, Dvorak MF. Incidence and prevalence of traumatic spinal cord injury in Canada using health administrative data. Front Neurol 2023; 14:1201025. [PMID: 37554392 PMCID: PMC10406385 DOI: 10.3389/fneur.2023.1201025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Incidence and prevalence data are needed for the planning, funding, delivery and evaluation of injury prevention and health care programs. The objective of this study was to estimate the Canadian traumatic spinal cord injury (TSCI) incidence, prevalence and trends over time using national-level health administrative data. METHODS ICD-10 CA codes were used to identify the cases for the hospital admission and discharge incidence rates of TSCI in Canada from 2005 to 2016. Provincial estimates were calculated using the location of the admitting facility. Age and sex-specific incidence rates were set to the 2015/2016 rates for the 2017 to 2019 estimates. Annual incidence rates were used as input for the prevalence model that applied annual survivorship rates derived from life expectancy data. RESULTS For 2019, it was estimated that there were 1,199 cases (32.0 per million) of TSCI admitted to hospitals, with 123 (10% of admissions) in-hospital deaths and 1,076 people with TSCI (28.7 per million) were discharged in Canada. The estimated number of people living with TSCI was 30,239 (804/million); 15,533 (52%) with paraplegia and 14,706 (48%) with tetraplegia. Trends included an increase in the number of people injured each year from 874 to 1,199 incident cases (37%), an older average age at injury rising from 46.6 years to 54.3 years and a larger proportion over the age of 65 changing from 22 to 38%, during the 15-year time frame. CONCLUSION This study provides a standard method for calculating the incidence and prevalence of TSCI in Canada using national-level health administrative data. The estimates are conservative based on the limitations of the data but represent a large Canadian sample over 15 years, which highlight national trends. An increasing number of TSCI cases among the elderly population due to falls reported in this study can inform health care planning, prevention strategies, and future research.
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Affiliation(s)
| | | | - Xiaozhi Chen
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
| | - Brian K. Kwon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Shepherd J, Tu K, Young J, Chishtie J, Craven BC, Moineddin R, Jaglal S. Identifying cases of spinal cord injury or disease in a primary care electronic medical record database. J Spinal Cord Med 2021; 44:S28-S39. [PMID: 34779726 PMCID: PMC8604482 DOI: 10.1080/10790268.2021.1971357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR). DESIGN A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database. SETTING Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada. PARTICIPANTS A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score. RESULTS 126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9-78.4), 98.5% specificity (97.3-99.3), 89.9% PPV (82.2-95.0), 94.7% NPV (92.8-96.3), and an F-score of 79.1. CONCLUSIONS Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.
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Affiliation(s)
- John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: John Shepherd, Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, Ontario, Canada.
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,North York General Hospital, Toronto, Ontario, Canada,Toronto Western Hospital Family Health Team, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jawad Chishtie
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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6
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Hird AE, Saskin R, Liu Y, Lee Y, Ajib K, Matta R, Kodama R, Carr L, Kulkarni GS, Herschorn S, Narod SA, Nam RK. Association between chronic bladder catheterisation and bladder cancer incidence and mortality: a population-based retrospective cohort study in Ontario, Canada. BMJ Open 2021; 11:e050728. [PMID: 34475180 PMCID: PMC8413958 DOI: 10.1136/bmjopen-2021-050728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To compare the risk of bladder cancer and bladder cancer mortality among patients with chronic bladder catheterisation (indwelling or intermittent) to patients from the general population. DESIGN Retrospective cohort study. SETTING Population-based study in Ontario, Canada between 2003 and 2018. PARTICIPANTS Adult patients 18-90 years of age with chronic bladder catheterisation were hard matched to patients from the general population without a history of bladder catheterisation. INTERVENTIONS The presence of a chronic catheter was defined as a minimum of two physician encounters for bladder catheterisation, suprapubic tube insertion or home care for catheter care separated by at least 28 days. Urinary tract infection (UTI) rates were collected. MAIN OUTCOME MEASURES Bladder cancer and bladder cancer-specific mortality after a 1-year lag period were compared between groups. RESULTS We identified 36 903 patients with chronic catheterisation matched to 110 709 patients without a history of catheterisation. Patients were followed for a median of 8.8 years (IQR: 5.2-11.9 years). The median age was 62 years (IQR: 50-71) and 52% were female. More patients in the catheter group developed bladder cancer (393 (1.1%) vs 304 (0.3%),p<0.001). There were 106 (0.3%) bladder cancer deaths in the catheter group and 59 (0.1%) in the comparison group (p<0.001). Chronic catheterisation (adjusted subdistribution HR (sdHR)=4.80, 95% CI: 4.26 to 5.42,p<0.001) and the number of UTIs (adjusted sdHR=1.04 per UTI, 95% CI: 1.04 to 1.05,p<0.001) were independent predictors of bladder cancer. The relative rate of bladder cancer-specific death was more than eightfold higher among patients with chronic catheterisation (adjusted sdHR=8.68, 95% CI: 6.97 to 10.81,p<0.001). Subgroup analysis among patients with neurogenic bladder and bladder calculi similarly revealed an increased risk of bladder cancer diagnosis and mortality. Bladder cancer risk was highest among patients in the two longest catheter duration quintiles (2.9-5.9 and 5.9-15.5 years). CONCLUSIONS This is the first study to quantify the increase in bladder cancer incidence and mortality in a large, diverse cohort of patients with chronic indwelling or intermittent bladder catheterisation. The risk was highest among patients with a chronic catheter beyond 2.9 years.
