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Ye SC, Cheung CC, Lauder E, Grunau B, Moghaddam N, van Diepen S, Holmes DT, Sekhon MS, Christenson J, Tallon JM, Fordyce CB. Association of admission serum sodium and outcomes following out-of-hospital cardiac arrest. Am Heart J 2024; 268:29-36. [PMID: 37992794 DOI: 10.1016/j.ahj.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The prognostic association between dysnatremia and outcomes in out-of-hospital cardiac arrest (OHCA) is not well understood. Given hypernatremia is associated with poor outcomes in critical illness and hyponatremia may exacerbate cerebral edema, we hypothesized that dysnatremia on OHCA hospital admission would be associated with worse neurological outcomes. METHODS We studied adults (≥19 years) with non-traumatic OHCA between 2009 and 2016 who were enrolled in the British Columbia Cardiac Arrest Registry and survived to hospital admission at 2 quaternary urban hospitals. We stratified cases by admission serum sodium into hyponatremic (<135 mmol/L), normonatremic (135-145 mmol/L), and hypernatremic (>145 mmol/L) groups. We used logistic regression models, adjusted for age, sex, shockable rhythm, admission serum lactate, and witnessed arrest, to estimate the association between admission sodium and favorable neurological outcome (cerebral performance category 1-2 or modified Rankin scale 0-3). RESULTS Of 414 included patients, 63 were hyponatremic, 330 normonatremic, and 21 hypernatremic. In each respective group, 21 (33.3%), 159 (48.2%), and 3 (14.3%) experienced good neurological outcomes. In univariable models, hyponatremia (OR 0.53, 95% CI 0.30-0.93) and hypernatremia (OR 0.19, 95% CI 0.05-0.65) were associated with lower odds of good neurological outcomes compared to the normonatremia group. After adjustment, only hypernatremia was associated with lower odds of good neurological outcomes (OR 0.22, 95% CI 0.05-0.98). CONCLUSIONS Hypernatremia at admission was independently associated with decreased probability of good neurological outcomes at discharge post-OHCA. Future studies should focus on elucidating the pathophysiology of dysnatremia following OHCA.
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Affiliation(s)
- Si Cong Ye
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Lauder
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Grunau
- BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Emergency Health Services, Vancouver, British Columbia, Canada
| | - Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- BC Resuscitation Research Collaborative, British Columbia, Canada; Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel T Holmes
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mypinder S Sekhon
- BC Resuscitation Research Collaborative, British Columbia, Canada; Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jim Christenson
- BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Tallon
- BC Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Emergency Health Services, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
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2
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Taylor J, Gezer R, Ivkov V, Erdogan M, Hejazi S, Green R, Tallon JM, Tuyp B, Thakore J, Engels PT, Ackery A, Beckett A, Vogt K, Parry N, Heyd C, Coates A, Lampron J, MacPhail I. Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CAN J EMERG MED 2023:10.1007/s43678-023-00516-z. [PMID: 37184823 DOI: 10.1007/s43678-023-00516-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Trauma team leaders (TTLs) have traditionally been general surgeons; however, some trauma centres use a mixed model of care where both surgeons and non-surgeons (primarily emergency physicians) perform this role. The objective of this multicentre study was to provide a well-powered study to determine if TTL specialty is associated with mortality among major trauma patients. METHODS Data were collected from provincial trauma registries at six level 1 trauma centres across Canada over a 10-year period. We included adult trauma patients (age ≥ 18 yrs) who triggered the highest-level trauma activation. The primary outcome was the difference in risk-adjusted in-hospital mortality for trauma patients receiving initial care from a surgeon versus a non-surgeon TTL. RESULTS Overall, 12,961 major trauma patients were included in the analysis. Initial treatment was provided by a surgeon TTL in 57.8% (n = 7513) of cases, while 42.2% (n = 5448) of patients were treated by a non-surgeon TTL. Unadjusted mortality occurred in 11.6% of patients in the surgeon TTL group and 12.7% of patients in the non-surgeon TTL group (OR 0.87, 95% CI 0.78-0.98, p = 0.02). Risk-adjusted mortality was not significantly different between patients cared for by surgeon and non-surgeon TTLs (OR 0.92, 95% CI 0.80-1.06, p = 0.23). Furthermore, we did not observe differences in risk-adjusted mortality for any of the subgroups evaluated. CONCLUSIONS After risk adjustment, there was no difference in mortality between trauma patients treated by surgeon or non-surgeon TTLs. Our study supports emergency physicians performing the role of TTL at level 1 trauma centres.
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Affiliation(s)
- John Taylor
- Royal Columbian Hospital Emergency Department, New Westminster, BC, Canada.
| | | | - Vesna Ivkov
- Emergency and Trauma, Fraser Health Authority, Surrey, BC, Canada
| | - Mete Erdogan
- NS Health Trauma Program, Implementation Science, Nova Scotia Health, Halifax, NS, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC, Canada
| | - Robert Green
- Departments of Critical Care, Emergency Medicine, Anesthesia, and Surgery, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Community Health and Epidemiology, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Jaimini Thakore
- Data, Evaluation and Analytics, Trauma Services BC, Fort Langley, BC, Canada
| | - Paul T Engels
- Trauma, General Surgery and Critical Care, Trauma and Acute Care Surgery, McMaster University, Hamilton, ON, Canada
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Trauma and Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Beckett
- University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, ON, Canada
| | - Kelly Vogt
- Western University, London, ON, Canada
- Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Neil Parry
- Trauma Program, Surgery and Critical Care Medicine, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christopher Heyd
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Coates
- Trauma Program Manager, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jacinthe Lampron
- General Surgery, Acute Care and Trauma, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Iain MacPhail
- Fraser Health Trauma Network, UBC, Vancouver, BC, Canada
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3
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Ho K, Abu-Laban RB, Stewart K, Duncan R, Scheuermeyer FX, Hedden L, Lauscher HN, Sundhu S, Chadha R, Christenson J, Grafstein E, Lavallee DC, Purssell R, Tallon JM, Wood N, Bryan S. Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study. CMAJ Open 2023; 11:E459-E465. [PMID: 37220956 DOI: 10.9778/cmajo.20220196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. METHODS We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. RESULTS We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. INTERPRETATION This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits.
