SREMI Researcher Profile

Keerat GrewalSREMI research fellow and emergency physician, Dr. Keerat Grewal has quickly become a rising star in the emergency medicine research community. Dr. Grewal is a health services researcher who is using provincial administrative data to improve the care and outcomes of cancer patients presenting to the emergency department (ED). She is also a fellow with the Cancer Program at the Institute for Clinical Evaluative Sciences (ICES).

Patients with cancer have complex care requirements and frequently use the ED. However, the intersection of oncology and emergency medicine is rarely addressed in the literature. For her Masters degree and subsequent first author publication in the prestigious Canadian Medical Association Journal, Dr. Grewal used provincial administrative data to determine if continuity 
of care, cancer expertise of an institution, or both, were associated with outcomes in patients with cancer in the emergency setting. Patients seen in EDs at alternative hospitals that were not associated with a cancer centre were less likely to be admitted to hospital, and had higher 30-day mortality. These results suggest the cancer expertise of an institution is an important predictor of outcomes in the emergency care of patients with cancer.

In her first year following residency, Dr. Grewal has won numerous grants and awards in recognition of her outstanding contribution to emergency medicine research. These awards included the Early Researcher Sponsorship Award from the Cancer and Primary Care Research International Network and an Early Career Investigator Program Award from the Institute of Cancer Research at CIHR. These awards have allowed Dr. Grewal to attend primary and cancer care conferences where she has established important National and International research connections and had the opportunity to present some of her preliminary work. 

Keerat Grewal
Keerat GrewalIn August, Dr. Grewal received a fellowship award in partnership with the Canadian Venous thromboEmbolism Clinical Trials and Outcomes Research Network (CanVECTOR). Venous thromboembolism (VTE) is common worldwide, and is associated with significant morbidity and mortality. Although lower limb immobilization is associated with the development of deep vein thrombosis (DVT) and pulmonary embolism (PE), there is limited data on the magnitude of the problem in Canada. Thus, there is little evidence to assist emergency physicians in evaluating the risk of VTE when treating patients with ankle fractures, and subsequently no guidelines suggesting who would likely benefit from thromboprophylaxis and when to initiate thromboprophylaxis for these patients in the ED. For her fellowship project, Dr. Grewal will be leading a study to examine the risk of VTE among patients discharged from the ED with ankle fractures. This study will provide Canadian population-level data to examine this issue, and will be one of the largest studies on the topic to date world-wide.

Dr. Grewal also received a 2019 Canadian Association of Emergency Physicians (CAEP) grant to examine the risk of intracranial hemorrhage among elderly patients on anticoagulation seen in the ED with a head injury. At present, there are no published guidelines on the management of elderly patients on anticoagulation after a minor head injury. With this study, she hopes to compare outcomes between patients using different types of anticoagulants and provide clinicians with guidance on management of these patients based on outcomes.