Reassessing the Methods of Medical Record Review Studies in Emergency Medicine Research

Worster, Andrew; Bledsoe, Rebecca; Cleve, Paul; Fernandes, Christopher M.B.; Upadhye, Suneel; Eva, Kevin W.

doi:10.1016/j.annemergmed.2004.11.021

Cited by 243 publications

(199 citation statements)

References 6 publications

(10 reference statements)

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“…13 Hospital-level data were abstracted through a systematic chart review, adhering to accepted criteria. 18,19 We recorded the occurrence of invasive coronary angiography, coronary artery bypass surgery, targeted temperature management, and assessed outcomes at hospital discharge: (1) survival; and (2) neurologic outcome. Cases of missing or conflicting data were noted by each abstractor and prompted a full chart review; if still in question, the primary investigator reviewed the case.…”

Section: Data Collectionmentioning

confidence: 99%

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Grunau

Scheuermeyer

Stub

et al. 2016

CJEM

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Objective: Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. Methods: We performed a secondary analysis from a 52-month prospective registry of consecutive adult nontraumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. Results: Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. Conclusion: In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes. RÉSUMÉObjectif: La réanimation cardiorespiratoire extracorporelle (RCREC), bien qu'elle soit exigeante sur le plan des ressources, peut améliorer les résultats cliniques chez certains patients ayant subi un arrêt cardiaque extrahospitalier (ACEH) réfrac-taire. Les auteurs de l'étude cherchaient à déterminer les patients qui répondaient aux un ensemble de critères de la RCREC afin d'estimer, d'une part, la proportion de patients ayant subi un arrêt cardiaque réfractaire qui auraient pu profiter de la méthode de réanimation et, d'autre part, les résultats cliniques obtenus par la méthode habituelle de réanimation. Méthode: Les auteurs ont procédé à une analyse secondaire d'un registre prospectif, constitué de cas consécutifs d'ACEH non traumatique, survenus chez des adultes, sur une période de 52 mois, dans une seule région sanitaire urbaine d'un million de personnes, au Canada. Les auteurs ont formé une cohorte fictive d'adultes, âgés de moins de 60 ans, susceptibles d'être traités par la RCREC après avoir subi un ACEH devant des témoins et avoir fait l'objet de manoeuvres de réanimation cardiorespiratoire par des passants ou avoir reçu des soins donnés par des services médicaux d'urgence (SMU), et ce, en l'espace de cinq minutes. Le principal critère d'éval...

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Section: Data Collectionmentioning

confidence: 99%

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Grunau

Scheuermeyer

Stub

et al. 2016

CJEM

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“…We attempted to reduce the risk of bias in patient selection and the abstraction process through adhering to methodological standards for medical record review studies. [29][30][31][32] We only included patients with a local address to maximize outcome assessment and excluded presyncope patients to avoid contamination. Very few patients had important clinical and investigation variables missing, but such patients were low risk for SAEs; hence, we believe it is reasonable for us to assume, when necessary, these variables to be absent or normal.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted this study by strictly adhering to previously reported methodological standards for medical records review. [29][30][31][32] We also conducted the study in keeping with the methodological standards for clinical decision rules. [33][34][35] Our study does have potential limitations.…”

Section: Discussionmentioning

confidence: 99%

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Thiruganasambandamoorthy

Wells

Hess

et al. 2014

CJEM

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Background: Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days. Methods: We conducted a medical record review to include syncope patients age $ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed. Results: Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age $ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure , 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen . 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0-10) was found to accurately stratify patients into low risk (score , 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score . 1, $ 10% SAE risk). Conclusion: We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this

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“…The data abstractors were involved in creating the data abstraction forms and, after the creation of these forms, the data abstractors each reviewed 25 charts and then discussed problems encountered and variables requiring further defining. 12 Throughout the study, the investigators at each site regularly communicated by teleconference or email, as needed, to clarify questions that arose in the process of data abstraction. Interrater reliability was not formally assessed; however, 10% of the cases were reviewed by senior investigators (IGS, DN).…”

Section: Data Collection and Processingmentioning

confidence: 99%

“…12 We were able to follow abstractor training, case selection criteria, variable definition, use of abstraction forms, monitoring of performance of abstractors, identifying medical records, describing sampling methods and obtaining ethics board approval but could not adhere to abstractor blinding to hypothesis, measuring of interobserver reliability, and management of missing data. There was a small chance that patients were missed during follow-up in Ottawa.…”

Section: Limitationsmentioning

confidence: 99%

Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings

Lai

Tenpenny

Nestler

et al. 2015

CJEM

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IntroductionThe objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.MethodsThis was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.ResultsIn total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).ConclusionsThe U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

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Reassessing the Methods of Medical Record Review Studies in Emergency Medicine Research

Cited by 243 publications

References 6 publications

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings

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