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Article: Delayed sequence intubation: is it ready for prime time?

Taylor, John A / Hohl, Corinne Michele

2017 Volume 19, Issue 1, Page(s) 68–70

Abstract: Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational ... ...

Abstract	Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation.
MeSH term(s)	Adult ; Anesthetics, Dissociative/administration & dosage ; Cohort Studies ; Conscious Sedation/methods ; Critical Care/methods ; Drug Administration Schedule ; Female ; Humans ; Intubation, Intratracheal/methods ; Ketamine/administration & dosage ; Male ; Muscle Relaxants, Central/administration & dosage ; Oxygen Consumption/physiology ; Patient Compliance ; Prospective Studies ; Time Factors ; Treatment Outcome
Chemical Substances	Anesthetics, Dissociative ; Muscle Relaxants, Central ; Ketamine (690G0D6V8H)
Language	English
Publishing date	2017-01
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2059217-6
ISSN	1481-8035 ; 1481-8035 ; 1488-1543
ISSN (online)	1481-8035
ISSN	1481-8035 ; 1488-1543
DOI	10.1017/cem.2016.13
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Article ; Online: A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department.

Hohl, Corinne Michèle / Nosyk, Bohdan / Sadatsafavi, Mohsen / Anis, Aslam Hayat

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2008 Volume 15, Issue 1, Page(s) 32–39

Abstract: Objectives: To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED).: Methods: The authors conducted a cost-effectiveness analysis from the perspective ...

Abstract	Objectives: To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED). Methods: The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared to midazolam. A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated. The authors derived estimates of clinical effectiveness and risk of adverse events (AEs) from a systematic review. The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit, the cost of the drug, the cost of labor of physicians and nurses, the cost and probability of an AE, and the cost and probability of a PS failure. A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation. Results: Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed. This resulted in an incremental cost-effectiveness ratio of -$597.03 (95% credibility interval -$6,434.03 to $6,113.57) indicating savings of $597.03 per additional successful sedation performed with propofol. This result was driven by shorter recovery times and was robust to all sensitivity analyses performed. Conclusions: These results indicate that using propofol for PS in the ED is a cost-saving strategy.
MeSH term(s)	Conscious Sedation/economics ; Conscious Sedation/instrumentation ; Cost-Benefit Analysis ; Drug Costs ; Emergency Service, Hospital/economics ; Humans ; Hypnotics and Sedatives/economics ; Hypnotics and Sedatives/therapeutic use ; Midazolam/economics ; Midazolam/therapeutic use ; North America ; Propofol/economics ; Propofol/therapeutic use
Chemical Substances	Hypnotics and Sedatives ; Midazolam (R60L0SM5BC) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2008-01
Publishing country	United States
Document type	Comparative Study ; Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/j.1553-2712.2007.00023.x
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Article ; Online: Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review.

Hohl, Corinne Michèle / Sadatsafavi, Mohsen / Nosyk, Bohdan / Anis, Aslam Hayat

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2008 Volume 15, Issue 1, Page(s) 1–8

Abstract: Objectives: To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting.: Methods: The authors conducted a systematic ... ...

Abstract	Objectives: To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting. Methods: The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and/or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS. Results: Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2). Conclusions: The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.
MeSH term(s)	Adult ; Conscious Sedation/instrumentation ; Emergency Medical Services/methods ; Humans ; Hypnotics and Sedatives/therapeutic use ; Midazolam/therapeutic use ; Outcome and Process Assessment (Health Care) ; Propofol/therapeutic use ; Treatment Outcome
Chemical Substances	Hypnotics and Sedatives ; Midazolam (R60L0SM5BC) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2008-01
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/j.1553-2712.2007.00022.x
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Article ; Online: Accuracy of Self-Reported COVID-19 Vaccination Status Compared With a Public Health Vaccination Registry in Québec: Observational Diagnostic Study.