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Affiliation(s)
- Kendall Ho
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Riyad B Abu-Laban
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Kurtis Stewart
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Ross Duncan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Frank X Scheuermeyer
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Lindsay Hedden
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Helen Novak Lauscher
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Sandra Sundhu
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Rina Chadha
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Jim Christenson
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Danielle C Lavallee
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Roy Purssell
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - John M Tallon
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Nancy Wood
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
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4
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Mackay MH, Chruscicki A, Christenson J, Cairns JA, Lee T, Turgeon R, Tallon JM, Helmer J, Singer J, Wong GC, Fordyce CB. Association of pre‐hospital time intervals and clinical outcomes in ST‐elevation myocardial infarction patients. J Am Coll Emerg Physicians Open 2022; 3:e12764. [PMID: 35702143 PMCID: PMC9174874 DOI: 10.1002/emp2.12764] [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: 04/04/2022] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Study Objectives Timely coronary reperfusion is critical for favorable outcomes after ST‐elevation myocardial infarction (STEMI). A substantial proportion of the total ischemic time is patient related, occurring before first medical contact (FMC). We aimed to expand the limited current understanding of the associations between prehospital intervals and clinical outcomes. Methods We conducted a retrospective analysis of consecutive STEMI patients who underwent primary percutaneous coronary intervention (pPCI) (January 2009–March 2016) and assessed the associations between prehospital intervals and the incidence of new heart failure, cardiogenic shock, and hospital length of stay (LOS), adjusting for important clinical variables. Results A total of 773 patients (77% men, median age 65 years) met eligibility criteria. The median pre‐911 activation interval was 29 minutes (interquartile range: 11, 89); the median 911 call to FMC interval was 12 minutes (interquartile range: 9, 15). In multivariable analysis, there was a V‐shaped relationship between the pre‐911 activation interval and outcomes: a lower likelihood of new heart failure (odds ratio [OR] 0.51; 95% confidence interval [CI]: 0.30, 0.87), cardiogenic shock (OR 0.40; 95% CI: 0.21, 0.75) and prolonged LOS (OR 0.24; 95% CI: 0.14, 0.42) for midrange intervals (11–88 minutes) when compared to the early (< 11‐minute) interval. There was no statistically significant relationship between total pre‐FMC time and FMC to device activation time. Conclusions Among ambulance‐transported STEMI patients receiving pPCI, the shortest and longest pre‐911 activation time intervals were associated with poorer outcomes. However, variation in post‐FMC interval alone was not associated with outcomes, suggesting that interventions to reduce pre‐FMC intervals must be prioritized.
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Affiliation(s)
- Martha H. Mackay
- School of Nursing University of British Columbia Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
| | - Adam Chruscicki
- Division of Internal Medicine Vancouver Coastal Health Diamond Health Care Centre Vancouver British Columbia Canada
| | - Jim Christenson
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
| | - John A. Cairns
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
| | - Ricky Turgeon
- St. Paul's Hospital Vancouver British Columbia Canada
| | - John M. Tallon
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Jennifer Helmer
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- School of Population and Public Health Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Graham C. Wong
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Christopher B. Fordyce
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
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5
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Heidet M, Hubert H, Grunau BE, Cheskes S, Baert V, Fraticelli L, Freyssenge J, Lecarpentier E, Stitt A, Tallon JM, Tazarourte K, Truong C, Vaillancourt C, Vilhelm C, Wysocki K, Christenson J, El Khoury C. Rationale, development and implementation of the ReACanROC registry for out-of-hospital cardiac arrests in France and Canada. Emerg Med J 2021; 39:547-553. [PMID: 34083429 DOI: 10.1136/emermed-2020-211073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2020] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Abstract
France and Canada prehospital systems and care delivery in out-of-hospital cardiac arrests (OHCAs) show substantial differences. This article aims to describe the rationale, design, implementation and expected research implications of the international, population-based, France-Canada registry for OHCAs, namely ReACanROC, which is built from the merging of two nation-wide, population-based, Utstein-style prospectively implemented registries for OHCAs attended to by emergency medical services. Under the supervision of an international steering committee and research network, the ReACanROC dataset will be used to run in-depth analyses on the differences in organisational, practical and geographic predictors of survival after OHCA between France and Canada. ReACanROC is the first Europe-North America registry ever created to meet this goal. To date, it covers close to 80 million people over the two countries, and includes approximately 200 000 cases over a 10-year period.
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Affiliation(s)
- Matthieu Heidet
- SAMU 94, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France .,EA-3956 (Intelligent Control in Networks, CIR), Université Paris-Est Créteil (UPEC), Créteil, France.,Emergency department, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Hervé Hubert
- ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France.,French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Brian E Grunau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Emergency Department, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for health evaluation and outcomes sciences (CHEOS), Vancouver, British Columbia, Canada.,British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Sheldon Cheskes
- Sunnybrook center for prehospital medicine, Toronto, Ontario, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Valentine Baert
- ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France.,French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Laurie Fraticelli
- RESCUE Network, Hussel Hospital, Vienne, France.,EA-4129 (Laboratory Systemic Health Care), University of Lyon 1, Lyon, France
| | - Julie Freyssenge
- RESCUE Network, Hussel Hospital, Vienne, France.,INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Eric Lecarpentier
- SAMU 94, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
| | - Audra Stitt
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - John M Tallon
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Karim Tazarourte
- INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.,Emergency Department and SAMU69, Hospices Civils de Lyon, Lyon, France
| | - Courtney Truong
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christian Vilhelm
- French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Kosma Wysocki
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Jim Christenson
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Emergency Department, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for health evaluation and outcomes sciences (CHEOS), Vancouver, British Columbia, Canada
| | - Carlos El Khoury
- RESCUE Network, Hussel Hospital, Vienne, France.,INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.,Emergency Department, Médipôle, Villeurbanne, France
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6
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MacPherson A, Petrie DA, Tallon JM, Campana B, Atkinson P. CJEM Debate Series: what's in a name? It is simply an emergency room, and we are ERPs! CAN J EMERG MED 2021; 23:585-589. [PMID: 33970461 DOI: 10.1007/s43678-021-00137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew MacPherson
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, Island Health, Victoria, BC, Canada
| | - David A Petrie
- Department of Emergency Medicine, Dalhousie University, Nova Scotia Health, Halifax, NS, Canada.
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bruce Campana
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, Island Health, Victoria, BC, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John, NB, Canada
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Wong D, Su G, Mabasa VH, Tallon JM, Acker J, Wan W, Jenneson S. Assessing the clinical utilization of tranexamic acid by paramedics for patients with major trauma (ACUTE). CAN J EMERG MED 2021; 23:219-222. [PMID: 33709358 DOI: 10.1007/s43678-020-00040-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to characterize the clinical utilization of tranexamic acid (TXA) by paramedics in British Columbia (BC) for acute major trauma and to quantify the percentage of patients who received TXA among those who met the indications for administration. METHODS A quality assurance review of eligible trauma patients across the province was performed using a convenience sample. Trauma patients between April 1, 2016 and March 31, 2017 with suspected or actual hemorrhage were selected if they met inclusion criteria (systolic blood pressure < 90 mm Hg ± heart rate > 120 beats per minute) and exclusion criteria (age < 16 years, injuries exclusively to the extremities). RESULTS 35 of the 100 eligible patients assessed in this review received a dose of TXA from paramedics. All 35 of the patients received TXA within 180 min of injury regardless of their original location of injury in BC (mean: 50 min; range: 15-140 min). CONCLUSIONS 35% of eligible patients identified in this study received TXA, which is an improvement over rates cited by previous Canadian literature. With further education opportunities for paramedics in BC and other EMS systems, there is potential to continue improving pre-hospital TXA administration rates.
