Clinical Decision Rules and Scales

The Ottawa Rules App
The Ottawa Rules App is now available for iPhone or Android and currently contains the Canadian C-Spine Rule, The Ottawa Ankle Rules, and the Ottawa Knee Rule. The app provides an easy mobile, on the go reference to the Ottawa Rules for physicians and nurses. 

Canadian C-Spine Rule
The Canadian C-Spine Rule is a validated set of rules to determine necessary radiography in alert and stable trauma patients with a potential cervical spine injury. Through a series of risk-factor determining questions, the highly sensitive rule provides clinicians a simple and clear tool for considering x-ray. Additionally, the C-Spine rule has been a successful tool to train Registered Nurses to safely remove the C-spine collar on patients and ambulate to less urgent care areas if applicable. The C-Spine Rule is internationally recognized and helps in patient comfort the reduction of unnecessary radiography, which cuts costs as well as emergency department wait times.

Ottawa Ankle Rules
The Ottawa Ankle Rules were derived and validated for alert ED patients (>2 years) with a recent blunt trauma to the ankle or mid-foot. Radiography is recommended if the patient meets the criteria for any of the questions listed. The Ankle Rules are internationally recognized and their high sensitivity helps clinicians determine whether the injury is a sprain, or a fracture which requires radiography without jeopardizing patient safety. Emergency department costs and patient flow are improved by using the Ottawa Ankle Rules.

Ottawa Knee Rule
The Ottawa Knee Rule provides physicians with a simple guideline to aid in radiography decisions for alert patients (>18 years) with recent minor knee trauma. The simple “yes or no” risk criteria provide a valid and highly sensitive scale to determine the need for x-ray without compromising patient satisfaction. The Ottawa Knee Rule can be safely used by physicians in many countries, and reduces the use of imaging and wait times.

Canadian CT Head Rule
The Canadian CT Head Rule safely limits use of imaging for patients (>16 years) with minor head injuries ensuring those who do need imaging receive CT in a timely manner. The validated rule consists of 5 high risk factors and 2 medium risk factors to provide physicians with a standardized care of head injury patients in the emergency department. This highly sensitive rule provides improvement in patient management by reducing unnecessary imaging, improving patient flow and reducing costs.

HEARTRISK6 Heart Failure Risk Score
We have clinically validated and revised the HEARTRISK6 tool which now consists of six simple variables and which estimates the short-term risk of SSOs (Short-term Serious Outcomes) in acute heart failure patients treated in the ED. The Revised HEARTRISK6 will assist physicians in making rational disposition plans in the ED. This should improve and standardize admission practices, diminishing both unnecessary admissions for low-risk patients and unsafe discharge decisions for high-risk patients, ultimately leading to improved safety for patients and more efficient use of precious hospital resources.

Ottawa COPD Risk Scale (OCRS)
We have clinically validated the OCRS tool and are now in the analysis process to refine the tool which estimates the short-term risk of SAEs (Serious Adverse Events) in COPD (Chronic Obstructive Pulmonary Disease) patients treated in the ED. The OCRS will assist physicians in making rational disposition plans in the ED by improving and standardizing admission practices, diminishing both unnecessary admissions for low-risk patients and unsafe discharge decisions for high-risk patients, ultimately leading to improved safety for patients and more efficient use of precious hospital resources. 

Current In-Hospital Research Studies

RAFF 4 Study:  Vernakalant vs. Procainamide for Acute Atrial Fibrillation in the Emergency Department (Stiell)
 
RAFF 5 Study:  Project to Improve the Quality & Safety of the Immediate & Subsequent Care of Patients Seen in the ED with Acute Atrial Fibrillation & Flutter (Stiell)
 
Weekend Discharges Study:  A Study to Decrease Emergency Department Crowding by Creating and Implementing Interventions to Increase Weekend Discharges of Admitted Patients (Stiell)

Hyperglycemia Study:  Risk Factors for Recurrent ED Visits for Hyperglycemia in Patients with Diabetes:  A Prospective Cohort Study (Stiell)

TIA-3 Study: Prospective Validation of the Abbreviated Canadian TIA Score (Perry)                

TIA-4 Study:  Implementation phase (Perry)

COBRRA-AF Study: Comparison of Bleeding Risk between Rivaroxaban & Apixaban in Patients with Atrial Fibrillation (Perry)  

VALUE Study:  The right care, for the right patient, at the right time, by the right provider: A value-based comparison of the management of ambulatory patients in walk-in clinics, primary care physician practices and EDs (Perry)

PEITHO-3:  A Reduced Dose of Thrombolytic Treatment for Patients with Intermediate High-risk Acute Pulmonary Embolism: A Randomized Controlled Trial (Perry)

FIND-UM Study:  Understanding Delirium Pathophysiology using Urine Metabolomics from Older People with Hip Fractures (Perry)

Validation of a clinical risk score to predict if a stroke, TIA, vertebral artery dissection or a brain tumour is the cause of vertigo in emergency department patients (Perry)

Can SCAHn:  Selective Neuroimagiing for Head-injured Emergency Patients Who take Anticoagulant Medication (Eagles)

Frailty:  Frailty Evaluation in the Emergency Department (Eagles)

HI-DOCC:  High-Dose Cephalexin for Cellulitis (HI-DOCC): A Randomized Controlled Trial (Yadav)