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Affiliation(s)
- Amanda E Hird
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ying Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yuna Lee
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Khaled Ajib
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Carr
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Toronto, Ontario, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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7
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Welk B. The argument against screening for bladder cancer in neuro-urological patients. World J Urol 2021; 40:1915-1919. [PMID: 34410468 DOI: 10.1007/s00345-021-03802-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The objective of this article was to present the case against screening people with neuro-urological disease for bladder cancer. METHODS Literature around bladder cancer in neuro-urological patients (primarily spinal cord injured patients [SCI]) was identified. RESULTS Bladder cancer is more common among patients with spinal cord injury, although the absolute risk is still low (between 0.3 and 0.6%). It is generally an aggressive disease, with atypical pathologic subtypes, and a high risk of mortality. It usually presents 15-30 years after SCI, and chronic inflammation of the bladder (due to catheters and urinary infections) may be risk factors. The debate about whether these patients should be screened for bladder cancer has persisted in the literature, and many physicians have justified a yearly cystoscopy as means of screening for bladder cancer. However, when examining the limited direct evidence of screening for bladder cancer, and the requirements for a screening test, it does not appear that bladder cancer screening is a rationale undertaking due to the low incidence, and unclear natural history. However, urologists should continue to be vigilant and appropriately investigate patients with high-risk symptoms such as hematuria, frequent UTIs, scrotal infection, or urethral discharge. CONCLUSION The current literature does not support screening patients with SCI for bladder cancer; however, physicians should have a high-evel of suspicion for symptoms suggestive of bladder cancer, and evaluate these at-risk patients promptly.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, Room B4-667, St Joseph's Health Care, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Noonan VK, Jaglal SB, Humphreys S, Cronin S, Waheed Z, Fallah N, Kwon BK, Dvorak MF. Linking Spinal Cord Injury Data Sets to Describe the Patient Journey Following Injury: A Protocol. Top Spinal Cord Inj Rehabil 2021; 26:232-242. [PMID: 33536728 DOI: 10.46292/sci20-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background To optimize traumatic spinal cord injury (tSCI) care, administrative and clinical linked data are required to describe the patient's journey. Objectives To describe the methods and progress to deterministically link SCI data from multiple databases across the SCI continuum in British Columbia (BC) and Ontario (ON) to answer epidemiological and health service research questions. Methods Patients with tSCI will be identified from the administrative Hospital Discharge Abstract Database using International Classification of Diseases (ICD) codes from Population Data BC and ICES data repositories in BC and ON, respectively. Admissions for tSCI will range between 1995-2017 for BC and 2009-2017 for ON. Linkage will occur with multiple administrative data holdings from Population Data BC and ICES to create the "Admin SCI Cohorts." Clinical data from the Rick Hansen SCI Registry (and VerteBase in BC) will be transferred to Population Data BC and ICES. Linkage of the clinical data with the incident cases and administrative data at Population Data BC and ICES will create subsets of patients referred to as the "Clinical SCI Cohorts" for BC and ON. Deidentified patient-level linked data sets will be uploaded to a secure research environment for analysis. Data validation will include several steps, and data analysis plans will be created for each research question. Discussion The creation of provincially linked tSCI data sets is unique; both clinical and administrative data are included to inform the optimization of care across the SCI continuum. Methods and lessons learned will inform future data-linking projects and care initiatives.