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Affiliation(s)
- Daniel Wong
- Pharmacy Department, Royal Columbian Hospital, 330 E Columbia St, New Westminster, BC, V3L 3W7, Canada.
| | - Gloria Su
- Burnaby Hospital, Burnaby, BC, Canada
| | | | - John M Tallon
- BC Emergency Health Services, Vancouver, BC, Canada.,Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joe Acker
- BC Emergency Health Services, Vancouver, BC, Canada
| | - Wilson Wan
- BC Emergency Health Services, Vancouver, BC, Canada
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8
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Saavedra Dias R, Barros AN, Silva AJ, Leitão JC, Narciso J, Costa AM, Tallon JM. The effect of school intervention programs on the body mass index of adolescents: a systematic review with meta-analysis. Health Educ Res 2020; 35:396-406. [PMID: 32772070 DOI: 10.1093/her/cyaa021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
Effective obesity interventions in adolescent populations have been identified as an immediate priority action to stem the increasing prevalence of adult obesity. The purpose of this meta-analysis was to make a quantitative analysis of the impact of school-based interventions on body mass index during adolescence. Studies were retrieved from PubMed, Scopus, Science Direct and Web of Science databases. Results were pooled using a random-effects model with 95% confidence interval considered statistically significant. Of the 18 798 possible relevant articles identified, 12 articles were included in this meta-analysis. The global result showed a low magnitude effect, though it was statistically significant (N = 14 428), global e.s. = -0.055, P = 0.004 (95% CI = -0.092, -0.017). Heterogeneity was low among the studies (I2 = 9.017%). The funnel plot showed no evidence of publication bias. The rank-correlation test of Begg (P = 0.45641) and Egger's regression (P = 0.19459) confirmed the absence of bias. This meta-analysis reported a significant effect favoring the interventions; however, future research are needed since the reported the evidence was of low magnitude, with the studies following a substantial range of approaches and mostly had a modest methodological quality.
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Affiliation(s)
- R Saavedra Dias
- University of Trás-os-Montes and Alto Douro, Vila Real 5000-801, Portugal
| | - A N Barros
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro (CITAB-UTAD), Vila Real 5000-801, Portugal
| | - A J Silva
- University of Trás-os-Montes and Alto Douro, Vila Real 5000-801, Portugal
- Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real 5000-801, Portugal
| | - J C Leitão
- University of Trás-os-Montes and Alto Douro, Vila Real 5000-801, Portugal
- Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real 5000-801, Portugal
| | - J Narciso
- University of Beira Interior, Rua Marquês D'Ávila e Bolama, Covilhã 6201-001, Portugal
| | - Aldo M Costa
- Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real 5000-801, Portugal
- University of Beira Interior, Rua Marquês D'Ávila e Bolama, Covilhã 6201-001, Portugal
- Health Sciences Research Center (CICS-UBI), Covilhã, Portugal
| | - J M Tallon
- University of Trás-os-Montes and Alto Douro, Vila Real 5000-801, Portugal
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Rowell SE, Meier EN, McKnight B, Kannas D, May S, Sheehan K, Bulger EM, Idris AH, Christenson J, Morrison LJ, Frascone RJ, Bosarge PL, Colella MR, Johannigman J, Cotton BA, Callum J, McMullan J, Dries DJ, Tibbs B, Richmond NJ, Weisfeldt ML, Tallon JM, Garrett JS, Zielinski MD, Aufderheide TP, Gandhi RR, Schlamp R, Robinson BRH, Jui J, Klein L, Rizoli S, Gamber M, Fleming M, Hwang J, Vincent LE, Williams C, Hendrickson A, Simonson R, Klotz P, Sopko G, Witham W, Ferrara M, Schreiber MA. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. JAMA 2020; 324:961-974. [PMID: 32897344 PMCID: PMC7489866 DOI: 10.1001/jama.2020.8958] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration of tranexamic acid may benefit patients with TBI. OBJECTIVE To determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blinded, randomized clinical trial at 20 trauma centers and 39 emergency medical services agencies in the US and Canada from May 2015 to November 2017. Eligible participants (N = 1280) included out-of-hospital patients with TBI aged 15 years or older with Glasgow Coma Scale score of 12 or less and systolic blood pressure of 90 mm Hg or higher. INTERVENTIONS Three interventions were evaluated, with treatment initiated within 2 hours of TBI: out-of-hospital tranexamic acid (1 g) bolus and in-hospital tranexamic acid (1 g) 8-hour infusion (bolus maintenance group; n = 312), out-of-hospital tranexamic acid (2 g) bolus and in-hospital placebo 8-hour infusion (bolus only group; n = 345), and out-of-hospital placebo bolus and in-hospital placebo 8-hour infusion (placebo group; n = 309). MAIN OUTCOMES AND MEASURES The primary outcome was favorable neurologic function at 6 months (Glasgow Outcome Scale-Extended score >4 [moderate disability or good recovery]) in the combined tranexamic acid group vs the placebo group. Asymmetric significance thresholds were set at 0.1 for benefit and 0.025 for harm. There were 18 secondary end points, of which 5 are reported in this article: 28-day mortality, 6-month Disability Rating Scale score (range, 0 [no disability] to 30 [death]), progression of intracranial hemorrhage, incidence of seizures, and incidence of thromboembolic events. RESULTS Among 1063 participants, a study drug was not administered to 96 randomized participants and 1 participant was excluded, resulting in 966 participants in the analysis population (mean age, 42 years; 255 [74%] male participants; mean Glasgow Coma Scale score, 8). Of these participants, 819 (84.8%) were available for primary outcome analysis at 6-month follow-up. The primary outcome occurred in 65% of patients in the tranexamic acid groups vs 62% in the placebo group (difference, 3.5%; [90% 1-sided confidence limit for benefit, -0.9%]; P = .16; [97.5% 1-sided confidence limit for harm, 10.2%]; P = .84). There was no statistically significant difference in 28-day mortality between the tranexamic acid groups vs the placebo group (14% vs 17%; difference, -2.9% [95% CI, -7.9% to 2.1%]; P = .26), 6-month Disability Rating Scale score (6.8 vs 7.6; difference, -0.9 [95% CI, -2.5 to 0.7]; P = .29), or progression of intracranial hemorrhage (16% vs 20%; difference, -5.4% [95% CI, -12.8% to 2.1%]; P = .16). CONCLUSIONS AND RELEVANCE Among patients with moderate to severe TBI, out-of-hospital tranexamic acid administration within 2 hours of injury compared with placebo did not significantly improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01990768.
