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Featured researches published by Grant Stotts.


Canadian Medical Association Journal | 2011

Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack

Jeffrey J. Perry; Mukul Sharma; Marco L.A. Sivilotti; Jane Sutherland; Cheryl Symington; Andrew Worster; Marcel Émond; Grant Stotts; Albert Y. Jin; Weislaw J. Oczkowski; Demetrios J. Sahlas; Heather Murray; Ariane Mackey; Steve Verreault; George A. Wells; Ian G. Stiell

Background: The ABCD2 score (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) is used to identify patients having a transient ischemic attack who are at high risk for imminent stroke. However, despite its widespread implementation, the ABCD2 score has not yet been prospectively validated. We assessed the accuracy of the ABCD2 score for predicting stroke at 7 (primary outcome) and 90 days. Methods: This prospective cohort study enrolled adults from eight Canadian emergency departments who had received a diagnosis of transient ischemic attack. Physicians completed data forms with the ABCD2 score before disposition. The outcome criterion, stroke, was established by a treating neurologist or by an Adjudication Committee. We calculated the sensitivity and specificity for predicting stroke 7 and 90 days after visiting the emergency department using the original “high-risk” cutpoint of an ABCD2 score of more than 5, and the American Heart Association recommendation of a score of more than 2. Results: We enrolled 2056 patients (mean age 68.0 yr, 1046 (50.9%) women) who had a rate of stroke of 1.8% at 7 days and 3.2% at 90 days. An ABCD2 score of more than 5 had a sensitivity of 31.6% (95% confidence interval [CI] 19.1–47.5) for stroke at 7 days and 29.2% (95% CI 19.6–41.2) for stroke at 90 days. An ABCD2 score of more than 2 resulted in sensitivity of 94.7% (95% CI 82.7–98.5) for stroke at 7 days with a specificity of 12.5% (95% CI 11.2–14.1). The accuracy of the ABCD2 score as calculated by either the enrolling physician (area under the curve 0.56; 95% CI 0.47–0.65) or the coordinating centre (area under the curve 0.65; 95% CI 0.57–0.73) was poor. Interpretation: This multicentre prospective study involving patients in emergency departments with transient ischemic attack found the ABCD2 score to be inaccurate, at any cut-point, as a predictor of imminent stroke. Furthermore, the ABCD2 score of more than 2 that is recommended by the American Heart Association is nonspecific.


Stroke | 2010

Stratified, Urgent Care for Transient Ischemic Attack Results in Low Stroke Rates

Jason K. Wasserman; J.J. Perry; Dar Dowlatshahi; Grant Stotts; Ian G. Stiell; Jane Sutherland; Cheryl Symington; Mukul Sharma

Background and Purpose— Transient ischemic attack (TIA) is a marker for early risk of stroke. No previous studies have assessed the use of urgent stroke prevention clinics for emergency department (ED) patients with TIA. We hypothesized that an ABCD2-based ED triaging tool for TIA with outpatient management would be associated with lower 90-day stroke rate than that predicted by ABCD2. Methods— A cohort of prospectively identified patients presenting with symptoms suggestive of TIA seen in 2 tertiary-care EDs. These patients were divided into 3 strata based on their ACBD2 score, and triage targets were set for each stratum. All patients received the same standard of care in the Stroke Clinic regardless of their risk score. Primary outcome was stroke by 90 days of index TIA. Secondary outcomes were subsequent TIA, myocardial infarction, or death. Results— One-thousand ninety-three patients met the inclusion criteria; 982 patients completed 90-day follow-up and comprised the final cohort. After stratification, 32%, 49%, and 19% of patients were categorized as low-, moderate-, or high-risk, respectively. The overall 90-day risk of stroke in all patients was 3.2%, compared with the ABCD2-predicted risk of 9.2%. Only 1.6% of patients with TIA/minor stroke were admitted from the ED. The risk of subsequent TIA, myocardial infarction, or death by 90 days was 5.5%, 0.1%, and 1.7%, respectively. Conclusion— Outpatient care in a rapid-access stroke prevention clinic using the ABCD2 score for triage resulted in a low 90-day stroke rate for patients in the ED with TIA. Benefit occurred without requiring admission for most patients.


