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Aim To determine the number of warfarinised hospital patients experiencing over‐anticoagulation; to identify how over‐anticoagulation is managed and whether local guidelines are adhered to. Method 2 prospective one‐week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over‐anticoagulation clinical management and treatment options. Results Data were collected for 58 patients (Audit 1: n = 30; Audit 2: n = 28). At least one‐third of all patients experienced over‐anticoagulation (Audit 1: 53%; Audit 2: 36%). Haemorrhagic events occurred in 40% of patients in Audit 1 and 18% in Audit 2 (p = 0.06) – not all were associated with elevated international normalised ratios. Most cases of over‐anticoagulation were managed by withholding warfarin doses and one case (Audit 2) required Prothrombinex. Drug interactions were the most common risk factor (> 50% of patients) for over‐anticoagulation in both audits. Problems with documentation were more prevalent in Audit 1 than in Audit 2. Conclusion Over‐anticoagulation is a common occurrence in warfarinised hospital patients. Hospital over‐anticoagulation management practices need to be reviewed to ensure safe and efficacious anticoagulation.

Introduction: 2018 data from the Canadian Medical Association website shows that of practicing emergency physicians country-wide, only 31% were female. While there are some studies that examine the number and proportion of Canadian female applicants applying to surgical specialties, there are very few studies that are specific to emergency medicine (EM), and none that are Canadian in scope. Given the changing gender ratio of graduating medical students in Canada, the primary objective of this study is to assess the mean proportion and trends in proportion of females who applied and matched to English-language Canadian EM programs including Canadian College of Family Physicians emergency medicine certificate (CCFP-EM) and Fellow of the Royal College of Physicians of Canada emergency medicine (FRCPC-EM), family medicine (CCFP) programs, and all specialties combined. Methods: A retrospective data analysis on residency match results from 2013-2019 inclusively was performed. Data was accessed through a freedom of information request from the Canadian resident matching service (CaRMS). The mean proportions and trends in the proportions of females applying and matching to CCFP-EM, FRCPC-EM, CCFP, and all specialties were computed. Cochrane-Armitage trend of test was used for analysis. Results: From 2013-2019, the mean (SD) percentage of females who applied and matched respectively were as follows: CCFP-EM [44.4 (3.5);46.0(4.5)]; FRCPC-EM [41.3(4.1);44.0 (4.5], CCFP [56.5(1.3);61.0(1.9)], all specialties [54.0(1.1);55.5(0.9)]. There was a significant increase in the proportion of female applying to the FRCPC-EM (p < 0.0001), CCFP (p = 0.0002), and all disciplines (p = 0.0013). There was no significant change in the proportion of females applying for the CCFP-EM program (p = 0.6435). Conclusion: Our study shows that there is an increasing trend in the percentage of female applicants in all programs except the CCFP-EM program, where it remained statistically the same over time. There was a consistent percentage of applied versus matched female applicants over time for both CCFP-EM and FRCPC-EM programs. However, the percentage of females applying or matching to both CCFP-EM and FRCPC-EM programs remained less than 50%. Further research could focus on evaluating reasons for program choice, in order to further increase the percentage of female medical students and residents applying and matching to both emergency medicine programs.

Introduction: With the increased accessibility of computed tomography (CT), use in the emergency department has increased. Increased use has lead to a reduction in missed diagnoses but also an increase in radiation burden and the increased likelihood of incidental findings. In this study, we sought to characterize the use of abdominal CTs at an academic tertiary center in order to quantify the rate and clinical significance incidental findings. Methods: This was a retrospective chart review of radiological database of all abdominal CT ordered by the emergency department from January 1 st to March 21 st 2015. Incidental findings requiring follow up were defined by the American college of radiology guidelines. Clinically significant incidental findings were defined as those that resulted in a finding of malignancy or comparably serious disease. Abdominal CTs were excluded if they were ordered together with CT thorax. The data was abstracted by one trained reviewer using a standardized data collection sheet and 10% of the data was verified by a second reviewer. Inter-rater reliability reported by Kappa statistic. Data were reported as mean and standard deviation. A sample size of 770 was calculated based on an expected difference in prevalence between significant and non-significant incidental findings of 80% (α = 5%, Power = 90%). Results: A total of 1882 imaging studies were included (56.3% female, age 59.4 years (16.3), CTAS 3 (1.3). The most common presenting complaints: abdominal pain (980, 52.1%), flank pain (196, 10.4%) and nausea/vomiting (111, 6%). Indications included rule out (r/o) obstructing renal stones/colic (329; 17.5%), r/o diverticulitis/colitis (307; 16.4%) and abdominal pain not yet differentiated (283; 15.1%). The most common final diagnoses as a result of CT were renal stone/ colic (212, 11.3%), colitis/diverticulitis (191, 10.2%), and bowel obstruction (111, 6%).Incidental findings recommending further imaging occurred in 93 (4.9%). Of these, 43 were completed, and 15 resulted in clinically significant findings: cancer of the colon (2), lung (2), bladder (2), metastatic cancer (2), adnexa (4), endometrium (1), lymphoma (1), and venous thrombus (1). Conclusion: Incidental findings are far less common (5%) then previously reported (as high as 30%) and rarely clinically significant. Keywords: abdominal computed tomography, emergency department Introduction: Syncope is a common emergency department (ED) presentation and constitutes 1% of all ED visits, approximately 160,000 visits annually across Canada. Lack of standardized syncope care has economic and cost implications. Currently, emergency medical services (EMS) is over utilized, variations in ED management exist and a substantial proportion (46.5%) are hospitalized for cardiac monitoring. Our previous studies have proposed ways to reduce health care utilization through development of EMS clinical decision tool, ED risk scores and remote cardiac monitoring. We sought to: 1) Estimate costs associated with syncope care in the pre-hospital, ED a...

Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age &gt;50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure &gt;180 or &lt;100 mmHg, heart rate &lt;50 or &gt;100/minute, respiratory rate &gt;25/minute, oxygen saturation &lt;91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.