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1. Off-Road Vehicle Crash Risk during the Six Months after a Birthday.

Author

Jason D Woodfine, Deva Thiruchelvam, and Donald A Redelmeier

Subjects
Medicine, Science
Abstract

Off-road vehicles are popular and thrilling for youth outside urban settings, yet sometimes result in a serious crash that requires emergency medical care. The relation between birthdays and the subsequent risk of an off-road vehicle crash is unknown.We conducted a population-based before-and-after longitudinal analysis of youth who received emergency medical care in Ontario, Canada, due to an off-road vehicle crash between April 1, 2002, and March 31, 2014. We identified youth injured in an off-road vehicle crash through population-based health-care databases of individuals treated for medical emergencies. We included youth aged 19 years or younger, distinguishing juniors (age ≤ 15 years) from juveniles (age ≥ 16 years).A total 32,777 youths accounted for 35,202 emergencies due to off-road vehicle crashes within six months of their nearest birthday. Comparing the six months following a birthday to the six months prior to a birthday, crashes increased by about 2.7 events per 1000 juniors (18.3 vs 21.0, p < 0.0001). The difference equaled a 15% increase in relative risk (95% confidence interval 12 to 18). The increase extended for months following a birthday, was not observed for traffic crashes due to on-road vehicles, and was partially explained by a lack of helmet wearing. As expected, off-road crash risks did not change significantly following a birthday among juveniles (19.2 vs 19.8, p = 0.61).Off-road vehicle crashes leading to emergency medical care increase following a birthday in youth below age 16 years. An awareness of this association might inform public health messages, gift-giving practices, age-related parental permissions, and prevention by primary care physicians.

Published
2016
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2. Criteria for Hyponatremic Overcorrection: Systematic Review and Cohort Study of Emergently Ill Patients

Author

Carl van Walraven and Jason D. Woodfine

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Hospitalized patients, 010102 general mathematics, English language, Emergency department, Electrolyte disturbance, medicine.disease, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Cohort, Internal Medicine, Medicine, In patient, 030212 general & internal medicine, 0101 mathematics, business, Hyponatremia, Cohort study
Abstract

Hyponatremia is the most common electrolyte disturbance amongst hospitalized patients. An overly rapid rate of correction of chronic hyponatremia is believed to increase the risk of poor clinical outcomes including osmotic demyelination syndrome (ODS). There is disagreement in the literature regarding the definition of hyponatremic overcorrection. We performed a systematic review of all English language studies to identify those that calculated sodium correction rate and classified patients’ overcorrection status. We then identified all patients who presented to our hospital’s emergency department between 2003 and 2015 with a corrected serum sodium ≤ 116 mmol/L. All methods from the systematic review for sodium correction rate calculation and overcorrection status were applied to this cohort. We identified 24 studies citing 9 distinct sodium correction rate methods and 14 criteria for overcorrection. Six hundred twenty-four patients presenting with severe hyponatremia (median initial value 113 mMol) were identified. Depending on the method used, the median sodium correction rates in our cohort ranged from 0.271 to 1.13 mmol/L per hour. The proportion of patients classified with overcorrection with the different criteria varied almost 11-fold, ranging from 8.5 to 89.9%. Published methods disagree regarding the calculation of sodium correction rates and the definition of hyponatremic overcorrection. This leads to wide variations in sodium correction rates and the prevalence of overcorrection in patient cohorts. Definitions based on ODS risk are needed.