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Affiliation(s)
- Susan E Rowell
- Department of Surgery, Oregon Health & Science University, Portland
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Eric N Meier
- Department of Biostatistics, University of Washington, Seattle
| | | | - Delores Kannas
- Department of Biostatistics, University of Washington, Seattle
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle
| | - Kellie Sheehan
- Department of Biostatistics, University of Washington, Seattle
| | | | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ralph J Frascone
- Department of Emergency Medicine, Regions Hospital, St Paul, Minnesota
| | - Patrick L Bosarge
- Department of Surgery, University of Alabama, Birmingham
- Department of Surgery, University of Arizona, Phoenix
| | - M Riccardo Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Jay Johannigman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Bryan A Cotton
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Jeannie Callum
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jason McMullan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - David J Dries
- Department of Surgery, Regions Hospital, St Paul, Minnesota
| | - Brian Tibbs
- Trauma Surgery, Texas Health Presbyterian Hospital, Dallas
| | - Neal J Richmond
- Department of Emergency Medicine, John Peter Smith Health Network, Ft Worth, Texas
| | | | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
| | | | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Rajesh R Gandhi
- Department of Surgery, John Peter Smith Health Network, Ft Worth, Texas
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Lauren Klein
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Sandro Rizoli
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mark Gamber
- Department of Emergency Medicine, Medical City Plano, Plano, Texas
| | - Michael Fleming
- Department of Surgery, Oregon Health & Science University, Portland
| | - Jun Hwang
- Department of Biostatistics, University of Washington, Seattle
| | - Laura E Vincent
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston
| | | | - Audrey Hendrickson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Robert Simonson
- Emergency Medicine, Methodist Dallas Medical Center, Dallas, Texas
| | - Patricia Klotz
- Department of Surgery, University of Washington, Seattle
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - William Witham
- Trauma Surgery, Texas Health Harris Methodist Hospital, Ft Worth
| | - Michael Ferrara
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
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Tallon JM, Saavedra R, Costa AM, Narciso J, Barros A, Silva AJ. P2 Nutrition Knowledge of Portuguese Adolescents – a Pilot Evaluation of the Impact of Using an Interactive Multimedia Platform to Provide Nutrition Education. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz097.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J M Tallon
- University of Trás-os-Montes e Alto Douro, Vila Real, PORTUGAL
| | - R Saavedra
- University of Trás-os-Montes e Alto Douro, Vila Real, PORTUGAL
| | - A M Costa
- University of Beira Interior, Covilhã, PORTUGAL
- Research Centre in Sports, Health and Human Development (CIDESD), Vila Real, PORTUGAL
- Health Science Research Center (CICS-UBI), Covilhã, PORTUGAL
| | - J Narciso
- University of Beira Interior, Covilhã, PORTUGAL
| | - A Barros
- University of Trás-os-Montes e Alto Douro, Vila Real, PORTUGAL
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Vila Real, PORTUGAL
| | - A J Silva
- University of Trás-os-Montes e Alto Douro, Vila Real, PORTUGAL
- Research Centre in Sports, Health and Human Development (CIDESD), Vila Real, PORTUGAL
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Abstract
OBJECTIVES Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing. DESIGN Retrospective cohort study. SETTING Tertiary trauma centre in Halifax, Canada. PARTICIPANTS 2306 trauma patients who required activation of the trauma team. PRIMARY OUTCOME MEASURE The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing. RESULTS Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend. CONCLUSIONS At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.
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Affiliation(s)
- Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Nelofar Kureshi
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John M Tallon
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Abstract
ABSTRACT
Objectives:
The optimal approach to airway management in penetrating neck injuries (PNIs) remains controversial. The primary objective of this study was to review the method of endotracheal intubation in PNI at a Canadian tertiary trauma centre. Secondarily, we sought to determine the incidence of PNI in our trauma population and to describe the epidemiologic elements of this population.
Methods:
We conducted a review of patients with PNIs who were enrolled in the Nova Scotia Trauma Registry database. We included all patients 16 years of age or under who presented between April 1, 1994 and March 31, 2005 with penetrating injuries of the neck and an Injury Severity Score (ISS) of 9 or less or who underwent Trauma Team activation at our Tertiary Trauma Centre (regardless of ISS) and/or who were identified upon admission as a “major” trauma case. The variables of interest were patient age and sex, injury mechanism, injury location, place of intubation and method of intubation.
Results:
There were 19 people who met inclusion criteria and they were enrolled in our study. The injury mechanisms involved knife (n = 13) or gunshot (n = 5) wounds (one patient's injuries were categorized as “other”). Three patients (15.8%) were not intubated. The remaining 16 patients were intubated during prehospital care (n = 5), in the emergency department (n = 6) or in the operating room (n = 5). Of these, 8 patients (42.1%) underwent awake intubation and 8 (42.1%) underwent rapid sequence intubation.
Conclusion:
There is clear variability of airway management in PNI. We believe that such patients represent a heterogeneous group where the attending physician must have a conservative yet varied approach to airway management based on the individual clinical scenario.
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Affiliation(s)
- John M Tallon
- Department of Emergency Medicine, Dalhousie University, Halifax, NS.
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14
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Campbell SG, Magee KD, Kovacs GJ, Petrie DA, Tallon JM, McKinley R, Urquhart DG, Hutchins L. Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series. CAN J EMERG MED 2015; 8:85-93. [PMID: 17175868 DOI: 10.1017/s148180350001352x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACTObjectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital.Methods:Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period.Results:Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%–2.3%), and desaturation (Sao2≤ 90) in 14 of 979 (1.4%; CI 0.1%–2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs.Conclusions:Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.
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Affiliation(s)
- Sam G Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, NS.
