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Dharsee S, Laliberté Durish C, Tang K, Brooks BL, Noel M, Ware AL, Beauchamp MH, Craig W, Doan Q, Freedman SB, Goodyear BG, Gravel J, Zemek R, Yeates KO. Association of Psychological Resilience, Cognitive Reserve, and Brain Reserve with Post-Concussive Symptoms in Children with Mild Traumatic Brain Injury and Orthopedic Injury: An A-CAP Study. J Neurotrauma 2024. [PMID: 38874919 DOI: 10.1089/neu.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Protective factors, including psychological resilience, cognitive reserve, and brain reserve, may be positively associated with recovery after pediatric mild traumatic brain injury (mTBI) but are yet to be studied concurrently. We sought to examine these factors as moderators of post-concussive symptoms (PCS) in pediatric mTBI compared with mild orthopedic injury (OI). Participants included 967 children (633 mTBI, 334 OI) aged 8-16.99 years, recruited from 5 Canadian pediatric emergency departments as part of a prospective longitudinal cohort study. At 10 days post-injury, psychological resilience was measured using the Connor-Davidson Resilience Scale and brain reserve was measured using total brain volume derived from structural magnetic resonance imaging. Cognitive reserve was measured at 3 months post-injury using IQ scores from the Wechsler Abbreviated Scale of Intelligence-Second Edition. Cognitive and somatic PCS were measured using child and parent ratings on the Health and Behavior Inventory, completed weekly for 3 months and biweekly to 6 months. Analyses involved generalized least-squares regression models using restricted cubic splines. Covariates included age at injury, sex, racialized identity, material and social deprivation, pre-injury migraine and concussion history, and retrospective pre-injury PCS. Psychological resilience moderated group differences in parent-reported PCS. At 30 days post-injury, estimated group differences in parent-reported cognitive and somatic PCS (mTBI > OI) were larger at higher (75th percentile) resilience scores (Est = 2.25 [0.87, 3.64] and Est = 2.38 [1.76, 3.00], respectively) than at lower (25th percentile) resilience scores (Est = 1.44 [0.01, 2.86] and Est = 2.08 [1.45, 2.71], respectively). Resilience did not moderate group differences in child-reported PCS but was negatively associated with child-reported PCS in both groups (ps ≤ 0.001). Brain reserve (i.e., total brain volume [TBV]) also moderated group differences, but only for parent-reported somatic PCS (p = 0.018). Group difference (mTBI > OI) at 30 days was larger at smaller (25th percentile) TBV (Est = 2.78 [2.17, 3.38]) than at larger (75th percentile) TBV (Est = 1.95 [1.31, 2.59]). TBV was not associated with parent-reported cognitive PCS or child-reported PCS. IQ did not moderate PCS in either group but had a significant non-linear association in both groups with child-reported somatic PCS (p = 0.018) and parent-reported PCS (p < 0.001), with higher PCS scores at both lower and higher IQs. These findings suggest that higher resilience predicts fewer PCS, but less strongly after mTBI than OI; greater brain reserve may reduce the effect of mTBI on somatic PCS; and cognitive reserve has an unexpected curvilinear association with PCS across injury types. The results highlight the importance of protective factors as predictors of recovery and potential targets for intervention following pediatric mTBI.