Published
2019
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3. Derivation and Validation of a Novel Risk Score to Predict Overcorrection of Severe Hyponatremia

Author

Jason D. Woodfine, Rodrigo B. Cavalcanti, Thomas E. MacMillan, Manish M. Sood, and Carl van Walraven

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Epidemiology, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Transplantation, Framingham Risk Score, business.industry, Sodium, Original Articles, Emergency department, Middle Aged, medicine.disease, Hypokalemia, Nephrology, Vomiting, Female, medicine.symptom, Complication, Hyponatremia, business, Acid–base imbalance, Cohort study
Abstract

BACKGROUND AND OBJECTIVES: Osmotic demyelination syndrome is the most concerning complication of severe hyponatremia, occurring with an overly rapid rate of serum sodium correction. There are limited clinical tools to aid in identifying individuals at high risk of overcorrection with severe hyponatremia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We identified all patients who presented to a tertiary-care hospital emergency department in Ottawa, Canada (catchment area 1.2 million) between January 1, 2003 and December 31, 2015, with serum sodium (corrected for glucose levels)

Published
2019
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4. Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis

Author

Sam Schulman, Marc Carrier, Jason D. Woodfine, Joseph R. Shaw, and James D. Douketis

Subjects
anticoagulants, medicine.medical_specialty, review, 030204 cardiovascular system & hematology, Post surgery, Vitamin k, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, atrial fibrillation, In patient, 030212 general & internal medicine, business.industry, Atrial fibrillation, Hematology, Perioperative, medicine.disease, meta‐analysis, Meta-analysis, Original Article, hemorrhage, business, Original Articles: Thrombosis, Major bleeding, Systematic search
Abstract

Essentials Little evidence exists to guide procedural interruption of direct oral anticoagulants (DOACs). Conducted a meta-analysis of the interruption of DOACs in patients with atrial fibrillation (AF). The 30-day risk for thromboembolic and major bleeding events were 0.4% and 1.8%, respectively. Perioperative interruption of DOACs in patients with AF appears to be safe and effective. Background Patients with atrial fibrillation (AF) frequently undergo invasive procedures that require temporary interruption of anticoagulation. There is little evidence to guide the perioperative interruption of direct oral anticoagulants (DOACs). Methods A systematic literature search including studies that evaluated the perioperative interruption of DOACs for non-emergent invasive procedures in patients with AF was performed. The primary outcomes of interest were the 30-day risk of thromboembolic events and major bleeding. Secondary outcomes of interest included the 30-day risk of minor bleeding and overall mortality. The systematic review protocol and search strategy were registered online (PROSPERO January 27th 2017:CRD42017056124). Results A total of 8 publications encompassing 14 446 patients and 17 107 periprocedural interruptions were included in our study. Our analysis revealed a pooled postoperative 30-day thromboembolic complication risk of 0.41% (95% CI 0.29- 0.54), and a pooled 30-day postoperative major bleeding risk of 1.81% (95% CI 0.84-3.13). Pooled 30-day postoperative risks of minor bleeding and overall mortality were 3.08% (95% CI 1.02-6.20) and 0.67% (95% CI 0.29-1.23), respectively. Meta-analysis of the included comparative studies did not reveal any significant differences in these postoperative outcomes following the perioperative interruption of DOACs or vitamin K antagonists. Conclusions The perioperative interruption of DOACs in patients with AF was associated with 0.4% thromboembolic and 1.8% major bleeding events at 30 days post surgery. These findings seem reassuring, but require validation in large prospective management studies where pre-operative DOAC levels are measured and compared with clinical outcomes in this patient population.

