Grant: Foundation Grant

This application focuses on research to improve care for emergency department (ED) patients with vascular emergencies. My program includes: 1) Implementing the Ottawa SAH Rule to identify headache patients at risk for subarachnoid hemorrhage (SAH); 2) Developing the Canadian TIA Score to identify transient ischemic attack (TIA) patients at risk for subsequent stroke; 3) Conducting trials for recent-onset atrial fibrillation (RAF); and 4) Optimizing and measuring knowledge translation (KT) for each condition. SAH is a life-threatening hemorrhagic stroke, which is worse with a delayed diagnosis. We developed the Ottawa SAH Rule to determine which headache patients need investigations to rule-out SAH. We have proven the Ottawa SAH Rule to be safe, but further study is needed to 1) assess its impact and 2) optimize physician use. TIAs precede up to 20% of strokes. We developed the Canadian TIA Score, to determine the impending stroke risk. This study will test the Canadian TIA Score in 5,000 new TIA patients to confirm it is accurate to identify patients' risk of stroke within 7 days. The Canadian TIA Score will improve patient outcomes through the efficient use of existing resources. RAF results in a rapid heart rate, requiring urgent treatment to restore normal heart rhythm. RAF is the most common rhythm disorder managed in the ED. No studies have been conducted comparing an electrical shock (Shock Only) or drugs followed by shock (Drug-Shock). Our trial compares these two strategies for conversion to normal rhythm. Given a consistent failure to translate new and existing research into clinical and public health practice, this research program will measure the KT implementation of The Ottawa SAH Rule, The Canadian TIA Score and clinical practice guidelines for RAF and acute headache (including all causes of headache). This research will build the science of KT in acute settings and optimize uptake of new evidence from our research program.