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Affiliation(s)
- Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan B Jaglal
- ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Shawna Cronin
- ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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9
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Liu B, Reid J, Silverman M, Welk B. High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections. Neurourol Urodyn 2020; 39:2401-2408. [PMID: 32902908 DOI: 10.1002/nau.24502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/17/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To characterize the use of common urinary tract infections (UTI)-relevant antibiotics after an SCI and determine the risk of Clostridium difficile infection (CDI) from these antibiotics. METHODS We used routinely collected data from Ontario (Canada) to conduct a retrospective, cohort study. We identified people >18 years of age with a traumatic SCI between April 2003 and March 2017. The primary exposure was an outpatient UTI-relevant antibiotic prescription during our observation period, and the primary outcome was evidence of a CDI. An adjusted cox proportional hazards model was used, and antibiotic exposure was modeled as a categorical, time-varying variable based on whether the patient likely had a UTI or not. RESULTS We identified 2528 people with SCI; 1642 (65%) were exposed at least once to an antibiotic of interest. The most commonly prescribed UTI-relevant antibiotic was fluoroquinolone (34%). Most patients did not have investigations for a UTI before the use of any of the different antibiotic classes. A small number of patients (5%) used chronic (>3 months) UTI-relevant antibiotics. The overall proportion of patients diagnosed with CDI was 7.4% (9.3/10 000 patient-days). The adjusted hazard ratio for CDI within 30 days was 3.5 (95% confidence interval, 1.9-6.7, p < .01) if they were exposed to a UTI-relevant antibiotic likely associated with a UTI, which was similar to the risk from UTI-relevant antibiotics which may not have been for a UTI. CONCLUSIONS The rate of CDI is high in this population and outpatient antibiotics that are commonly used for UTIs are a significant risk factor for CDI.
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Affiliation(s)
- Bonnie Liu
- Department of Surgery, Western University, London, ON, Canada
| | | | - Michael Silverman
- Division of Infectious Diseases, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Surgery, Western University, London, ON, Canada.,ICES, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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10
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Patient-reported symptoms in metastatic gastric cancer patients in the last 6 months of life. Support Care Cancer 2020; 29:515-524. [DOI: 10.1007/s00520-020-05501-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
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11
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Ho C, Guilcher SJT, McKenzie N, Mouneimne M, Williams A, Voth J, Chen Y, Cronin S, Noonan VK, Jaglal SB. Validation of Algorithm to Identify Persons with Non-traumatic Spinal Cord Dysfunction in Canada Using Administrative Health Data. Top Spinal Cord Inj Rehabil 2018; 23:333-342. [PMID: 29339909 DOI: 10.1310/sci2304-333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Administrative health data, such as the hospital Discharge Abstract Database (DAD), can potentially be used to identify patients with non-traumatic spinal cord dysfunction (NTSCD). Algorithms utilizing administrative health data for this purpose should be validated before clinical use. Objective: To validate an algorithm designed to identify patients with NTSCD through DAD. Method: DAD between 2006 and 2016 for Southern Alberta in Canada were obtained through Alberta Health Services. Cases of NTSCD were identified using the algorithm designed by the research team. These were then validated by chart review using electronic medical records where possible and paper records where electronic records were unavailable. Measures of diagnostic accuracy including sensitivity, specificity, and positive and negative predictive values and 95% confidence intervals (CI) were computed. Results: Two hundred and eighty cases were identified to have both the administrative codes for neurological impairments and NTSCD etiology. Twenty-eight cases were excluded from analysis as 5 had inadequate medical record information, 17 had traumatic spinal cord injury, and 6 were considered "other" non-spinal cord conditions. Measures of diagnostic accuracy that were computed were sensitivity 97% (95% CI, 94%-98%), specificity 60% (95% CI, 47%-73%), positive predictive value (PPV) 92% (95% CI, 88%-95%), and negative predictive value (NPV) 80% (95% CI, 65%-90%). The most prevalent etiologies were degenerative (36.9%), infection (19.0%), oncology malignant (15.1%), and vascular (10.3%). Conclusion: Our algorithm has high sensitivity and PPV and satisfactory specificity and NPV for the identification of persons with NTSCD using DAD, though the limitations for using this method should be recognized.