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Affiliation(s)
- Safira Dharsee
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | | - Ken Tang
- Independent Statistical Consulting, Richmond, British Columbia, Canada
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital Research Institute, University of Calgary; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley L Ware
- Department of Psychology, Georgia State University, Georgia, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | | | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Dharsee S, Tang K, Beauchamp MH, Craig W, Doan Q, Freedman SB, Gravel J, Zemek R, Yeates KO. Do preinjury life events moderate the outcomes of mild traumatic brain injuries in children? An A-CAP Study. J Pediatr Psychol 2024; 49:195-206. [PMID: 38457314 DOI: 10.1093/jpepsy/jsae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE To examine preinjury life events as moderators of postconcussive symptoms (PCS) and quality of life (QoL) in children with pediatric mild traumatic brain injury (mTBI) versus orthopedic injury (OI). METHODS Participants were 633 children with mTBI and 334 with OI, ages 8-16.99, recruited from 5 pediatric emergency departments and followed for 6 months postinjury as part of a prospective cohort study. Preinjury life events were measured retrospectively using the Child and Adolescent Survey of Experiences, PCS using the Health and Behavior Inventory (HBI) and Post-Concussion Symptom Interview (PCS-I), and QoL using the Pediatric Quality of Life Inventory (PedsQL). Analyses involved longitudinal regression using restricted cubic splines, with group, positive and negative life events, and time as primary predictors. Covariates included age, sex, race, socioeconomic status, preinjury history (i.e., headache, migraine, previous concussion), and parent-rated retrospective PCS-I, HBI, and PedsQL scores. RESULTS PCS and QoL were worse after mTBI than OI, but group differences declined with time (all p < .001). Group differences in PCS were larger at higher levels of positive life events, which predicted lower PCS (p= .03 to p < .001) and higher QoL (p = .048) after OI but not after mTBI. Negative life events predicted worse PCS and QoL in both groups (p = .002 to p < .001). CONCLUSIONS Preinjury positive life events moderate outcomes after pediatric injury, with a protective effect seen in OI but not in mTBI. Negative life events are consistently associated with worse outcomes regardless of injury type.
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Affiliation(s)
- Safira Dharsee
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Ken Tang
- Independent Statistical Consulting, Vancouver, BC, Canada
| | - Miriam H Beauchamp
- Department of Psychology, Université de Montréal and CHU Sainte-Justine Hospital Research Center, Montréal, QC, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Onicas AI, Deighton S, Yeates KO, Bray S, Graff K, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson B, Craig W, Dehaes M, Deschenes S, Doan Q, Freedman SB, Goodyear BG, Gravel J, Lebel C, Ledoux AA, Zemek R, Ware AL. Longitudinal Functional Connectome in Pediatric Concussion: An Advancing Concussion Assessment in Pediatrics Study. J Neurotrauma 2024; 41:587-603. [PMID: 37489293 DOI: 10.1089/neu.2023.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Advanced magnetic resonance imaging (MRI) techniques indicate that concussion (i.e., mild traumatic brain injury) disrupts brain structure and function in children. However, the functional connectivity of brain regions within global and local networks (i.e., functional connectome) is poorly understood in pediatric concussion. This prospective, longitudinal study addressed this gap using data from the largest neuroimaging study of pediatric concussion to date to study the functional connectome longitudinally after concussion as compared with mild orthopedic injury (OI). Children and adolescents (n = 967) 8-16.99 years with concussion or mild OI were recruited from pediatric emergency departments within 48 h post-injury. Pre-injury and 1-month post-injury symptom ratings were used to classify concussion with or without persistent symptoms based on reliable change. Subjects completed a post-acute (2-33 days) and chronic (3 or 6 months via random assignment) MRI scan. Graph theory metrics were derived from 918 resting-state functional MRI scans in 585 children (386 concussion/199 OI). Linear mixed-effects modeling was performed to assess group differences over time, correcting for multiple comparisons. Relative to OI, the global clustering coefficient was reduced at 3 months post-injury in older children with concussion and in females with concussion and persistent symptoms. Time post-injury and sex moderated group differences in local (regional) network metrics of several brain regions, including degree centrality, efficiency, and clustering coefficient of the angular gyrus, calcarine fissure, cuneus, and inferior occipital, lingual, middle occipital, post-central, and superior occipital gyrus. Relative to OI, degree centrality and nodal efficiency were reduced post-acutely, and nodal efficiency and clustering coefficient were reduced chronically after concussion (i.e., at 3 and 6 months post-injury in females; at 6 months post-injury in males). Functional network alterations were more robust and widespread chronically as opposed to post-acutely after concussion, and varied by sex, age, and symptom recovery at 1-month post-injury. Local network segregation reductions emerged globally (across the whole brain network) in older children and in females with poor recovery chronically after concussion. Reduced functioning between neighboring regions could negatively disrupt specialized information processing. Local network metric alterations were demonstrated in several posterior regions that are involved in vision and attention after concussion relative to OI. This indicates that functioning of superior parietal and occipital regions could be particularly susceptibile to the effects of concussion. Moreover, those regional alterations were especially apparent at later time periods post-injury, emerging after post-concussive symptoms resolved in most and persisted up to 6 months post-injury, and differed by biological sex. This indicates that neurobiological changes continue to occur up to 6 months after pediatric concussion, although changes emerge earlier in females than in males. Changes could reflect neural compensation mechanisms.