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15
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Vu EN, Schlamp RS, Wand RT, Kleine-Deters GA, Vu MP, Tallon JM. Prehospital use of tranexamic acid for hemorrhagic shock in primary and secondary air medical evacuation. Air Med J 2013; 32:289-292. [PMID: 24001917 DOI: 10.1016/j.amj.2013.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/18/2013] [Accepted: 05/15/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Major hemorrhage remains a leading cause of death in both military and civilian trauma. We report the use of tranexamic acid (TXA) as part of a trauma exanguination/massive transfusion protocol in the management of hemorrhagic shock in a civilian primary and secondary air medical evacuation (AME) helicopter EMS program. METHODS TXA was introduced into our CCP flight paramedic program in June 2011. Indications for use include age > 16 years, major trauma (defined a priori based on mechanism of injury or findings on primary survey), and heart rate (HR) > 110 beats per minute (bpm) or systolic blood pressure (SBP) < 90 mmHg. Our protocol, which includes 24-hour online medical oversight, emphasizes rapid initiation of transport, permissive hypotension in select patients, early use of blood products (secondary AME only), and infusion of TXA while en route to a major trauma center. RESULTS Over a 4-month period, our CCP flight crews used TXA a total of 13 times. Patients had an average HR of 111 bpm [95% CI 90.71-131.90], SBP of 91 mmHg [95% CI 64.48-118.60], and Glascow Coma Score of 7 [95% CI 4.65-9.96]. For primary AME, average response time was 33 minutes [95% CI 19.03-47.72], scene time 22 minutes [95% CI 20.23-24.27], and time to TXA administration 32 minutes [95% CI 25.76-38.99] from first patient contact. There were no reported complications with the administration of TXA in any patient. CONCLUSION We report the successful integration of TXA into a primary and secondary AME program in the setting of major trauma with confirmed or suspected hemorrhagic shock. Further studies are needed to assess the effect of such a protocol in this patient population.
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Affiliation(s)
- Erik Nelson Vu
- British Columbia Emergency Health Services, BC Ambulance Service Provincial AirEvac and Critical Care Operations, Vancouver, British Columbia, Canada.
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16
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Tallon JM. Re: Impaired Driving Charges in Injured Impaired Drivers Requiring Emergency Department Treatment. CAN J EMERG MED 2013; 15:197. [DOI: 10.2310/8000.2013.131092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Tallon JM, Flowerdew G, Stewart RD, Kovacs G. Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ijcm.2013.42015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Riding all-terrain vehicles (ATVs) is a popular recreational activity, with approximately 1.5 million users in Canada. Despite legislation aimed at reducing injury rates, ATV-related incidents remain a major cause of trauma and death. This paper reviews the epidemiology of major injury associated with ATV use in Nova Scotia. METHODS The Nova Scotia Trauma Registry was used to identify all adults over age 15 who sustained major ATV-related trauma (Injury Severity Score [ISS] >/=12) within a 5-year period. Demographic variables, temporal statistics, alcohol use, helmet use, injury characteristics and injury outcome variables, including ISS, length of stay (LOS), Glasgow Coma Scale score and discharge status were evaluated. RESULTS Twenty-five patients met the inclusion criteria. Most (92%) were males, and 64% were between 16 and 34 years of age. Most injuries occurred between 1300 hrs and 1900 hrs, 52% occurred on the weekend, and 40% occurred in the spring. The average ISS was 22.1, and injuries to the central nervous system comprised 39% of all major injuries. Alcohol was involved in up to 56% of all incidents, and only 4 patients (16%) were known to be wearing a helmet at the time of injury. Average hospital LOS was 21.6 days. INTERPRETATION ATV-related incidents are a continuing source of major injury. This paper describes the epidemiology of ATV-related major trauma presenting to the sole tertiary care referral centre in one province. Information gained from this study should be used to influence ATV public education programs.
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Affiliation(s)
- Aaron K Sibley
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Tallon JM, Fell DB, Karim SA, Ackroydstolarz S, Petrie D. Influence of a province-wide trauma system on motor vehicle collision process of trauma care and mortality: a 10-year follow-up evaluation. Can J Surg 2012; 55:8-14. [PMID: 22269307 DOI: 10.1503/cjs.016710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mature trauma systems have evolved to respond to major injury-related morbidity and mortality. Studies of mature trauma systems have demonstrated improved survival, especially among seriously injured patients. From 1995 to 1998, a province-wide trauma system was implemented in the province of Nova Scotia. We measured the proportion of admissions to a tertiary level trauma centre and the proportion of in-hospital deaths among patients with major injuries as a result of a motor vehicle collisions (MVCs) before and 10 years after provincial trauma systems implementation. METHODS We identified major trauma patients aged 16 years and older using external cause of injury codes pertaining to MVCs from population-based hospital claims and vital statistics data. Individuals who were admitted to hospital or died because of an MVC in 1993-1994 (preimplementation), were compared with those who were admitted to hospital or died in 2003-2005 (postimplementation). RESULTS Postimplementation, there was a 9% increase in the number of seriously injured individuals with primary admission to tertiary care. This increase was statistically significant even after we adjusted for age, head injury and municipality of residence (relative risk [RR] 1.09, 95% confidence interval [CI] 1.04-1.14). The probability of dying while in hospital in the postimplementation period decreased by 29% (adjusted RR 0.57, 95% CI 0.32-1.03), although this difference was not statistically significant. CONCLUSION Individuals seriously injured in MVCs in Nova Scotia were more likely to be admitted to tertiary care after the implementation of a province-wide trauma system. There was a trend toward decreased mortality, but further research is warranted to confirm the survival benefit and delineate other contributing factors.
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Affiliation(s)
- John M Tallon
- Departments of Emergency Medicine and Surgery, Dalhousie University, Halifax, NS.
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Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg 2008; 51:339-345. [PMID: 18841222 PMCID: PMC2556533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The purpose of this paper is to review the population-based epidemiology of surgically treated post-traumatic epidural hematomas (EDHs) and/or subdural hematomas (SDHs) among patients who presented to the single neurosurgical centre in Nova Scotia. METHODS We included all patients aged 16 years or older who presented to the tertiary care hospital with acute post-traumatic EDHs and/or SDHs between May 23, 1996, and May 22, 2005, and who were surgically treated. We generated an initial cohort from the provincial trauma registry and reviewed a total of 152 charts for possible inclusion; 70 (46%) patients met the study criteria. We performed a blinded, explicit chart review using a standardized data collection form, and we generated descriptive statistics. RESULTS Of the patients who had surgery, 34 (49%) presented with SDHs, 23 (33%) presented with EDHs and 13 (19%) presented with both conditions. The median age was 45 years, and 80% of the cohort was male. The major mechanisms of injury were falls (51%), motor vehicle collisions (30%) and assault (11%). More than half (61%) of patients were transferred from referring hospitals while the remainder (39%) arrived directly without an intermediate facility. There were 18 postoperative deaths (26%). Forty-four of 70 patients (63%) had associated good outcomes at 6 months (Glasgow Outcome Scale). CONCLUSION Acute post-traumatic EDHs and/or SDHs are relatively rare (0.83/100,000 population per annum) and are generally associated with good outcomes. Death was more likely among older, more severely injured patients and among those who required surgery for SDH rather than EDH.
