Browsing by Author "Doig, Christopher James"

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    An Analysis of a Cohort of Surgical-Related Intra-Abdominal Sepsis with PIRO
    (2013-07-10) Posadas Calleja, Juan Gabriel; Doig, Christopher James; Stelfox, H. Tomas; Ferland, Andre
    Introduction: Sepsis constitutes an important cause of morbidity and mortality; mortality in patients with intraabdominal sepsis remains high. The PIRO concept is a classification scheme for sepsis. Methods: Retrospective analysis of a prospective observational cohort. Results: 905 patients were analyzed. A PIRO score was developed including the following variables: age > 65 years, comorbidities, leukopenia, hypothermia, cardiovascular, renal, respiratory, and CNS failure, one point was given for each present feature. The mean PIRO score was significantly higher in nonsurvivors than in survivors (3.9 vs. 2.3 respectively, p < 0.0001). When the patients were distributed according PIRO scoring, mortality rate increased (p <0.0001). The aROC showed consistent mortality discrimination by PIRO score (0.80, 95%CI 0.79 to 0.83), outperforming APACHE II (0.72, 95%CI 0.68 to 0.75) and SOFA (0.72, 95%CI 0.68 to 0.76) p <0.0001. Conclusion: The PIRO score performed well as an ICU mortality predictor tool for surgical related intra-abdominal sepsis.m
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    Caring for the Critically Ill
    (2021-09-21) Moss, Stephana Julia; Bobawsky, Kirsten Marie; Stelfox, Henry Thomas; Doig, Christopher James; Patten, Scott Burton
    Family or informal caregivers are key to the delivery of patient-centered care and often act as patient advocates. Visitation from family caregivers in the intensive care unit (ICU) can have long-term impacts on ICU patients post-hospital discharge. A relationship between exposure to critical illness and negative psychological sequalae among family caregivers of critically ill patients is consistently reported. The literature on mental health interventions to improve psychological outcomes in family caregivers of the critically ill has not been appraised. Bereavement interventions in the ICU have not been mapped to core outcomes for evaluating bereavement support among family caregivers. The effect of family visitation on ICU survivors post-discharge psychiatric outcomes is unknown. Perspectives from designated family caregivers during the coronavirus disease 2019 (COVID-19) pandemic have not been well characterized. The work reported in this thesis addresses these knowledge gaps. Based on a systematic review of 102 trials, mental health interventions reduced anxiety (Ratio of Means (RoM), 0.92; 95% confidence interval (CI): 0.87–0.97) and depression (RoM, 0.83; 95%CI: 0.69–0.99), but not post-traumatic stress disorder (RoM, 0.91; 95%CI: 0.80–1.04) or distress (RoM, 1.01; 95%CI: 0.95–1.07) among family caregivers within 3-months post-discharge. Increased burden among family caregivers within 3-months post-discharge (RoM, 1.08; 95%CI: 1.05–1.12) was observed. Three studies of ICU bereavement interventions indicated that available trial evidence is sparse and does not support use of bereavement interventions for family caregivers of patients who die in ICU. Using administrative databases, it was found that ICU family visitation was associated with decreased risk for psychiatric disorders (risk ratio (RR), 0.87; 95%CI: 0.79-0.97), mainly trauma- and stressor-related disorders (RR 0.66; 95%CI: 0.38-0.87), in ICU survivors up to one-year post-discharge. In COVID-19, designated family caregivers of critically ill patients perceived emotional distress related to being the only family member allowed to visit. The results of these studies characterize the impact of a family-centered care approach in the ICU on caring for the critically ill, which is integrated into recommendations for the field.
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    Intestinal permeability and multiple organ dysfunction in critically ill patients
    (1996) Doig, Christopher James; Sutherland, Lloyd R.