Archambault, Patrick M / Rosychuk, Rhonda J / Audet, Martyne / Bola, Rajan / Vatanpour, Shabnam / Brooks, Steven C / Daoust, Raoul / Clark, Gregory / Grant, Lars / Vaillancourt, Samuel / Welsford, Michelle / Morrison, Laurie J / Hohl, Corinne M

JMIR public health and surveillance

2023 Volume 9, Page(s) e44465

Abstract: Background: The accuracy of self-reported vaccination status is important to guide real-world vaccine effectiveness studies and policy making in jurisdictions where access to electronic vaccine registries is restricted.: Objective: This study aimed ... ...

Abstract	Background: The accuracy of self-reported vaccination status is important to guide real-world vaccine effectiveness studies and policy making in jurisdictions where access to electronic vaccine registries is restricted. Objective: This study aimed to determine the accuracy of self-reported vaccination status and reliability of the self-reported number of doses, brand, and time of vaccine administration. Methods: This diagnostic accuracy study was completed by the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive patients presenting to 4 emergency departments (EDs) in Québec between March 24, 2020, and December 25, 2021. We included adult patients who were able to consent, could speak English or French, and had a proven COVID-19 infection. We compared the self-reported vaccination status of the patients with their vaccination status in the electronic Québec Vaccination Registry. Our primary outcome was the accuracy of the self-reported vaccination status (index test) ascertained during telephone follow-up compared with the Québec Vaccination Registry (reference standard). The accuracy was calculated by dividing all correctly self-reported vaccinated and unvaccinated participants by the sum of all correctly and incorrectly self-reported vaccinated and unvaccinated participants. We also reported interrater agreement with the reference standard as measured by unweighted Cohen κ for self-reported vaccination status at telephone follow-up and at the time of their index ED visit, number of vaccine doses, and brand. Results: During the study period, we included 1361 participants. At the time of the follow-up interview, 932 participants reported at least 1 dose of a COVID-19 vaccine. The accuracy of the self-reported vaccination status was 96% (95% CI 95%-97%). Cohen κ for self-reported vaccination status at phone follow-up was 0.91 (95% CI 0.89-0.93) and 0.85 (95% CI 0.77-0.92) at the time of their index ED visit. Cohen κ was 0.89 (95% CI 0.87-0.91) for the number of doses, 0.80 (95% CI 0.75-0.84) for the brand of the first dose, 0.76 (95% CI 0.70-0.83) for the brand of the second dose, and 0.59 (95% CI 0.34-0.83) for the brand of the third dose. Conclusions: We reported a high accuracy of self-reported vaccination status for adult patients without cognitive disorders who can express themselves in English or French. Researchers can use self-reported COVID-19 vaccination data on the number of doses received, vaccine brand name, and timing of vaccination to guide future research with patients who are capable of self-reporting their vaccination data. However, access to official electronic vaccine registries is still needed to determine the vaccination status in certain susceptible populations where self-reported vaccination data remain missing or impossible to obtain. Trial registration: Clinicaltrials.gov NCT04702945; https://clinicaltrials.gov/ct2/show/NCT04702945.
MeSH term(s)	Adult ; Humans ; Canada ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Testing ; COVID-19 Vaccines ; Quebec/epidemiology ; Registries ; Reproducibility of Results ; Self Report ; Vaccination ; Vaccines
Chemical Substances	COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2023-06-16
Publishing country	Canada
Document type	Journal Article ; Observational Study
ISSN	2369-2960
ISSN (online)	2369-2960
DOI	10.2196/44465
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Article ; Online: Correction to: Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN).

Hohl, Corinne M / Rosychuk, Rhonda J / Hau, Jeffrey P / Hayward, Jake / Landes, Megan / Yan, Justin W / Ting, Daniel K / Welsford, Michelle / Archambault, Patrick M / Mercier, Eric / Chandra, Kavish / Davis, Philip / Vaillancourt, Samuel / Leeies, Murdoch / Small, Serena / Morrison, Laurie J

CJEM

2022 Volume 24, Issue 4, Page(s) 461–462

Language	English
Publishing date	2022-04-22
Publishing country	England
Document type	Published Erratum
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-022-00314-z
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Article ; Online: Intubation practices and outcomes for patients with suspected or confirmed COVID-19: a national observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN).