Published
2018
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5. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Flavia K Borges, Mohit Bhandari, Ernesto Guerra-Farfan, Ameen Patel, Alben Sigamani, Masood Umer, Maria E Tiboni, Maria del Mar Villar-Casares, Vikas Tandon, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Victoria RA Avram, Mitchell Winemaker, Mmampapatla T Ramokgopa, Wojciech Szczeklik, Giovanni Landoni, Chew Yin Wang, Dilshad Begum, John D Neary, Anthony Adili, Parag K Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Paweł Ślęczka, Richard J Jenkinson, Aamer Nabi Nur, Gavin CA Wood, Robert J Feibel, Stephen J McMahon, Alen Sigamani, Ekaterine Popova, Bruce M Biccard, Iain K Moppett, Patrice Forget, Paul Landais, Michael H McGillion, Jessica Vincent, Kumar Balasubramanian, Valerie Harvey, Yaiza Garcia-Sanchez, Shirley M Pettit, Leslie P Gauthier, Gordon H Guyatt, David Conen, Amit X Garg, Shrikant I Bangdiwala, Emilie P Belley-Cote, Maura Marcucci, Andre Lamy, Richard Whitlock, Yannick Le Manach, Dean A Fergusson, Salim Yusuf, PJ Devereaux, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean Cyr Yombi, Nassim Touil, Maike Reul, Jigme Tshering Bhutia, Carol Clinckaert, Dirk De Clippeleir, Justin de Beer, Diane L Simpson, Andrew Worster, Kim A Alvarado, Krysten K Gregus, Kelly H Lawrence, Darryl P Leong, Philip G Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J Wood, Daniel M Tushinski, David AJ Wilson, Clive Kearon, David D Cowan, Vickas Khanna, Amna Zaki, Janet C Farrell, Anne Marie MacDonald, Steven CW Wong, Arsha Karbassi, Douglas Steven Wright, Harsha Shanthanna, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D Macleod, David W Sanders, Edward Vasarhelyi, Debra Bartley, George K Dresser, Christina Tieszer, Steven Shadowitz, Jacques S Lee, Stephen Choi, Hans J Kreder, Markku Nousiainen, Monica R Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David JG Stephen, Diane Nam, Patrick DG Henry, Stephen M Mann, Melanie T Jaeger, Marco LA Sivilotti, Christopher A Smith, Christopher C Frank, Heather Grant, Leone Ploeg, Jeff D Yach, Mark M Harrison, Aaron R Campbell, Ryan T Bicknell, Davide D Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J Hadden, Brian P-J Chen, Stephanie A Coupal, Lisa M McLean, Hemant R Shirali, Syed Y Haider, Crystal A Smith, Evan Watts, David J Santone, Kevin Koo, Allan J Yee, Ademilola N Oyenubi, Aaron Nauth, Emil H Schemitsch, Timothy R Daniels, Sarah E Ward, Jeremy A Hall, Henry Ahn, Daniel B Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P Coles, Kelly Trask, Shelley MacDonald, J Andrew I Trenholm, William Oxner, C Glen Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J White, Loretta Olivieri, Stephen B Hunt, Thomas R Turgeon, Eric R Bohm, Sarah Tran, Stephen M Giilck, Tom Hupel, Pierre Guy, Peter J O'Brien, Andrew W Duncan, Gordon A Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan Manuel Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Sebastien Beroud, Jean Marie Fayet, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag Kantilal Sancheti, Chetan Vijay Pradhan, Atul Ashok Patil, Chetan Prabhakar Puram, Madhav Pandurang Borate, Kiran Bhalchandra Kudrimoti, Bharati Anil Adhye, Himanshu Vijaykumar Dongre, Bobby John, Valsamma Abraham, Ritesh Arvind Pandey, Arti Rajkumar, Preetha Elizabeth George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, AM Georgekutty, Ahamad Shaheel Sulthan, S Adinarayanan, Deep Sharma, Satish Prasad Barnawal, Srinivasan Swaminathan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Jagdish Menon, Niranjan M, Varghese Zachariah K, Santosh Angad Hiremath, Madhusudhan NC, Abhijit Jawali, Kingsly Robert Gnanadurai, Carolin Elizabeth George, Tatarao Maddipati, Mary KP KP, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem Haridas Menon, Mandeep S Dhillon, Devendra K Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth Nabhirajappa Bilchod, Surya Udai Singh, Uttam Vaidya Gattu, Ravi Prabhakar Dashputra, Prashant Vitthal Rahate, Maurizio Turiel, Giuseppe De Blasio, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Eleonora Colnaghi, Vincenzo Salini, Giuseppe Denaro, Luigi Beretta, Giacomo Placella, Giuseppe Giardina, Mirko Binda, Anna Marcato, Luca Guzzetti, Fabio Piccirillo, Maurizio Cecconi, HM Khor, Hou Yee Lai, CS Kumar, KH Chee, PS Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL Ngim, Huck Wee Boon, Im Im Chin, Ydo V Kleinlugtenbelt, Ellie BM Landman, Elvira R Flikweert, Herbert W Roerdink, Roy B.G. Brokelman, Hannie F Elskamp-Meijerman, Maarten R Horst, Jan-Hein MG Cobben, Anila Anjum, Pervaiz Mehmood Hashmi, Tashfeen Ahmed, Haroon Ur Rashid, Mujahid Jamil Khattak, Rizwan Haroon Rashid, Riaz Hussain Lakdawala, Shahryar Noordin, Naveed