Browsing by Author "Stelfox, H. Tomas"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    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
  • Thumbnail Image
    ItemOpen Access
    An analysis of the risk of readmission or death following patient discharge from the intensive care unit
    (2013-09-04) Hosein, F Shaun; Stelfox, H. Tomas
    Introduction: The discharge of patients from the intensive care unit (ICU) to a hospital ward is a common transition of care that is associated with error and adverse events. Further identification of risk stratification tools, risk factors and overall adverse event rates may help identify high-risk patients and improve the ICU discharge process. Methods: Ovid EMBASE, Ovid MEDLINE, CINAHL, PUBMED and Cochrane Central Register of Controlled Trials were searched from the earliest available date through March 2013, plus reference lists and citations of all studies included in the systematic review. Data were extracted on the study design, setting, population, sample size, tool and outcomes. Results: The literature search identified 9,926 citations, of which 58 studies identifying eight tools and 41 risk factors met the inclusion criteria. Reported outcomes included ICU readmission and post-ICU mortality .We were able to determine a pooled ICU readmission rate of 6.3%(95% CI 5.5-7.2%). and post-ICU mortality rate of 7.4% (95% CI 6.6-8.2%). Pooling of identified risk factors facilitated the development of two ICU discharge meta-prediction models, which were tested in a local database yielding areas under receiver operator curves ranging from 0.72 to 0.97. Conclusions: Eight risk stratification tools and 41 risk factors were identified from systematic review. Two meta-prediction models were developed and tested; yielding promising results, but further optimization is warranted. Although risk stratification tools may help clinician decision-making, further evaluation of the existing tools’ effects on care is required prior to clinical implementation. The identification of pooled adverse event rates from systematic review is proposed to serve as ICU benchmarks, contributing to improvement of ICU quality of patient care.
  • Thumbnail Image
    ItemOpen Access
    Development of an In‐Hospital Standardized Mortality Ratio for Emergency Department Sensitive Conditions
    (2014-05-02) Berthelot, Simon; Stelfox, H. Tomas; Lang, Eddy; Quan, Hude
    Healthcare systems in developed countries are grappling with emergency department (ED) overcrowding. Although a prominent issue yielding many related metrics, accessibility is only one dimension by which to measure ED performance. To gain a broader understanding of healthcare performance and to adequately measure it in the ED setting, a more comprehensive approach is required. If valuable process and timeline indicators have to be closely linked with patients’ outcomes, the outcomes themselves must also be measured. In direct response to this challenge, this thesis project aimed to develop and validate an in-hospital standardized mortality ratio specific to emergency sensitive conditions as one tool for measuring ED care performance.