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Affiliation(s)
- Adrian I Onicas
- MoMiLab, IMT School for Advanced Studies Lucca, Lucca, LU, Italy
- Computer Vision Group, Sano Centre for Computational Medicine, Kraków, Poland. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Deighton
- Department of Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Signe Bray
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kirk Graff
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nishard Abdeen
- Department of Radiology, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Bjornson
- Division of Neurology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Sylvain Deschenes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Departments of Pediatric and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Department of Pediatric Emergency Medicine, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Catherine Lebel
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrée-Anne Ledoux
- Department of Cellular and Molecular Medicine, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ashley L Ware
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA, and Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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La PL, Walker R, Bell TK, Craig W, Doan Q, Beauchamp MH, Zemek R, Yeates KO, Harris AD. Longitudinal changes in brain metabolites following pediatric concussion. Sci Rep 2024; 14:3242. [PMID: 38331924 PMCID: PMC10853495 DOI: 10.1038/s41598-024-52744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Concussion is commonly characterized by a cascade of neurometabolic changes following injury. Magnetic Resonance Spectroscopy (MRS) can be used to quantify neurometabolites non-invasively. Longitudinal changes in neurometabolites have rarely been studied in pediatric concussion, and fewer studies consider symptoms. This study examines longitudinal changes of neurometabolites in pediatric concussion and associations between neurometabolites and symptom burden. Participants who presented with concussion or orthopedic injury (OI, comparison group) were recruited. The first timepoint for MRS data collection was at a mean of 12 days post-injury (n = 545). Participants were then randomized to 3 (n = 243) or 6 (n = 215) months for MRS follow-up. Parents completed symptom questionnaires to quantify somatic and cognitive symptoms at multiple timepoints following injury. There were no significant changes in neurometabolites over time in the concussion group and neurometabolite trajectories did not differ between asymptomatic concussion, symptomatic concussion, and OI groups. Cross-sectionally, Choline was significantly lower in those with persistent somatic symptoms compared to OI controls at 3 months post-injury. Lower Choline was also significantly associated with higher somatic symptoms. Although overall neurometabolites do not change over time, choline differences that appear at 3 months and is related to somatic symptoms.
