SREMI Clinician Scientist Profile

Dr. Keerat Grewal

Keerat Grewal headshot

A dreaded part of a patient’s journey with cancer can be ending up in an emergency department with acute illness or side effects from treatment. Moreover, during the COVID-19 pandemic, patients have been more frequently diagnosed with cancer during emergency department visits for prolonged, unexplained symptoms. 

To date, very little is known about how these emergency department visits impact the outcomes for cancer patients, but SREMI Clinician Scientist Dr. Keerat Grewal is using some of the world’s largest health administrative databases to study the relationship between the emergency department and patient outcomes throughout the cancer continuum. “Even prior to the COVID-19 pandemic, we often saw patients with a new or suspected cancer that were diagnosed in the emergency department. However, during the pandemic, it seems we are seeing more cancers being diagnosed in the emergency department, often at a more advanced stage,” says Dr. Grewal.
As a health services researcher, Dr. Grewal taps into province-wide, administrative health databases to look at trends among patients across Ontario. In a first of its kind study, she found that cancer patients in Ontario frequently require emergency care, and that almost one in four emergency department visits by these patients are due to possible infection. 
This year she supervised University of Toronto emergency medicine resident, Dr. Sally Kang, who was awarded one of the Top Resident Research Awards at CAEP 2021 for her abstract “Patient characteristics and outcomes associated with cancer diagnosis in the emergency department: A systematic review.” As Dr. Grewal said, “These findings will inform future studies and I’m hoping we can positively impact outcomes and care for these patients.” 

Dr. Grewal is also using similar databases to quantify how the COVID-19 pandemic has affected emergency department usage and health outcomes of non-COVID-19 patients in Ontario. With many emergency departments reporting a significant drop in patient visits at the height of the pandemic, there is concern that people who should be seeking emergency care are delaying their care, and their health is suffering as a result. 

Keerat Grewal at CAEP - screenshot of title slide with image of Keerat
Keerat Grewal at CAEP

In addition, Dr. Grewal has built a successful research program studying venous thromboembolism and head injuries among patients on blood thinners. This year she completed a study examining patients with an ankle fracture requiring limb immobilization in the emergency department and found immobilization increased the risk of developing blood clots. Dr. Grewal presented this study at the Society for Academic Emergency Medicine (SAEM) conference as a plenary presentation and won the national Canadian Association of Emergency Physicians (CAEP) CanVECTOR award. The study was published in the field’s most prestigious journal, Annals of Emergency Medicine.

Dr. Grewal continues to lead the iBLEED-ED study, a study examining the risk of intracranial hemorrhage in older patients seen in the emergency department with a head injury and comparing these risks by anticoagulation status. The study was recently accepted by CMAJ, and was presented at the CAEP conference as a plenary presentation. For this work, Dr. Grewal won CAEP’s New Investigator Award. Several sub-studies from this project are in the process of being submitted for publication in high-impact, peer-reviewed journals. 

Keerat Grewal at CAEP screenshot of PowerPoint presentation with image of Keerat

Dr. Grewal is also working on the iBLEED-ED study, a study examining the risk of intracranial hemorrhage in older patients seen in the emergency department with a head injury and comparing these risks by anticoagulation status. She continues to mentor junior residents, is supervising multiple resident research projects and has published six peer-reviewed manuscripts this year. Her ICES appointment will guarantee streamlined access to ICES data and allow her to accelerate her health services research program, using population-level data to identify gaps in emergency medicine care and propose ways to improve care in emergency departments across Ontario.