Leeies, Murdoch / Rosychuk, Rhonda J / Ismath, Muzeen / Xu, Ke / Archambault, Patrick / Fok, Patrick T / Audet, Thomas / Jelic, Tomislav / Hayward, Jake / Daoust, Raoul / Chandra, Kavish / Davis, Phil / Yan, Justin W / Hau, Jeffrey P / Welsford, Michelle / Brooks, Steven C / Hohl, Corinne M

CJEM

2023 Volume 25, Issue 4, Page(s) 335–343

Abstract: Objective: Intubation practices changed during the COVID-19 pandemic to protect healthcare workers from transmission of disease. Our objectives were to describe intubation characteristics and outcomes for patients tested for SARS CoV-2 infection. We ... ...

Abstract	Objective: Intubation practices changed during the COVID-19 pandemic to protect healthcare workers from transmission of disease. Our objectives were to describe intubation characteristics and outcomes for patients tested for SARS CoV-2 infection. We compared outcomes between patients testing SARS COV-2 positive with those testing negative. Methods: We conducted a health records review using the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. We included consecutive eligible patients who presented to one of 47 EDs across Canada between March 1, 2020 and June 20, 2021, were tested for SARS-CoV-2 and intubated in the ED. The primary outcome was the proportion of patients experiencing a post-intubation adverse event during the ED stay. Secondary outcomes included first-pass success, intubation practices, and hospital mortality. We used descriptive statistics to summarize variables with subgroup differences examined using t tests, z tests, or chi-squared tests where appropriate with 95% CIs. Results: Of 1720 patients with suspected COVID-19 who were intubated in the ED during the study period, 337 (19.6%) tested SARS-CoV-2 positive and 1383 (80.4%) SARS-CoV-2 negative. SARS-CoV-2 positive patients presented to hospital with lower oxygen levels than SARS-CoV-2 negative patients (mean pulse oximeter SaO2 86 vs 94%, p < 0.001). In total, 8.5% of patients experienced an adverse event post-intubation. More patients in the SARS-CoV-2 positive subgroup experienced post-intubation hypoxemia (4.5 vs 2.2%, p = 0.019). In-hospital mortality was greater for patients who experienced intubation-related adverse events (43.2 vs 33.2%, p = 0.018). There was no significant difference in adverse event-associated mortality by SARS-CoV-2 status. First-pass success was achieved in 92.4% of all intubations, with no difference by SARS-CoV-2 status. Conclusions: During the COVID-19 pandemic, we observed a low risk of adverse events associated with intubation, even though hypoxemia was common in patients with confirmed SARS-CoV-2. We observed high rates of first-pass success and low rates of inability to intubate. The limited number of adverse events precluded multivariate adjustments. Study findings should reassure emergency medicine practitioners that system modifications made to intubation processes in response to the COVID-19 pandemic do not appear to be associated with worse outcomes compared to pre-COVID-19 practices.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics ; Canada/epidemiology ; Intubation, Intratracheal/adverse effects ; Emergency Service, Hospital
Language	English
Publishing date	2023-04-05
Publishing country	England
Document type	Observational Study ; Journal Article
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-023-00487-1
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Article ; Online: Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department.

Hohl, Corinne Michèle / Robitaille, Caroline / Lord, Vicky / Dankoff, Jerrald / Colacone, Antoinette / Pham, Luc / Bérard, Anick / Pépin, Jocelyne / Afilalo, Marc

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2005 Volume 12, Issue 3, Page(s) 197–205

Abstract: Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug-related events (ADREs) in elder patients presenting to the emergency department (ED).: Methods: This was a prospective observational study of ... ...