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Affiliation(s)
- Parker L La
- Department of Radiology, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Robyn Walker
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tiffany K Bell
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Miriam H Beauchamp
- Department of Psychology, Ste Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
- Childrens' Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
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5
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Dun-Dery F, Xie J, Winston K, Burstein B, Gravel J, Emsley J, Sabhaney V, Zemek R, Berthelot S, Beer D, Kam A, Freire G, Mater A, Porter R, Poonai N, Moffatt A, Dixon A, Salvadori MI, Freedman SB. Post-COVID-19 Condition in Children 6 and 12 Months After Infection. JAMA Netw Open 2023; 6:e2349613. [PMID: 38153737 PMCID: PMC10755606 DOI: 10.1001/jamanetworkopen.2023.49613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023] Open
Abstract
Importance There is a need to understand the long-term outcomes among children infected with SARS-CoV-2. Objective To quantify the prevalence of post-COVID-19 condition (PCC) among children tested for SARS-CoV-2 infection in pediatric emergency departments (EDs). Design, Setting, and Participants Multicenter, prospective cohort study at 14 Canadian tertiary pediatric EDs that are members of the Pediatric Emergency Research Canada network with 90-day, 6-month, and 12-month follow-up. Participants were children younger than 18 years who were tested for SARS-CoV-2 infection between August 2020 and February 2022. Data were analyzed from May to November 2023. Exposure The presence of SARS-CoV-2 infection at or within 14 days of the index ED visit. Main Outcomes and Measures Presence of symptoms and QoL reductions that meet the PCC definition. This includes any symptom with onset within 3 months of infection that is ongoing at the time of follow-up and affects everyday functioning. The outcome was quantified at 6 and 12 months following the index ED visit. Results Among the 5147 children at 6 months (1152 with SARS-CoV-2 positive tests and 3995 with negative tests) and 5563 children at 12 months (1192 with SARS-CoV-2 positive tests and 4371 with negative tests) who had sufficient data regarding the primary outcome to enable PCC classification, the median (IQR) age was 2.0 (0.9-5.0) years, and 2956 of 5563 (53.1%) were male. At 6-month follow-up, symptoms and QoL changes consistent with the PCC definition were present in 6 of 1152 children with positive SARS-CoV-2 tests (0.52%) and 4 of 3995 children with negative SARS-CoV-2 tests (0.10%; absolute risk difference, 0.42%; 95% CI, 0.02% to 0.94%). The PCC definition was met at 12 months by 8 of 1192 children with positive SARS-CoV-2 tests (0.67%) and 7 of 4371 children with negative SARS-CoV-2 tests (0.16%; absolute risk difference, 0.51%; 95% CI, 0.06 to 1.08%). At 12 months, the median (IQR) PedsQL Generic Core Scale scores were 98.4 (90.0-100) among children with positive SARS-CoV-2 tests and 98.8 (91.7-100) among children with negative SARS-CoV-2 tests (difference, -0.3; 95% CI, -1.5 to 0.8; P = .56). Among the 8 children with SARS-CoV-2 positive tests and PCC at 12-month follow-up, children reported respiratory (7 of 8 patients [88%]), systemic (3 of 8 patients [38%]), and neurologic (1 of 8 patients [13%]) symptoms. Conclusions and Relevance In this cohort study of children tested for SARS-CoV-2 infection in Canadian pediatric EDs, although children infected with SARS-CoV-2 reported increased chronic symptoms, few of these children developed PCC, and overall QoL did not differ from children with negative SARS-CoV-2 tests.
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Affiliation(s)
- Frederick Dun-Dery
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Winston
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason Emsley
- Department of Emergency Medicine, IWK Children's Health Centre and Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vikram Sabhaney
- Departments of Paediatrics and Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Simon Berthelot
- Département de médecine de famille et de médecine d'urgence, CHU de Québec-Université Laval, Québec City, Quebec, Canada
| | - Darcy Beer
- Department of Pediatrics and Child Health, The Children's Hospital of Winnipeg, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - April Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Gabrielle Freire
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Mater
- Section of Pediatric Emergency, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, Newfoundland and Labrador Health Services, St John's, Newfoundland and Labrador, Canada
| | - Naveen Poonai
- Department of Paediatrics, Children's Hospital London Health Sciences Centre, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Internal Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Anne Moffatt
- Department of Paediatrics, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Andrew Dixon