Annals of Neurology | 2015

Early Cerebral Small Vessel Disease and Brain Volume, Cognition, and Gait

Eric E. Smith; Martin O'Donnell; Gilles R. Dagenais; Scott A. Lear; Andreas Wielgosz; Mukul Sharma; Paul Poirier; Grant Stotts; Sandra E. Black; Stephen C. Strother; Michael D. Noseworthy; Oscar Benavente; Jayesh Modi; Mayank Goyal; Saima Batool; Karla Sanchez; Vanessa Hill; Cheryl R. McCreary; Richard Frayne; Shofiqul Islam; Jane DeJesus; Sumathy Rangarajan; Koon K. Teo; Salim Yusuf

Decline in cognitive function begins by the 40s, and may be related to future dementia risk. We used data from a community‐representative study to determine whether there are age‐related differences in simple cognitive and gait tests by the 40s, and whether these differences were associated with covert cerebrovascular disease on magnetic resonance imaging (MRI).


Stroke | 2014

Evolution of Computed Tomography Angiography Spot Sign Is Consistent With a Site of Active Hemorrhage in Acute Intracerebral Hemorrhage

Dar Dowlatshahi; Jason K. Wasserman; Franco Momoli; William Petrcich; Grant Stotts; Matthew J. Hogan; Mukul Sharma; Richard I. Aviv; Andrew M. Demchuk; Santanu Chakraborty

Background and Purpose— CT angiography spot sign predicts hematoma expansion in patients with acute intracerebral hemorrhage (ICH). The spot sign may represent a site of active extravasation, a locus of arrested hemorrhage forming fibrin globes, or represent associated epiphenomena such as hypertensive microaneurysms. We sought to describe the evolution of spot signs over 60 seconds in acute ICH using dynamic CT angiography and determine whether they grow and diffuse into the hematoma as would be expected with active extravasation. Methods— We prospectively identified consecutive patients presenting with spontaneous ICH <6 hours from symptom onset that completed dynamic CT angiography imaging over a 60-second acquisition protocol. We determined spot positivity, quantified spot volumes, and then used repeated-measures ANOVA to assess changes in spot volume over time. Results— We collected data on 35 patients; 13 of 35 (37%) patients were spot-positive. Spot-positive patients had larger median ICH volume compared with spot-negative patients (median 10.7 versus 49.2 mL; P=0.007). Maximal spot sign volumes ranged from 0.02 to 2.8 mL (median 0.17 mL). Spot sign volumes increased significantly with time (P<0.001) and seemed to disperse into the hematoma in all cases. Three of 13 (23%) spot-positive patients presented with 2 distinct spot signs, but the remaining patients either had only 1 spot sign or different contiguous components of an irregularly shaped spot sign. Conclusions— In this dynamic CT angiography study of ICH, spot signs evolve consistent with sites of active extravasation.


Stroke | 2014

A prospective cohort study of patients with transient ischemic attack to identify high-risk clinical characteristics.

Jeffrey J. Perry; Mukul Sharma; Marco L.A. Sivilotti; Jane Sutherland; Andrew Worster; Marcel Émond; Grant Stotts; Albert Y. Jin; Wieslaw Oczkowski; Demetrios J. Sahlas; Heather Murray; Ariane Mackey; Steve Verreault; George A. Wells; Ian G. Stiell