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Affiliation(s)
- Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.,Alberta Health Services
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Nicole McKenzie
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | | | - Jennifer Voth
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
| | | | - Shawna Cronin
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.,Institute of Health Policy, Management, and Evaluation, Toronto, Ontario
| | | | - Susan B Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario.,Institute of Health Policy, Management, and Evaluation, Toronto, Ontario.,Department of Physical Therapy, University of Toronto, Toronto, Ontario
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12
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James PD, Hegagi M, Antonova L, Tinmouth J, Heitman SJ, Simone C, Yeung E, Yong E. Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study. CMAJ Open 2017; 5:E437-E443. [PMID: 28600449 PMCID: PMC5498178 DOI: 10.9778/cmajo.20160153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario. METHODS We conducted a population-based retrospective cohort study using health administrative databases. We identified all patients who underwent an endoscopic ultrasound procedure in Ontario from 2003 to 2011 using physician billing data. Patient, physician and institution characteristics were examined. The primary outcome was use of endoscopic ultrasonography. RESULTS We identified 9076 endoscopic ultrasound procedures performed in 8001 patients (3858 women [48.2%]; median patient age at first procedure 59 years). A total of 3066 procedures (33.8%) involved fine-needle aspiration. Use of endoscopic ultrasonography increased 17-fold over the study period. In 2011, people living in the health region with the highest rate of use of endoscopic ultrasonography were more than 4 times more likely to undergo the procedure than people living in the health region with the lowest rate of use (standardized rate 61.6 v. 12.9 per 100 000). About 7 in 10 endoscopic ultrasound procedures were performed in an academic institution or regional cancer centre. All 17 endoscopists performing endoscopic ultrasonography during the study period practised in urban areas. INTERPRETATION Although the use of endoscopic ultrasonography increased over time in Ontario, there were marked regional differences in use. Provincial needs- and evidence-based initiatives may be needed to narrow the regional gaps in provision of endoscopic ultrasound services in the province.
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Affiliation(s)
- Paul D James
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Mae Hegagi
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Lilia Antonova
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Jill Tinmouth
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Steven J Heitman
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Carmine Simone
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yeung
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
| | - Elaine Yong
- Affiliations: Department of Medicine and Ottawa Hospital Research Institute (James, Hegagi, Antonova), University of Ottawa, Ottawa, Ont.; Department of Medicine (Tinmouth, Yeung, Yong), University of Toronto, Toronto, Ont.; Departments of Medicine and of Community Health Sciences (Heitman), University of Calgary, Calgary, Alta.; Department of Medicine (Tinmouth, Yong), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation (Tinmouth), University of Toronto; Cancer Care Ontario (Tinmouth); Department of Surgery (Simone), University of Toronto; Medicine Program (Yeung), The Scarborough Hospital, Toronto, Ont
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13
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The accuracy of burn diagnosis codes in health administrative data: A validation study. Burns 2017; 43:258-264. [PMID: 28069344 DOI: 10.1016/j.burns.2016.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health administrative databases may provide rich sources of data for the study of outcomes following burn. We aimed to determine the accuracy of International Classification of Diseases diagnoses codes for burn in a population-based administrative database. METHODS Data from a regional burn center's clinical registry of patients admitted between 2006-2013 were linked to administrative databases. Burn total body surface area (TBSA), depth, mechanism, and inhalation injury were compared between the registry and administrative records. The sensitivity, specificity, and positive and negative predictive values were determined, and coding agreement was assessed with the kappa statistic. RESULTS 1215 burn center patients were linked to administrative records. TBSA codes were highly sensitive and specific for ≥10 and ≥20% TBSA (89/93% sensitive and 95/97% specific), with excellent agreement (κ, 0.85/κ, 0.88). Codes were weakly sensitive (68%) in identifying ≥10% TBSA full-thickness burn, though highly specific (86%) with moderate agreement (κ, 0.46). Codes for inhalation injury had limited sensitivity (43%) but high specificity (99%) with moderate agreement (κ, 0.54). Burn mechanism had excellent coding agreement (κ, 0.84). CONCLUSIONS Administrative data diagnosis codes accurately identify burn by burn size and mechanism, while identification of inhalation injury or full-thickness burns is less sensitive but highly specific.