- Section of Pediatric Emergency Medicine, Departments of Pediatric, Women's and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Marina I Salvadori
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Ware AL, Lebel C, Onicas A, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson BH, Craig W, Dehaes M, Doan Q, Deschenes S, Freedman SB, Goodyear BG, Gravel J, Ledoux AA, Zemek R, Yeates KO. Longitudinal Gray Matter Trajectories in Pediatric Mild Traumatic Brain Injury. Neurology 2023; 101:e728-e739. [PMID: 37353339 PMCID: PMC10437012 DOI: 10.1212/wnl.0000000000207508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/24/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This prospective, longitudinal cohort study examined trajectories of brain gray matter macrostructure after pediatric mild traumatic brain injury (mTBI). METHODS Children aged 8-16.99 years with mTBI or mild orthopedic injury (OI) were recruited from 5 pediatric emergency departments. Reliable change between preinjury and 1 month postinjury symptom ratings was used to classify mTBI with or without persistent symptoms. Children completed postacute (2-33 days) and/or chronic (3 or 6 months) postinjury T1-weighted MRI, from which macrostructural metrics were derived using automated segmentation. Linear mixed-effects models were used, with multiple comparisons correction. RESULTS Groups (N = 623; 407 mTBI/216 OI; 59% male; age mean = 12.03, SD = 2.38 years) did not differ in total brain, white, or gray matter volumes or regional subcortical gray matter volumes. However, time postinjury, age at injury, and biological sex-moderated differences among symptom groups in cortical thickness of the angular gyrus, basal forebrain, calcarine cortex, gyrus rectus, medial and posterior orbital gyrus, and the subcallosal area all corrected p < 0.05. Gray matter macrostructural metrics did not differ between groups postacutely. However, cortical thinning emerged chronically after mTBI relative to OI in the angular gyrus in older children (d [95% confidence interval] = -0.61 [-1.15 to -0.08]); and in the basal forebrain (-0.47 [-0.94 to -0.01]), subcallosal area (-0.55 [-1.01 to -0.08]), and the posterior orbital gyrus (-0.55 [-1.02 to -0.08]) in females. Cortical thinning was demonstrated for frontal and occipital regions 3 months postinjury in males with mTBI with persistent symptoms vs without persistent symptoms (-0.80 [-1.55 to -0.05] to -0.83 [-1.56 to -0.10]) and 6 months postinjury in females and younger children with mTBI with persistent symptoms relative to mTBI without persistent symptoms and OI (-1.42 [-2.29 to -0.45] to -0.91 [-1.81 to -0.01]). DISCUSSION These findings signal little diagnostic and prognostic utility of postacute gray matter macrostructure in pediatric mTBI. However, mTBI altered the typical course of cortical gray matter thinning up to 6 months postinjury, even after symptoms typically abate in most children. Collapsing across symptom status obscured the neurobiological heterogeneity of discrete clinical outcomes after pediatric mTBI. The results illustrate the need to examine neurobiology in relation to clinical outcomes and within a neurodevelopmental framework.
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Affiliation(s)
- Ashley L Ware
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada.
| | - Catherine Lebel
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Adrian Onicas
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Nishard Abdeen
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Miriam H Beauchamp
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Christian Beaulieu
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Bruce H Bjornson
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - William Craig
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Mathieu Dehaes
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Quynh Doan
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Sylvain Deschenes
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Stephen B Freedman
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Bradley G Goodyear
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Jocelyn Gravel
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Andrée-Anne Ledoux
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Roger Zemek
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Keith Owen Yeates
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