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MESH Headings
- Accidental Falls/statistics & numerical data
- Accidents, Traffic/statistics & numerical data
- Adolescent
- Adult
- Air Ambulances/statistics & numerical data
- Decompression, Surgical
- Female
- Glasgow Outcome Scale
- Head Injuries, Closed/complications
- Hematoma, Epidural, Cranial/epidemiology
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Subdural, Acute/epidemiology
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Humans
- Male
- Middle Aged
- Nova Scotia/epidemiology
- Retrospective Studies
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Affiliation(s)
- John M Tallon
- Department of Emergency Medicine, Dalhousie University, Halifax, NS
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Abstract
A 37-year-old man with type I diabetes mellitus and chronic renal failure presented to the emergency department complaining of hallucinations. He was 5 days postoperative for left pars plana vitrectomy and intra-ocular lens implantation and had been taking ophthalmic atropine, tobramycin and prednisolone. He had presented 5 months earlier, on the same ophthalmic medications, with postoperative hallucinations after a right pars plana vitrectomy. Visual hallucinations are a major side effect of anticholinergic poisoning. Ophthalmic instillation of atropine has been documented to cause many central nervous sytstem symptoms, including hallucinations.
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Affiliation(s)
- A G Bishop
- Department of Emergency Medicine, New Halifax Infirmary, Dalhousie University, Halifax, NS
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Ahmed JM, Tallon JM, Petrie DA. Trauma Management Outcomes Associated With Nonsurgeon Versus Surgeon Trauma Team Leaders. Ann Emerg Med 2007; 50:7-12, 12.e1. [PMID: 17112634 DOI: 10.1016/j.annemergmed.2006.09.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 09/02/2006] [Accepted: 09/20/2006] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE We compare the effectiveness of surgeon and nonsurgeon trauma team leaders. METHODS This retrospective study was conducted using data from a Canadian trauma registry database. Data from April 1, 1998, to March 31, 2005, from blunt and penetrating trauma patients aged 16 years or older and with trauma team activation (and without major burns) were included. Patient age, sex, trauma team leader (surgeon or nonsurgeon), mechanism of injury, Injury Severity Score, survival to 3 hours and to discharge, length of stay in the hospital, and Trauma and Injury Severity Score (TRISS) z scores were tabulated. RESULTS Data from 807 patients were included. Because of the limited number of penetrating trauma cases, analyses focused on blunt trauma. Surgeon and nonsurgeon trauma team leader groups did not differ on injury severity, age, or sex. No difference was noted in survival to discharge (nonsurgeon 84.8%-surgeon 81.8%=3%; 95% confidence interval [CI] -3.5% to 9.5%), survival to 3 hours (nonsurgeon 96.8%-surgeon 96%=0.8%; 95% CI -2.2% to 3.8%), length of stay (median 13 days for nonsurgeon and 12 days for surgeon groups), or difference between actual and predicted survival (TRISS z scores nonsurgeon 0.64; surgeon 0.99). No trend toward group differences on any outcome variable was observed in penetrating trauma cases. CONCLUSION No differences were found in the outcome of trauma patients treated by nonsurgeon versus surgeon trauma team leaders. These findings support a more collaborative approach to resuscitative trauma management with involvement of nonsurgeons as trauma team leaders.
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Affiliation(s)
- Jennifer M Ahmed
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Hebb MO, Clarke DB, Tallon JM. Development of a provincial guideline for the acute assessment and management of adult and pediatric patients with head injuries. Can J Surg 2007; 50:187-94. [PMID: 17568490 PMCID: PMC2384275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Regionalized approaches to trauma care improve patient outcomes. We developed and distributed a clinical reference poster to standardize the emergency department evaluation and management of patients with traumatic head injuries in hospitals throughout Nova Scotia. METHODS We conducted a MEDLINE literature search to identify publications in the fields of prehospital and emergency management of head injuries. We reviewed and collated select studies to define contemporary standards of care. RESULTS We derived a 3-tiered decision tool that summarizes the indications for resuscitation, radiography, specialty consultation and transfer of adult and pediatric patients with minor and major head injuries. A guideline poster was constructed and distributed to all provincial emergency departments upon approval by local trauma and critical care staff. CONCLUSIONS This report describes the evidence for a population-based, province-wide assessment and early management tool that was developed for health care personnel who treat patients with head traumas. Comparison of outcome data from pre- and postguideline eras will ultimately shed light on the use of regionalized approaches to managing brain injuries.
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Affiliation(s)
- Matthew O Hebb
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada
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Mitchell AD, Tallon JM, Sealy B. Air versus ground transport of major trauma patients to a tertiary trauma centre: a province-wide comparison using TRISS analysis. Can J Surg 2007; 50:129-33. [PMID: 17550717 PMCID: PMC2384270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare the outcomes of adult (aged > 15 yr) blunt trauma patients with an Injury Severity Score (ISS) = 12 who were transported to a single tertiary trauma centre (TTC) by helicopter emergency medical service (HEMS) versus those transported by ground ambulance. METHODS We retrospectively analyzed all adult (aged > 15 yr) trauma patients between March 27, 1998 and March 28, 2002 with an ISS score = 12, as identified through the provincial trauma registry. We used the Trauma and Injury Severity Score (TRISS) methodology to determine a difference in outcomes between the 2 groups. RESULTS We identified 823 patients; of these, we excluded 32 (3.9%) penetrating trauma patients. Of the blunt trauma cases (n = 791) 237 (30%) patients were transported by air and 554 were transported by ground (70%). A total of 770 (97.3%) patients were eligible for TRISS analysis. Using the TRISS methodology, the air group had a Z statistic of 2.77, yielding a W score of 6.40. This compared with the ground transport group, whose Z statistic was 1.97 and W score was 2.39. CONCLUSION The transport of trauma patients with an ISS = 12 by a provincially dedicated rotor wing air medical service was associated with statistically significantly better outcomes than those transported by standard ground ambulance. This is the first large Canadian study to specifically compare the outcome of patients transported by ground with those transported by air.
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Affiliation(s)
- Alex D Mitchell
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS.
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Abstract
BACKGROUND Benchmarks are used in trauma care for program evaluation, quality improvement, and research. National outcome benchmarks relevant to the Canadian trauma population need to be defined for evaluation of trauma care in Canada. The purpose of this study was to derive survival probabilities associated with trauma diagnoses using International Classification of Diseases, Ninth Revision (ICD-9) codes. METHODS All patients admitted to an acute care hospital with nonpenetrating trauma and submitted to the National Trauma Registry of Canada between 1994 through 2000 inclusively were included in analyses. Both inclusive and exclusive survival risk ratios (SRRs) were calculated for groups of ICD-9 injury codes between 800 to 959. RESULTS For the study period, there were 1,003,905 and 803,776 eligible trauma patients used to calculate inclusive SRRs and exclusive SRRs, respectively. Survival probabilities for injuries are given according to ICD-9 codes. CONCLUSION This is the first study to define national survival benchmarks for the Canadian trauma population. These results can be used to assess survival of patients using the ICISS [(ICD-9) based Injury Severity Score (ISS)] methodology. With regular updates, these data can further be developed for continual trauma outcome assessment, quality improvement, and research into trauma care in Canada.