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    Optimally Linking Prehospital and Health System Data: The Association between Emergency Medical Services Offload Time, Response Time and Mortality
    (2020-01-14) Blanchard, Ian; Doig, Christopher James; Lang, Eddy S.; Dean, Stafford R.; Hagel, Brent Edward; Niven, Daniel J.; Williamson, Tyler S.
    INTRODUCTION: Delays in offloading Emergency Medical Services (EMS) patients in the hospital may impact timely response to emergencies, but no published studies are available. Little research has been conducted on the potential for bias when EMS data are linked to health system outcome and on the optimal EMS response time for survival of critically injured or ill patients. METHODS: Three years of EMS data from a large urban system were used to create hourly estimates of median hospital time and response time, and linked to health system outcome. Multivariable modelling and descriptive statistics were used to: 1. Explore the association between paramedic hospital time and response time while controlling for the effects of system volume, time of day, and season; 2. Describe the linkage rate between the standard strategy and one designed to optimize linkage; and 3. Explore the association between response time and mortality in critically injured or ill patients who did not experience an out-of-hospital cardiac arrest while controlling for age and sex. RESULTS: Depending on the time of day, there was between a one and three minute increase in predicted median response time when the system was experiencing a median hospital time of 90 minutes, during the winter in heavy system volume, compared to a 30 minute median hospital time, during the summer in light system volume. The optimized strategy increased the linkage rate from 88% to 97.1%, and reduced linkage failure in key clinical sub-groups. There was no significant association between response time and mortality except in one secondary analysis subgroup, which suggested longer response decreased mortality. CONCLUSIONS: There is an association between EMS hospital time and response time, but the relationship is complex and influenced by system level factors such as time of day, volume and season. An optimized strategy for linking EMS data to health system outcome improved the linkage rate and reduced the potential for bias. No consistent association between response time and mortality could be demonstrated. These analyses underscore the importance of research quality linked EMS data in the development of knowledge for EMS and paramedic practice.
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    The Potential Clinical Utility of Serum and Peritoneal C-Reactive Protein (CRP) Measurement in Trauma and Critically Ill Patients
    (2019-07) Al Hinai, Fatma; Kirkpatrick, Andrew Wallace W.; Doig, Christopher James; Ball, Chad G.
    C reactive protein (CRP) levels remain an enigma in the prognostication and management of trauma patients. Several studies have suggested that serum and peritoneal CRP levels may be associated with and predict morbidity and mortality. Other studies have raised doubts on these findings. A clear recognition of the critical role of CRP is required. We conducted a systematic review to investigate the role of serum CRP in trauma patients in predicting sepsis, organ failure and mortality. In addition, we investigated the association between serum CRP levels and ISS (injury Severity Score). A second study was conducted to evaluate the potential utility of serum and peritoneal CRP in predicting clinical outcomes in trauma and critically ill patients. Studies supported the association between high CRP measurements with clinical outcomes including sepsis and organ failure. High peritoneal CRP levels was associated with mortality in critically ill patients. In conclusion, CRP measurements may help identify patients at high risk who may benefit from more intense physiologic monitoring. Peritoneal CRP is a promising diagnostic tool in the assessment of the critically ill and injured.
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    The Role of Procalcitonin Measurements in Predicting Clinical Outcomes in Critically Ill/Injured Patients
    (2019-07-12) Al Rawahi, Aziza; Kirkpatrick, Andrew Wallace; Doig, Christopher James; Ball, Chad Geoffrey G.; Dixon, Elijah G.
    Background: Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD). We assessed the prognostic value of serum and peritoneal procalcitonin (PCT) levels after trauma. Methods: We searched electronic database and included original studies that assessed prognostic value of PCT after trauma. We performed a retrospective analysis of the Intraperitoneal Vacuum Trial to assess correlation of plasma and peritoneal levels of PCT with clinical outcomes in patients managed with the open abdomen (OA) technique. Results: Among 2,015 citations identified, 19 studies met inclusion criteria. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Initial peak PCT levels predicted development of sepsis and MOD after trauma. Conclusion: PCT seems to hold promise as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.