Dr Ian Stiell Group

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Contact Information

Ian Stiell, MD, MSc, FRCPC

istiell@ohri.ca

Carolyne Kennedy
Executive Assistant
Tel: 613-798-5555 x 18683
Email: cakennedy@ohri.ca

Research Activities

 

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.
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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.
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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.
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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.
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Ottawa Heart Failure Risk Scale (OHFRS)

We have clinically validated and revised the OHFRS tool which now consists of six simple variables and which estimates the short-term risk of SAEs (Serious Adverse Events) in acute heart failure patients treated in the ED. The Revised OHFRS 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



2013-2018: RAFF-2 (A Randomized, Controlled Comparison of Electrical versus Pharmacological Cardioversion for Emergency Department Patients with Recent-Onset Atrial Fibrillation and Flutter)
Principle Investigator
This trial will compare conversion to normal sinus rhythm between the two strategies of i) attempted pharmacological cardioversion with intravenous procainamide followed by DC cardioversion if necessary (Drug-Shock), and ii) DC cardioversion alone (Shock Only). The goal is to ensure ED RAFF patients are quickly and safely converted to sinus rhythm. This will also lead to shorter lengths of stay in the ED, fewer hospital admissions, early return to normal activities, and will inform future efforts for RAFF patient management in Canada.
Funding: Heart and Stroke Foundation of Ontario (HSFO)

2011-2015: RAD Study, Phase 2b (Validation of the Revised Ottawa Heart Failure Risk Scale (OHFRS))
Principle Investigator
The Revised OHFRS 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. We believe that the Revised OHFRS, in spite of its accuracy, cannot be endorsed for routine patient care until its accuracy, acceptability, and potential utility has been shown in a further, albeit smaller, validation study; thus, the goal of this phase is to prospectively test the performance of the Revised OHFRS in a new cohort of ED patients.
Funding: Pending

2015-2018: Gloria AF Registry Program, Phase 3 (Global Registry Program on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation)
This registry investigates patient characteristics that influence the choice on antithrombotic (blood thinner) treatment to identify patients recently diagnosed with AF who are risk of stroke. The study consists of collecting health information from patients throughout 5 study visits over the course of three years. The results from this information will be utilized in emergency departments to prevent stroke in patients around the world with atrial fibrillation.
Funding: Sponsored

 

Current Pre-Hospital Research

 

2016-Ongoing: CanROC Cardiac Arrest Registry
Co-Principle Investigator
CanROC is a new national registry and research consortium that aims to record pre-hospital cardiac arrest across Canada. Dr. Stiell is a founding Principle Investigator in this exciting new organization, and contributes the data of six Ontario rural and urban cities. This registry will strengthen our knowledge on effective pre-hospital cardiac arrest interventions, with the goal of commencing trials in the near future.