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14
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Vasta R, Boumédiene F, Couratier P, Nicol M, Nicoletti A, Preux PM, Marin B. Validity of medico-administrative data related to amyotrophic lateral sclerosis in France: A population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:24-31. [DOI: 10.1080/21678421.2016.1241280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosario Vasta
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy,
| | - Farid Boumédiene
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Philippe Couratier
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Service de Neurologie, Centre Expert SLA, Limoges, France, and
| | - Marie Nicol
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Service de Neurologie, Centre Expert SLA, Limoges, France, and
| | - Alessandra Nicoletti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy,
| | - Pierre-Marie Preux
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Benoit Marin
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
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15
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Welk B, Liu K, Winick-Ng J, Shariff SZ. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn 2016; 36:640-647. [PMID: 26928899 DOI: 10.1002/nau.22981] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/04/2016] [Indexed: 02/06/2023]
Abstract
AIMS The objective of this study was to measure the incidence of urinary tract infections (UTIs), urologic reconstruction/urinary diversion, and renal dysfunction after a traumatic spinal cord injury (TSCI). METHODS Retrospective cohort study using administrative data from Ontario, Canada. All incident adult TSCI patients (2002-2013) admitted to a rehabilitation center were included. The impact of lesion level on each outcome was assessed. The rate of outcomes was further compared to an age and sex matched sample from the general population. RESULTS A total of 2,023 incident TSCI patients were identified (median follow-up of 4.8 years). Most patients (73%) were male and median age was 50 years. Lesion level included cervical (39%), thoracolumbar (44%), and unknown (17%). The incidence of serious UTIs (requiring emergency room visit or hospital admission) was 40%. Thoracolumbar lesion TSCI patients had significantly greater risk of serious UTIs (HR 1.3, 95%CI 1.1-1.7, P < 0.01) compared to those with a cervical lesion. Urologic reconstruction/urinary diversion was carried out on 2.4% of patients. New onset renal dysfunction was identified in 4.2% (84) TSCI patients. The rate ratios for serious UTIs (10.59, 95%CI 8.71-12.89), urologic reconstruction/urinary diversion (6.48, 95%CI 3.07-13.68), and renal dysfunction (2.55, 95%CI 1.70-3.83) were significantly increased among TSCI patients compared to matched controls. CONCLUSIONS Urologic disease is still an important source of morbidity for contemporary TSCI patients, and is more common compared to the general population. Neurourol. Urodynam. 36:640-647, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Kuan Liu
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Jennifer Winick-Ng
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Salimah Z Shariff
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
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16
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Welk B, Liu K, Shariff SZ. The use of urologic investigations among patients with traumatic spinal cord injuries. Res Rep Urol 2016; 8:27-34. [PMID: 26955621 PMCID: PMC4768889 DOI: 10.2147/rru.s99840] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the use of urologic investigations among traumatic spinal cord injury (TSCI) patients. Methods This is a retrospective cohort study from Ontario, Canada. We included all adult TSCI patients injured between 2002 and 2012. The primary outcome was the frequency of urodynamic testing, renal imaging, and cystoscopy. Primary exposure was the year of injury. The impact of age, sex, comorbidity, socioeconomic status, and lesion level was assessed with Cox regression models. Results One thousand five hundred and fifty one incident TSCI patients were discharged from a rehabilitation hospital. The median follow-up time of this cohort was 5.0 years (interquartile range =2.9–7.5). At least one urodynamics, renal imaging, or cystoscopy was performed during follow-up for 50%, 80%, and 48% of the cohort, respectively. The overall rate of these tests was 0.22, 0.60, and 0.22 per person-year of follow-up. The proportion of patients who had regular, yearly urodynamics (<2%), renal imaging (6%), or cystoscopy (<2%) was low. There were no significant linear trends in the use of these tests over the 10-year study period. Urodynamics were significantly less likely to be performed in patients over 65 years of age (hazard ratio [HR] =0.63, P<0.01) and those with a higher level of comorbidity (HR =0.72, P<0.01). Patients with quadriplegia were significantly less likely to receive any of the investigations compared to those with paraplegia. Conclusion Renal imaging is done at least once for the majority of patients with TSCI; however, only half undergo urodynamics or cystoscopy. Few patients have regular urologic testing. The reality of urologic testing after TSCI is very different from urologist’s ideals and practice guidelines.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, ON, Canada; Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
| | - Kuan Liu
- Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
| | - Salimah Z Shariff
- Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
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17