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Affiliation(s)
- Eric Bergeron
- Research Committee of the Trauma Association of Canada, Quebec, Canada.
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Abstract
INTRODUCTION Appropriate use of helicopter emergency medical services (HEMS) ensures the maximum impact of a limited resource on improved health outcomes. Overtriage increases real and opportunity costs and may unjustifiably expose the program to small but inherent safety risks. The purpose of this study is to describe the mission acceptance process for an integrated, provincially based HEMS program and determine its utilization patterns. METHODS This is a retrospective review of patient care and administrative databases. All missions were reviewed to determine whether they were medically appropriate. "Appropriateness" was defined a priori as requiring admission to a critical care unit, death during transportation or in first 24 hours, or in the case of trauma, an injury severity scale (ISS) score > or = 12. Overtriage was defined as not meeting these a priori definitions. RESULTS Five hundred eighty-four missions were reviewed from March 31, 2003 through December 31, 2004. Our mission acceptance process consists of three distinct but complementary phases: ongoing outreach education, scanning by dispatchers in an integrated dispatch center, and a clinician to online physician discussion about each case. The overall overtriage rate was 13.1%. CONCLUSION The rate of medically appropriate missions in this system is relatively high. Prospective research is required to improve HEMS triage systems.
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Affiliation(s)
- David A Petrie
- Department of Emergency Medicine, Dalhouse University, Halifax, NS, Canada.
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Abstract
BACKGROUND Mature trauma systems have evolved to respond to high rates of major injury morbidity and mortality. Characterized by prehospital care, triage, transportation, aggressive resuscitation, surgery, and rehabilitation, trauma systems have been found to improve survival for seriously injured patients. In Nova Scotia, a province-wide trauma system was implemented between 1995 and 1998. This study investigated the influence of the province-wide trauma system on motor vehicle trauma care and mortality in its first 2 years of existence. METHODS Subjects over the age of 15 years were identified using E-codes pertaining to motor vehicle traffic crashes from population-based hospital claims and vital statistics data. Individuals who were hospitalized or died because of a motor vehicle crash in 1993 through 1994, before trauma system implementation, were compared with those who were hospitalized or died in 1999 through 2000, after the trauma system was implemented. RESULTS In the 2-year period after trauma system implementation, there was a 21% increase in the number of seriously injured individuals with a primary admission to tertiary care. This increase was both clinically and statistically significant even after adjustment for age, gender, multiple injuries, head injury, municipality of residence, and vital status at discharge (RR, 1.21, 95% CI, 1.05-1.35). There was no evidence that the probability of dying while in hospital significantly changed in the first 2 years after trauma system implementation. INTERPRETATION These results indicate that individuals seriously injured in motor vehicle crashes in Nova Scotia are more likely to be admitted to tertiary care in the postimplementation period.
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Affiliation(s)
- John M Tallon
- Department of Emergency, Dalhousie University, Halifax, Nova Scotia.
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Sibley AK, Tallon JM, Day AL, Ackroyd-Stolarz S. Occupational injuries and stressors among Canadian air medical health care professionals in rotor-wing programs. Air Med J 2005; 24:252-7. [PMID: 16314280 DOI: 10.1016/j.amj.2005.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Air medical health care providers work in a unique environment that may affect occupational injury rates and patterns. Despite this knowledge, little high-quality evidence exists regarding occupational injuries specifically incurred by air medical health care professionals. We sought to characterize the epidemiology of occupational injuries experienced by Canadian rotor-wing health care providers. METHODS A survey was sent to the 4 rotor-wing programs in Canada. All crewmembers participating directly in patient care were asked to complete the survey detailing any acute occupational injuries sustained within the previous year. A series of both open- and closed-ended questions was used to collect participant demographics and information regarding any injuries sustained. RESULTS One hundred and six (40.6%) participants completed the survey. Three hundred and thirty acute injuries were reported. Hand lacerations and leg contusions were most prevalent (31 and 24 individuals incurred these injuries, respectively). Acute back injuries were also prevalent with 25 (23.6%) participants reporting at least one back injury. Overall, an injury rate of 3.2 injuries per person per year was reported. Lifting was cited as a common factor in injury (30 cases). Most injuries required little treatment, with only 17 needing physician intervention, and only 6 required more than 1 week off work. CONCLUSION Injuries among Canadian air medical crews are common, but fortunately, the majority are minor. Specific injury prevention strategies may focus on stretcher design, cabin ergonomics, and extremity protective equipment.
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Affiliation(s)
- Aaron K Sibley
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
INTRODUCTION EHS LifeFlight, the air medical transport program for the province of Nova Scotia, is a rotor-wing program with fixed-wing backup. It flies more than 600 missions per year, but a varying, significant number of other requested missions are aborted. The purpose of this study was to examine the reasons for these cancellations and related pertinent descriptive data and evaluate the potential implications for patient care and quality service. METHODS This study is a descriptive, retrospective review of all aborted missions between July 1, 1997, and June 30, 2001. Data source was the EHS LifeFlight computer patient care record database. RESULTS A total of 2723 air medical requests were received during the study period. Of these, 1846 were completed flight missions (68%) and 876 were aborted missions (32%). Reasons for aborted missions included weather (30%), aircraft not required/not appropriate (27%), aborted by medical control physician (15%), aircraft out on another mission (11%), aircraft down for maintenance (9%), patient died before aircraft arrival (5%), no suitable landing zone (2%), and other (1%). CONCLUSIONS A significant percentage of requested missions are aborted in this program. Reasons vary, but 20% of missions canceled could have been performed with the availability of a second dedicated aircraft. Overall, weather is the number 1 reason for aborting a mission.