Background and Purpose— The occurrence of a transient ischemic attack (TIA) increases an individual’s risk for subsequent stroke. The objectives of this study were to determine clinical features of patients with TIA associated with impending (⩽7 days) stroke and to develop a clinical prediction score for impending stroke. Methods— We conducted a prospective cohort study at 8 Canadian emergency departments for 5 years. We enrolled patients with a new TIA. Our outcome was subsequent stroke within 7 days of TIA diagnosis. Results— We prospectively enrolled 3906 patients, of which 86 (2.2%) experienced a stroke within 7 days. Clinical features strongly correlated with having an impending stroke included first-ever TIA, language disturbance, longer duration, weakness, gait disturbance, elevated blood pressure, atrial fibrillation on ECG, infarction on computed tomography, and elevated blood glucose. Variables less associated with having an impending stroke included vertigo, lightheadedness, and visual loss. From this cohort, we derived the Canadian TIA Score which identifies the risk of subsequent stroke ⩽7 days and consists of 13 variables. This model has good discrimination with a c-statistic of 0.77 (95% confidence interval, 0.73–0.82). Conclusions— Patients with TIA with their first TIA, language disturbance, duration of symptoms ≥10 minutes, gait disturbance, atrial fibrillation, infarction on computed tomography, elevated platelets or glucose, unilateral weakness, history of carotid stenosis, and elevated diastolic blood pressure are at higher risk for an impending stroke. Patients with vertigo and no high-risk features are at low risk. The Canadian TIA Score quantifies the impending stroke risk following TIA.


Canadian Journal of Neurological Sciences | 2014

Good is not Good Enough: The Benchmark Stroke Door-to-Needle Time Should be 30 Minutes.

Noreen Kamal; Oscar Benavente; Karl Boyle; Brian Buck; Kenneth Butcher; Leanne K. Casaubon; Robert Côté; Andrew M. Demchuk; Yan Deschaintre; Dar Dowlatshahi; Gordon J. Gubitz; Gary Hunter; Tom Jeerakathil; Albert Y. Jin; Eddy Lang; Sylvain Lanthier; Patrice Lindsay; Nancy Newcommon; Jennifer Mandzia; Colleen M. Norris; Wes Oczkowski; Céline Odier; Stephen Phillips; Alexandre Y. Poppe; Gustavo Saposnik; Daniel Selchen; Ashfaq Shuaib; Frank L. Silver; Eric E. Smith; Grant Stotts

Noreen Kamal, Oscar Benavente, Karl Boyle, Brian Buck, Ken Butcher, Leanne K. Casaubon,RobertCote,AndrewMDemchuk,YanDeschaintre,DarDowlatshahi,GordonJGubitz,GaryHunter,Tom Jeerakathil, Albert Jin, Eddy Lang, Sylvain Lanthier, Patrice Lindsay, Nancy Newcommon,Jennifer Mandzia, Colleen M. Norris, Wes Oczkowski, Celine Odier, Stephen Phillips,Alexandre Y Poppe, Gustavo Saposnik, Daniel Selchen, Ashfaq Shuaib, Frank Silver, Eric E Smith,Grant Stotts, Michael Suddes, Richard H. Swartz, Philip Teal, Tim Watson, Michael D. Hill


Case reports in neurological medicine | 2014

Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE) for Intracerebral Hemorrhage

Benjamin Ritsma; Amin Kassam; Dariush Dowlatshahi; Thanh Nguyen; Grant Stotts

Background. Spontaneous intracerebral hemorrhage (ICH) is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative management may be attributable to adverse surgical effect, collateral tissue injury. This is particularly relevant for ICH in dominant, eloquent cortex. Minimally invasive surgery (MIS) offers the potential advantage of reduced collateral damage. MIS utilizing a parafascicular approach has demonstrated such benefit for intracranial tumor resection. Methods. We present a case of dominant hemisphere spontaneous ICH evacuated via the minimally invasive subcortical parafascicular transsulcal access clot evacuation (Mi SPACE) model. We use this report to introduce Mi SPACE and to examine the application of this novel MIS paradigm. Case Presentation. The featured patient presented with a left temporal ICH and severe global aphasia. The hematoma was evacuated via the Mi SPACE approach. Postoperative reassessments showed significant improvement. At two months, bedside language testing was normal. MRI tractography confirmed limited collateral injury. Conclusions. This case illustrates successful application of the Mi SPACE model to ICH in dominant, eloquent cortex and subcortical regions. MRI tractography illustrates collateral tissue preservation. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.