Abstract	Objectives: The authors examined the ability of emergency physicians (EPs) to recognize adverse drug-related events (ADREs) in elder patients presenting to the emergency department (ED). Methods: This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review. Results: A total of 161 patients were enrolled in the study. Thirty-seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class. Conclusions: EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.
MeSH term(s)	Aged ; Diagnostic Errors/statistics & numerical data ; Drug Therapy/statistics & numerical data ; Drug-Related Side Effects and Adverse Reactions ; Emergency Medicine/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Outcome and Process Assessment (Health Care) ; Prospective Studies ; Quebec
Language	English
Publishing date	2005-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1197/j.aem.2004.08.056
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Article ; Online: Derivation and validation of a clinical decision rule to risk-stratify COVID-19 patients discharged from the emergency department: The CCEDRRN COVID discharge score.

Brooks, Steven C / Rosychuk, Rhonda J / Perry, Jeffrey J / Morrison, Laurie J / Wiemer, Hana / Fok, Patrick / Rowe, Brian H / Daoust, Raoul / Vatanpour, Shabnam / Turner, Joel / Landes, Megan / Ohle, Robert / Hayward, Jake / Scheuermeyer, Frank / Welsford, Michelle / Hohl, Corinne

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 6, Page(s) e12868

Abstract: Objective: To risk-stratify COVID-19 patients being considered for discharge from the emergency department (ED).: Methods: We conducted an observational study to derive and validate a clinical decision rule to identify COVID-19 patients at risk for ... ...

Abstract	Objective: To risk-stratify COVID-19 patients being considered for discharge from the emergency department (ED). Methods: We conducted an observational study to derive and validate a clinical decision rule to identify COVID-19 patients at risk for hospital admission or death within 72 hours of ED discharge. We used data from 49 sites in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) between March 1, 2020, and September 8, 2021. We randomly assigned hospitals to derivation or validation and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting short-term adverse outcomes in a validation cohort. Results: Of 15,305 eligible patient visits, 535 (3.6%) experienced the outcome. The score included age, sex, pregnancy status, temperature, arrival mode, respiratory rate, and respiratory distress. The area under the curve was 0.70 (95% confidence interval [CI] 0.68-0.73) in derivation and 0.71 (95% CI 0.68-0.73) in combined derivation and validation cohorts. Among those with a score of 3 or less, the risk for the primary outcome was 1.9% or less, and the sensitivity of using 3 as a rule-out score was 89.3% (95% CI 82.7-94.0). Among those with a score of ≥9, the risk for the primary outcome was as high as 12.2% and the specificity of using 9 as a rule-in score was 95.6% (95% CI 94.9-96.2). Conclusion: The CCEDRRN COVID discharge score can identify patients at risk of short-term adverse outcomes after ED discharge with variables that are readily available on patient arrival.
Language	English
Publishing date	2022-12-22
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12868
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Article ; Online: The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study.

Hohl, Corinne M / Rosychuk, Rhonda J / Archambault, Patrick M / O'Sullivan, Fiona / Leeies, Murdoch / Mercier, Éric / Clark, Gregory / Innes, Grant D / Brooks, Steven C / Hayward, Jake / Ho, Vi / Jelic, Tomislav / Welsford, Michelle / Sivilotti, Marco L A / Morrison, Laurie J / Perry, Jeffrey J

CMAJ open

2022 Volume 10, Issue 1, Page(s) E90–E99

Abstract: Background: Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to ... ...