Muhammed Juman, Robyna Irshad Khan, Muhammad Mehmood Riaz, Syedah Saira Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad Naqi Khan, Eraj Khurshid Khan, Kholood Abid Janjua, Sajjad Hassan Orakzai, Abdus Salam Khan, Khawaja Junaid Mustafa, Mian Amjad Sohail, Muhammad Umar, Siddra Ahmed Khan, Muhammad Ashraf, Muhammad Kashif Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla Thomas Ramokgopa, Gregory Bodley Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad Nasir Iqbal, Ryan Jonathan Campbell, Matimba Lenny Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B Nejthardt, Sean Chetty, Rubendren Naidoo, Miriam Garrido Clua, Vicente Molero-Garcia, Joan Minguell-Monyart, Jordi Selga Marsa, Juan A Porcel-Vazquez, Jose-Vicente Andres-Peiro, Marc Aguilar, Jaume Mestre-Torres, Maria J Colomina, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pedro Martinez-Ripol, MA Gonzalez Posada, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Pere Torner, Monsant Jornet-Gibert, Jorge Serrano-Sanz, Jaume Cámara-Cabrera, Mònica Salomó-Domènech, Christian Yela-Verdú, Anna Peig-Font, Laura Ricol, Anna Carreras-Castañer, Luis Martínez-Sañudo, Susana Herranz, Carlos Feijoo-Massó, Mònica Sianes-Gallén, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javiera Abarca, Cristina Estrada, Marga Novellas, Mercè Torra, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, JL Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J Aguado, Gonzalo Martinez-Municio, Ricardo León, Silvia Santiago-Maniega, Ana Zabalza, Gregorio Labrador, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Jose Manuel Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam Adel Kadry, Surendini Thayaparan, Ihab Abdlaziz, Arash Aframian, Arjuna Imbuldeniya, Souad Bentoumi, Sherif Omran, Marcela Paola Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE Mayor, Sally Dillingham, Laura Nicholson, Mohamed Elnaggar, Joby John, Shashi Kumar Nanjayan, Martyn J Parker, Susan O'Sullivan, Meir T Marmor, Amir Matityahu, Robert Trigg McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Gerard Slobogean, Katherine Joseph, Robert O'Toole, Marcus Sciadini, Scott P Ryan, Molly E Clark, Charles Cassidy, Konstantin Balonov, Sergio D Bergese, Laura S Phieffer, Alicia A Gonzalez Zacarias, Andrew J Marcantonio, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R Wells, Sandra N Ofori, Stephen S Yang, Michael K Wang, Emmanuelle Duceppe, Jessica Spence, Javiera P Vasquez, Francesc Marcano-Fernández, Hyungjoo Ham, Carlos Prada, Terence CH Yung, Isidro Sanz Pérez, Michael J Bosch, Michael R Prystajecky, Chinmoy Chowdhury, James S Khan, Steffan F Stella, Behrouz Heidary, Allen Tran, Katarzyna Wawrzycka-Adamczyk, Yu Chiao Peter Chen, Aránzazu González-Osuna, Grzegorz Biedroń, Anna Wludarczyk, Marco Lefebvre, Jaclyn A Ernst, Bas Staffhorst, Jason D Woodfine, Emad M Alwafi, Marko Mrkobrada, Simon Parlow, Robin Roberts, Finlay McAlister, David Sackett, James Wright, (HIP ATTACK, Investigators), Landoni, G., Faculty of Medicine and Pharmacy, Orthopaedics - Traumatology, Supporting clinical sciences, Emergency Medicine, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Postoperative Complications/epidemiology, Male, Internationality, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip, Myocardial Ischemia, Comorbidity, Time-to-Treatment/statistics & numerical data, 030204 cardiovascular system & hematology, law.invention, Fracture Fixation, Internal, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Residence Characteristics, law, Activities of Daily Living, Fracture fixation, Risk of mortality, Medicine and Health Sciences, Fracture Fixation, Internal/methods, Sepsis/epidemiology, 030212 general & internal medicine, Cardiovascular Diseases/mortality, Stroke, Aged, 80 and over, Hip fracture, Residence Characteristics/statistics & numerical data, Infections/epidemiology, General Medicine, Middle Aged, Open Fracture Reduction, Treatment Outcome, Cardiovascular Diseases, Diabetes Mellitus/epidemiology, Female, medicine.medical_specialty, Hip Fractures/epidemiology, Postoperative Hemorrhage, Infections, Early Medical Intervention/methods, Time-to-Treatment, 03 medical and health sciences, Arthroplasty, Replacement, Hip/methods, Early Medical Intervention, Sepsis, Diabetes Mellitus, medicine, Humans, Mortality, Myocardial Ischemia/epidemiology, Aged, Proportional Hazards Models, Postoperative Hemorrhage/epidemiology, Hip Fractures, Proportional hazards model, business.industry, Hemiarthroplasty/methods, Dementia/epidemiology, Delirium, Delirium/epidemiology, medicine.disease, Femoral Neck Fractures, Nursing Homes, Surgery, Open Fracture Reduction/methods, Dementia, Observational study, Hemiarthroplasty, business
Abstract