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Affiliation(s)
- Jill Lawless
- Nova Scotia Trauma Program, Halifax, Nova Scotia, Canada
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Tallon JM, Fell D, Ackroyd-Stolarz S, Petrie D. I NFLUENCE OF AN EWP ROVINCE-WIDET RAUMAS YSTEM ONM OTORV EHICLET RAUMAC ARE ANDO UTCOMES. PREHOSP EMERG CARE 2004. [DOI: 10.1080/312703003289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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LeBlanc CH, Tallon JM, Ackroyd-Stolarz S. Geriatric air medical transport: a program review. Air Med J 2002; 21:38-40. [PMID: 12166398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The purpose of this study is to descriptively review the air medical transport of geriatric patients within the provincial air medical program of Nova Scotia. METHODS This study was based on a retrospective review of charts from March 14, 1996, to February 24, 1998, and included patients 65 years or older transported by air ambulance. All trauma and nontrauma missions were included in the program's adult services component (more than 15 years old). The total population served is approximately 1 million. RESULTS Fifty-nine geriatric patients were transported from a total of 175 adult missions during the study period, representing 33.7% of the adult services total. Nontrauma missions numbered 48 (81.3%), with the remainder (11, 18.6%) being trauma. Overall mortality in our study cohort was 32.2%. CONCLUSION Air medical transport usually is associated with trauma transport of the younger patient. This program review demonstrates that one-third of adult air medical transports in this province are for patients older than 65 who are critically ill, though often with nontrauma conditions, and are associated with a high mortality rate. Air medical transport programs should have strategies, education, and protocols that reflect the unique pathophysiology of the elderly.
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Affiliation(s)
- Connie H LeBlanc
- Deparment of Emergeny Medicine, QEII Health Science Centre, Halifax, Nova Scotia, Canada
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Abstract
PURPOSE To review and characterize 4 years of experience with suggested nontraumatic aortic emergencies (dissections/ruptures) transported by a new, provincially dedicated rotor-wing air medical program METHODS Retrospective 4-year review of air medical program's mission records and review of related hospital records. Patients listed as suspected aortic emergencies (nontraumatic) in the air medical records were included. Mission records were reviewed for EMS diagnosis, blood pressures before and after transport, transport times, and mortality. Hospital records were reviewed for diagnosis, interventions/treatment, and mortality. Blood pressures below 80 mmHg systolic were considered hemodynamically unstable. RESULTS A cohort of 34 patients were identified, of whom 31 (91%) arrived at the hospital alive. Twenty-five patients (74%) arrived hemodynamically stable, with a mean out-of-hospital time of 60 minutes, and nine patients (26%) were hemodynamically unstable (mean out-of-hospital time was 54 minutes). No significant difference arose in times between these two groups (P = 0.16). Overall mortality was 53% (18). Differences in transport time between survivors and deaths was not statistically significant (P = 0.93). The diagnoses on admission to hospital: 14 (41%) were RAAA, five (15%) AAA no rupture, eight (24%) aortic dissections, and four (12%) had no aortic pathology. Seventeen patients (50%) received emergent surgical intervention. The EMS diagnosis was correct in 76% of cases. CONCLUSION Our program transported 34 suspected aortic emergencies of which 17 were immediate surgical candidates on arrival. Aortic emergencies are not infrequent within our program. Specific policies and procedures based on continuing quality review should be in place to optimize the transport and care of these patients.
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Affiliation(s)
- Alex D Mitchell
- Queen Elizabeth II Health Sciences Centre, Division of Emergency Medicine, EHS Lifeflight of Nova Scotia
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Tallon JM. Out of province, out of sight. CMAJ 2000; 162:1276-7. [PMID: 10813007 PMCID: PMC1232406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Keyes PD, Tallon JM, Rizos J. Topical anesthesia. Can Fam Physician 1998; 44:2152-6. [PMID: 9805170 PMCID: PMC2277899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To consider topical anesthetic options available to primary care physicians, indications for their use, and efficacy and safety of these agents as supported by the literature. QUALITY OF EVIDENCE Five randomized controlled trials were retrieved that compared various topical anesthetics as well as topical anesthetics versus infiltrative anesthesia. MAIN FINDINGS A combination of lidocaine, epinephrine, and tetracaine (LET) is currently the topical anesthetic of choice for repair of simple lacerations involving the faces and scalps of children. A promising new topical preparation is bupivacaine and epinephrine, but its efficacy must be studied in larger populations before widespread use can be advocated. Using EMLA (eutectic mixture of local anesthetics) for repair of extremity lacerations requires further study and cannot yet be recommended. Continued use of topical tetracaine, adrenaline, and cocaine (TAC) is not supported in the literature, because of its greater expense, its status as a restricted narcotic, its potential for toxicity, and better availability of an equally efficacious alternative, LET. CONCLUSIONS Children's simple facial and scalp lacerations can be safely repaired using topical LET gel. Physicians must adhere to recommendations to avoid mucous membrane contact and ensure appropriate dosing with these agents. Bupivacaine-epinephrine topical preparation is a promising analgesic agent that warrants further study.
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Affiliation(s)
- P D Keyes
- Division of Emergency Medicine, Dalhousie University, Halifax
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Rizos JD, DiGravio BE, Sehl MJ, Tallon JM. The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department. J Emerg Med 1998; 16:535-9. [PMID: 9696166 DOI: 10.1016/s0736-4679(98)00055-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This prospective cohort study evaluated the effectiveness and safety of a selective discharge policy for patients treated with racemic epinephrine (RE) and intramuscular (IM) dexamethasone (DEX) in the emergency department (ED). Children younger than 13 years of age presenting to the ED with croup who were treated with RE and IM DEX and discharged home were enrolled in the study. Patients were discharged home if they were free of intercostal retractions and stridor at rest, following a 2 h observation period. Telephone follow up determined whether further medical attention for croup was required within 48 h of discharge from the ED. Eighty-two patients were enrolled in the study over a one year period. Six of these patients (7%) required follow up for croup within 48 h of discharge and 2 (2%) required admission. We conclude that a subset of patients with croup treated with RE and IM DEX in the ED can be safely discharged home.
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Affiliation(s)
- J D Rizos
- Department of Emergency Medicine, Kitchener-Waterloo Hospital, Ontario, Canada
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Tallon JM. Canadian physicians in wartime. CMAJ 1994; 150:1944-5. [PMID: 8199974 PMCID: PMC1337003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Tallon JM. CT before lumbar puncture. CMAJ 1994; 150:464-5. [PMID: 8155155 PMCID: PMC1486307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Tallon JM. Improving the lot of emergency physicians. CMAJ 1993; 149:1227, 1230. [PMID: 8221470 PMCID: PMC1485714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Tallon JM, Montoya DR. Echocardiography to rule out metastatic disease. Ann Emerg Med 1990; 19:1355. [PMID: 2240742 DOI: 10.1016/s0196-0644(05)82325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Metastatic tumors to the heart are becoming more common due to improved survival afforded by advanced treatment of malignancies. Their presence should be sought in a cancer patient who develops new primary cardiac symptoms. We present a case of a 50-year-old woman who succumbed to acute cor pulmonale secondary to metastatic laryngeal carcinoma to the right ventricle with subsequent tumor emboli to the pulmonary vasculature.
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Affiliation(s)
- J M Tallon
- Emergency Medicine Associates KW, Kitchener, Ontario, Canada
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