Abstract	Background: Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to develop and validate a clinical score to predict emergency department and in-hospital mortality among consecutive nonpalliative patients with COVID-19; in this study, we define palliative patients as those who do not want resuscitative measures, such as intubation, intensive care unit care or cardiopulmonary resuscitation. Methods: This derivation and validation study used observational cohort data recruited from 46 hospitals in 8 Canadian provinces participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included adult (age ≥ 18 yr) nonpalliative patients with confirmed COVID-19 who presented to the emergency department of a participating site between Mar. 1, 2020, and Jan. 31, 2021. We randomly assigned hospitals to derivation or validation, and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting emergency department and in-hospital mortality in a validation cohort. Results: Of 8761 eligible patients, 618 (7.0%) died. The CCEDRRN COVID-19 Mortality Score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support. The area under the curve was 0.92 (95% confidence interval [CI] 0.90-0.93) in derivation and 0.92 (95% CI 0.90-0.93) in validation. The score had excellent calibration. These results suggest that scores of 6 or less would categorize patients as being at low risk for in-hospital death, with a negative predictive value of 99.9%. Patients in the low-risk group had an in-hospital mortality rate of 0.1%. Patients with a score of 15 or higher had an observed mortality rate of 81.0%. Interpretation: The CCEDRRN COVID-19 Mortality Score is a simple score that can be used for level-of-care discussions with patients and in situations of critical care resource constraints to accurately predict death using variables available on emergency department arrival. The score was derived and validated mostly in unvaccinated patients, and before variants of concern were circulating widely and newer treatment regimens implemented in Canada. Study registration: ClinicalTrials.gov, no. NCT04702945.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/mortality ; COVID-19/virology ; Canada/epidemiology ; Critical Care/statistics & numerical data ; Emergency Medical Services/statistics & numerical data ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; ROC Curve ; Risk Assessment ; Risk Factors ; SARS-CoV-2
Language	English
Publishing date	2022-02-08
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2701622-5
ISSN	2291-0026 ; 2291-0026
ISSN (online)	2291-0026
ISSN	2291-0026
DOI	10.9778/cmajo.20210243
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Article ; Online: Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN).

CJEM

2022 Volume 24, Issue 4, Page(s) 397–407

Abstract: Background: Treatment for coronavirus disease 2019 (COVID-19) evolved between pandemic waves. Our objective was to compare treatments, acute care utilization, and outcomes of COVID-19 patients presenting to emergency departments (ED) across pandemic ... ...

Abstract	Background: Treatment for coronavirus disease 2019 (COVID-19) evolved between pandemic waves. Our objective was to compare treatments, acute care utilization, and outcomes of COVID-19 patients presenting to emergency departments (ED) across pandemic waves. Methods: This observational study enrolled consecutive eligible COVID-19 patients presenting to 46 EDs participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 1 and December 31, 2020. We collected data by retrospective chart review. Our primary outcome was in-hospital mortality. Secondary outcomes included treatments, hospital and ICU admissions, ED revisits and readmissions. Logistic regression modeling assessed the impact of pandemic wave on outcomes. Results: We enrolled 9,967 patients in 8 provinces, 3,336 from the first and 6,631 from the second wave. Patients in the second wave were younger, fewer met criteria for severe COVID-19, and more were discharged from the ED. Adjusted for patient characteristics and disease severity, steroid use increased (odds ratio [OR] 7.4; 95% confidence interval [CI] 6.2-8.9), and invasive mechanical ventilation decreased (OR 0.5; 95% CI 0.4-0.7) in the second wave compared to the first. After adjusting for differences in patient characteristics and disease severity, the odds of hospitalization (OR 0.7; 95% CI 0.6-0.8) and critical care admission (OR 0.7; 95% CI 0.6-0.9) decreased, while mortality remained unchanged (OR 0.7; 95% CI 0.5-1.1). Interpretation: In patients presenting to cute care facilities, we observed rapid uptake of evidence-based therapies and less use of experimental therapies in the second wave. We observed increased rates of ED discharges and lower hospital and critical care resource use over time. Substantial reductions in mechanical ventilation were not associated with increasing mortality. Advances in treatment strategies created health system efficiencies without compromising patient outcomes. Trial registration: Clinicaltrials.gov, NCT04702945.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/therapy ; Canada/epidemiology ; Emergency Service, Hospital ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2022-04-01
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-022-00275-3
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Inter-library loan at ZB MED