CJEM Articles: Jonathan Dreyer

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  • Canadian C-Spine Rule study for alert and stable trauma patients: II. Study objectives and methodology
    May 2002 4 3
    Andreas Laupacis, Brian Holroyd, Brian Rowe, Catherine M. Clement, Daniel Cass, Gary H. Greenberg, George A. Wells, Glen Bandiera, Howard Lesiuk, Iain MacPhail, Ian G. Stiell, James Worthington, Jonathan Dreyer, Laurie Morrison, Mark Reardon, Mary A. Eisenhauer, Michael Schull, R. Douglas McKnight, Richard Verbeek, Robert Brison

    Clinical prediction rules are decision-making tools that incorporate three or more variables from the history, physical examination or simple tests. They help clinicians make diagnostic or therapeutic decisions by standardizing the collection and interpretation of clinical data. There is growing interest in the methodological standards for their development and validation. This article describes the methods used to derive the Canadian C-Spine Rule and provides a valuable reference for investigators planning to develop future clinical prediction rules.

  • Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale
    March 2002 4 2
    Andreas Laupacis, Brian Holroyd, Brian Rowe, Catherine M. Clement, Daniel Cass, Gary H. Greenberg, George A. Wells, Glen Bandiera, Howard Lesiuk, Iain MacPhail, Ian G. Stiell, James Worthington, Jonathan Dreyer, Laurie Morrison, Mark Reardon, Mary A. Eisenhauer, Michael Schull, R. Douglas McKnight, Richard Verbeek, Robert Brison

    This paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study.

  • Alternate funding plans
    January 2002 4 1
    Andrew Affleck, Howard Ovens, Jonathan Dreyer
  • Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system
    July 2001 3 3
    David A. Petrie, Ian G. Stiell, Jo-Anne O'Brien, Jonathan Dreyer, Michael Martin, Valerie De Maio

    Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system.

    Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival.

    Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were "CRI in minutes" (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77-0.98) and "bystander-witnessed" (OR = 2.6; 95% CI, 1.5-4.4).

    Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.