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Wilson JR, Voth J, Singh A, Middleton J, Jaglal SB, Singh JM, Mainprize TG, Yee A, Fehlings MG. Defining the Pathway to Definitive Care and Surgical Decompression after Traumatic Spinal Cord Injury: Results of a Canadian Population-Based Cohort Study. J Neurotrauma 2016; 33:963-71. [PMID: 26652196 DOI: 10.1089/neu.2015.4258] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Early access to specialized care after acute traumatic spinal cord injury (SCI) is associated with improved outcomes. However, many SCI patients do not receive timely access to such care. To characterize and quantify patients' pathway to definitive care and surgery post SCI, and to identify factors that may delay expeditious care, a population based cohort study was performed in Ontario. Using provincial administrative health data, adult patients with acute traumatic SCI who underwent surgery between 2002 and 2011 were identified using SCI specific ICD-10 codes. The relationship between predictor variables and a) time to arrival at the site of definitive care and b) time to surgery was statistically evaluated. Of 1,111 patients meeting eligibility criteria, mean times to arrival at the site of definitive care and to surgery were 8.1 ± 25.5 and 49.4 ± 65.0 hours respectively, with 53.3% of patients having surgery prior to 24 hours. While most patients (88.4%) reached the site of definitive care within 6 hours, only 34.2% reached surgery within 12 hours of arrival. Older age (IRR = 1.01; 95% CI: 1.01, 1.02), increased number of stops at intermediate health care centers (IRR = 7.70; 95% CI: 7.54, 7.86), higher comorbidity index (IRR = 1.43; 95% CI: 1.14, 1.72) and fall related SCI etiology (IRR = 1.16; 95% CI: 1.02, 1.29) were associated with increased time to arrival at definitive care. For surgery, increased age (OR = 1.02; 95% CI: 1.01, 1.03) and stops at intermediate health centers (OR = 2.48; 95% CI: 1.35, 4.56) were associated with a greater odds of undergoing late surgery (>24hrs). These results can inform policy decisions and facilitate creation of a streamlined path to specialized care for patients with acute SCI.
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Affiliation(s)
- Jefferson R Wilson
- 1 Division of Neurosurgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada
| | - Jennifer Voth
- 2 Institute of Clinical Evaluative Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Anoushka Singh
- 1 Division of Neurosurgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada
| | - James Middleton
- 3 Rehabilitation Studies Unit, University of Sydney , Sydney, Australia
| | - Susan B Jaglal
- 2 Institute of Clinical Evaluative Sciences, University of Toronto , Toronto, Ontario, Canada .,4 Department of Physical Therapy, University of Toronto , Toronto, Ontario, Canada
| | - Jeffrey M Singh
- 4 Department of Physical Therapy, University of Toronto , Toronto, Ontario, Canada
| | - Todd G Mainprize
- 1 Division of Neurosurgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada
| | - Albert Yee
- 5 Division of Orthopedic Surgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada
| | - Michael G Fehlings
- 1 Division of Neurosurgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada
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18
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Welk B, Tran KC, Liu K, Shariff S. The pattern of urologic care among traumatic spinal cord injured patients. Can Urol Assoc J 2014; 8:E805-9. [PMID: 25485007 DOI: 10.5489/cuaj.2403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTON We assessed the urologic care patterns of traumatic spinal cord injury (TSCI) patients. METHODS This was a retrospective cohort study of adult TSCI patients injured between 2002 and 2012. The primary outcome was urologic consultation. The primary exposure was the year of injury. Measured covariates included lesion level, age, gender, comorbidity burden, and socioeconomic status. RESULTS We identified 1551 incident TSCI patients who were discharged from a rehabilitation hospital in Ontario between 2002 and 2012. The median follow-up time of this cohort was 5.0 (inter-quartile range [IQR] 2.9-7.5) years. Within this cohort, 74% were male, and the mean age was 48 (IQR 33-63) years. In total, 66% of patients (1022/1551) were seen by a urologist in a median of 0.7 (IQR 0.2-3.0) years after the SCI. Over the study period, there was no change in the proportion of TSCI patients being assessed by a urologist within 1 year of their initial injury (median 55.1%, p = 0.92 for the trend). An adjusted Cox proportional hazards model demonstrated that TSCI patients who were female (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66-0.92) or over 65 years of age (HR 0.70, 95% CI 0.57-0.85) were significantly less likely to be referred to a urologist. CONCLUSIONS Urologists are often not involved in the care of TSCI patients, and this has not changed significantly over the last 10 years. Females and older patients are significantly less likely to be referred to a urologist.
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Affiliation(s)
- Blayne Welk
- Institute for Clinical Evaluative Sciences - Western University (ICES Western), London, ON; ; Department of Surgery, and Epidemiology and Biostatistics, Western University, London, ON
| | - Kim Chi Tran
- Department of Surgery, Western University, London, ON
| | - Kuan Liu
- Institute for Clinical Evaluative Sciences - Western University (ICES Western), London, ON
| | - Salimah Shariff
- Institute for Clinical Evaluative Sciences - Western University (ICES Western), London, ON
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