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Published
2020

6. Should emergentologists follow up on patients diagnosed with UTI having negative urine cultures? Implications for processing post-discharge laboratory results

Author

Carl van Walraven and Jason D. Woodfine

Subjects
Male, medicine.medical_specialty, medicine.drug_class, Urinary system, Antibiotics, Urine, 03 medical and health sciences, Internal medicine, medicine, Dementia, Humans, Geriatric Assessment, Aged, Retrospective Studies, Geriatrics, Aged, 80 and over, Medical Audit, business.industry, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Retrospective cohort study, Emergency department, medicine.disease, Laboratory results, Patient Discharge, Urinary Tract Infections, Female, 0305 other medical science, business, Emergency Service, Hospital
Abstract

OBJECTIVES After patients are discharged from the emergency department (ED), follow-up of test results focuses on abnormal values. In the elderly, non-specific symptoms can result in an incorrect diagnosis of urinary tract infection (UTI). This study compared the outcomes of patients discharged from the ED with a diagnosis of UTI based on urine culture results. METHODS We conducted a retrospective cohort study using linked health databases and chart review of a random sample of elderly patients (age > 65 years) discharged from the Ottawa Hospital ED between 2006 and 2014 with a diagnosis of UTI. Patients were categorized based on whether urine cultures were positive and bacterial sensitivity to prescribed antibiotics. Primary outcome was return to ED, admission to hospital, or death within 30 days. RESULTS A total of 1001 patients were included in the study (401 culture-negative; 474 culture-positive antibiotic-sensitive; 126 culture positive antibiotic-insensitive). Patients were elderly (mean age 80 years, SD 7.6) with a high prevalence of dementia (18.0%). Almost a third of patients (n = 313, 31.3%) experienced an outcome. Compared to culture-positive antibiotic-sensitive patients, culture negative patients (adjOR 1.45, 95% CI 1.07-1.97) and culture-positive antibiotic-insensitive patients (adjOR 1.49, 95% CI 0.90-2.14) were significantly more likely to experience an outcome (P = 0.04). CONCLUSIONS Patients discharged from the ED with a diagnosis of UTI have an increased risk of return to ED, urgent readmission or death if the uropathogen is insensitive to the prescribed antibiotic or if the culture is negative. Patients diagnosed with UTI with a negative culture may need further assessment.