Stroke | 2015

Rapid Assessment and Treatment of Transient Ischemic Attacks and Minor Stroke in Canadian Emergency Departments: Time for a Paradigm Shift.

Noreen Kamal; Michael D. Hill; Dylan Blacquiere; Jean-Martin Boulanger; Karl Boyle; Brian Buck; Kenneth Butcher; Marie-Christine Camden; Leanne K. Casaubon; Robert Côté; Andrew M. Demchuk; Dar Dowlatshahi; Veronique Dubuc; Thalia S. Field; Esseddeeg Ghrooda; Laura Gioia; David J. Gladstone; Mayank Goyal; Gordon J. Gubitz; Devin Harris; Robert G. Hart; Gary Hunter; Thomas Jeerakathil; Albert Y. Jin; Khurshid Khan; Eddy Lang; Sylvain Lanthier; M. Patrice Lindsay; Ariane Mackey; Jennifer Mandzia

A majority of acute cerebrovascular syndromes are transient ischemic attacks (TIA) or minor ischemic strokes. They are often thought of and managed as though benign, but are in fact a warning of impending disabling stroke. The risk of stroke progression or recurrence is highest in the first hours to days from initial symptom onset, with a 6.7% risk at 48 hours and a 10% risk by 7 days after a TIA.1,2 The highest risk period is early, with a median time to a recurrence or progression event of 1 day; many events occur overnight after the initial ictus.3 Many strokes are preventable after a TIA. Rapid diagnosis and treatment reduces the risk of stroke by as much as 80%4,5 and significantly reduces mortality, long-term disability, and costs.6,7 The estimated annual cost avoidance in Canada from the rapid assessment and treatment of TIA is


Stroke | 2014

Incidental Magnetic Resonance Diffusion-Weighted Imaging–Positive Lesions Are Rare in Neurologically Asymptomatic Community-Dwelling Adults

Saima Batool; Martin O’Donnell; Mukul Sharma; Shofiqul Islam; Gilles R. Dagenais; Paul Poirier; Scott A. Lear; Andreas Wielgosz; Koon K. Teo; Grant Stotts; Cheryl R. McCreary; Richard Frayne; Jane DeJesus; Sumathy Rangarajan; Salim Yusuf; Eric E. Smith

313.8 million (of which


CMAJ Open | 2016

Mechanical thrombectomy in patients with acute ischemic stroke: a cost-utility analysis

Xuanqian Xie; Anna Lambrinos; Brian Chan; Irfan Dhalla; Timo Krings; Leanne K. Casaubon; Cheemun Lum; Nancy Sikich; Aditya Bharatha; Vitor M. Pereira; Grant Stotts; Gustavo Saposnik; Christina O'Callaghan; Linda Kelloway; Michael D. Hill

269.2 million are indirect costs).8 To be most effective, the diagnosis and treatment of all TIAs and minor strokes must recognize the natural biology of the condition and should ideally occur on the same day as the event. Currently, this is not consistently achieved in Canada. There are several overlapping challenges with TIA/minor stroke management, including (1) establishing an accurate diagnosis of brain ischemia quickly; (2) establishing accurate triage approaches to risk-stratify patients; and (3) establishing systems of care that expedite both the diagnostic evaluation and initiation of treatment. Rapid access to both brain and vascular imaging is a unifying component of the solution to all these challenges. The clinical diagnosis of TIA/minor stroke is not always straightforward because a …

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Dar Dowlatshahi

Ottawa Hospital Research Institute

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Mukul Sharma

Population Health Research Institute

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Adebayo Adeeko

Sunnybrook Health Sciences Centre

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Murad Alturkustani

University of Western Ontario

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