Published
2018

7. Maternal organ donation and acute injuries in surviving children

Author

Jason D. Woodfine, Damon C. Scales, Deva Thiruchelvam, and Donald A. Redelmeier

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Tissue and Organ Procurement, Adolescent, Poison control, Critical Care and Intensive Care Medicine, Suicide prevention, Occupational safety and health, Organ transplantation, Cohort Studies, Cause of Death, Injury prevention, Confidence Intervals, medicine, Humans, Longitudinal Studies, Survivors, Organ donation, Child, Intensive care medicine, Cerebral Hemorrhage, Ontario, business.industry, Human factors and ergonomics, Middle Aged, Subarachnoid Hemorrhage, Tissue Donors, Socioeconomic Factors, Brain Injuries, Child, Preschool, Maternal Death, Wounds and Injuries, Female, business, Algorithms, Cohort study
Abstract

The purpose of this study is to test whether maternal deceased organ donation is associated with rates of subsequent acute injuries among surviving children after their mother's death.This is a longitudinal cohort analysis of children linked to mothers who died of a catastrophic brain event in Ontario, Canada, between April 1988 and March 2012. Surviving children were distinguished by whether their mother was an organ donor after death. The primary outcome was an acute injury event in surviving children during the year after their mother's death.Surviving children (n=454) had a total of 293 injury events during the year after their mother's death, equivalent to an average of 65 events per 100 children per year and a significant difference comparing children of mothers who were organ donors to children of mothers who were not organ donors (21 vs 82, P.001). This difference in subsequent injury rates between groups was equal to a 76% relative reduction in risk (95% confidence interval, 62%-85%).Deceased organ donation was associated with a reduction in excess acute injuries among surviving children after their mother's death. An awareness of this positive association provides some reassurance about deceased organ donation programs.

Published
2014
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8. Deceased organ donation and the Nicholas effect

Author

Jason D. Woodfine and Donald A. Redelmeier

Subjects
Male, Transplantation, medicine.medical_specialty, Brain Death, Health Knowledge, Attitudes, Practice, Chi-Square Distribution, Tissue and Organ Procurement, business.industry, Awareness, Gift Giving, Altruism, Tissue Donors, Appointments and Schedules, Health Care Surveys, Surveys and Questionnaires, medicine, Humans, Organ donation, Empathy, Intensive care medicine, business, Child, Language
Published
2013

9. Mo1140 Underuse of Iron Therapy Upon Discharge for Anemic Patients With Acute Gastrointestinal Bleeding

Author

Joshua Bernick, Zane Gallinger, Michael Bernstein, Kyle J. Fortinsky, Alan N. Barkun, Yulia Lin, Myriam Martel, Samir C. Grover, Arnav Agarwal, Adam Weizman, Lukasz Kwapisz, and Jason D. Woodfine

Subjects
Patient discharge, Gastrointestinal bleeding, medicine.medical_specialty, Hepatology, Anemia, Acute gastrointestinal bleeding, business.industry, Gastroenterology, medicine.disease, medicine, Intensive care medicine, business, Acute gastrointestinal hemorrhage, Iron therapy
Published
2016
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10. New Thinking About Honor and Deceased Organ Donation

Author

Jason D. Woodfine and Donald A. Redelmeier

Subjects
Tissue and Organ Procurement, business.industry, Economics, Behavioral, Altruism (ethics), MEDLINE, General Medicine, Altruism, Tissue Donors, United States, Professional-Family Relations, Honor, Humans, Medicine, Organ donation, business, Social psychology
Published
2014
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