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Doan Q, Chadwick L, Tang K, Brooks BL, Beauchamp M, Zemek R, Craig W, Gravel J, Yeates KO. A Prospective Cohort Study of the Association Between Preinjury Psychosocial Function and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury: An A-CAP Study. J Head Trauma Rehabil 2023; 38:294-307. [PMID: 36602261 DOI: 10.1097/htr.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We evaluated the moderating effect of preinjury psychosocial function on postconcussion symptoms for children with mild traumatic brain injury (mTBI). DESIGN, SETTING, AND POPULATION We conducted a prospective cohort study of children ages 8.0 to 16.9 years with mTBI ( n = 633) or orthopedic injury (OI; n = 334), recruited from 5 pediatric emergency departments from September 2016 to December 2018. MAIN MEASURES Participants completed baseline assessments within 48 hours of injury, and postconcussion symptoms assessments at 7 to 10 days, weekly to 3 months, and biweekly to 6 months post-injury. Preinjury psychosocial function was measured using parent ratings on the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ), retrospectively evaluating their child's status prior to the injury. Parent and child ratings on the Health and Behavior Inventory (HBI) (cognitive and somatic subscales) and the Post-Concussion Symptom Interview (PCS-I) were used as measures of postconcussion symptoms. We fitted 6 longitudinal regression models, which included 747 to 764 participants, to evaluate potential interactions between preinjury psychosocial function and injury group as predictors of child- and parent-reported postconcussion symptoms. RESULTS Preinjury psychosocial function moderated group differences in postconcussion symptoms across the first 6 months post-injury. Higher emotional and conduct problems were significantly associated with more severe postconcussion symptoms among children with mTBI compared with OI. Wald's χ 2 for interaction terms (injury group × SDQ subscales) ranged from 6.3 to 10.6 ( P values <.001 to .043) across parent- and child-reported models. In contrast, larger group differences (mTBI > OI) in postconcussion symptoms were associated with milder hyperactivity (Wald's χ 2 : 15.3-43.0, all P < .001), milder peer problems (Wald's χ 2 : 11.51, P = .003), and higher social functioning (Wald's χ 2 : 12.435, P = .002). CONCLUSIONS Preinjury psychosocial function moderates postconcussion symptoms in pediatric mTBI, highlighting the importance of assessing preinjury psychosocial function in children with mTBI.
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Affiliation(s)
- Quynh Doan
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada (Dr Doan); Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (Ms Chadwick and Dr Yeates); Independent Statistical Consultant, Vancouver, Canada (Dr Tang); Departments of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada (Dr Brooks); Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Canada (Dr Beauchamp); Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada (Dr Zemek); Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada (Dr Craig); and Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Canada (Dr Gravel)
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9
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Ware AL, Onicas AI, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson BH, Craig W, Dehaes M, Deschenes S, Doan Q, Freedman SB, Goodyear BG, Gravel J, Ledoux AA, Zemek R, Yeates KO, Lebel C. Altered longitudinal structural connectome in paediatric mild traumatic brain injury: an Advancing Concussion Assessment in Paediatrics study. Brain Commun 2023; 5:fcad173. [PMID: 37324241 PMCID: PMC10265725 DOI: 10.1093/braincomms/fcad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Advanced diffusion-weighted imaging techniques have increased understanding of the neuropathology of paediatric mild traumatic brain injury (i.e. concussion). Most studies have examined discrete white-matter pathways, which may not capture the characteristically subtle, diffuse and heterogenous effects of paediatric concussion on brain microstructure. This study compared the structural connectome of children with concussion to those with mild orthopaedic injury to determine whether network metrics and their trajectories across time post-injury differentiate paediatric concussion from mild traumatic injury more generally. Data were drawn from of a large study of outcomes in paediatric concussion. Children aged 8-16.99 years were recruited from five paediatric emergency departments within 48 h of sustaining a concussion (n = 360; 56% male) or mild orthopaedic injury (n = 196; 62% male). A reliable change score was used to classify children with concussion into two groups: concussion with or without persistent symptoms. Children completed 3 T MRI at post-acute (2-33 days) and/or chronic (3 or 6 months, via random assignment) post-injury follow-ups. Diffusion-weighted images were used to calculate the diffusion tensor, conduct deterministic whole-brain fibre tractography and compute connectivity matrices in native (diffusion) space for 90 supratentorial regions. Weighted adjacency matrices were constructed using average fractional anisotropy and used to calculate global and local (regional) graph theory metrics. Linear mixed effects modelling was performed to compare groups, correcting for multiple comparisons. Groups did not differ in global network metrics. However, the clustering coefficient, betweenness centrality and efficiency of the insula, cingulate, parietal, occipital and subcortical regions differed among groups, with differences moderated by time (days) post-injury, biological sex and age at time of injury. Post-acute differences were minimal, whereas more robust alterations emerged at 3 and especially 6 months in children with concussion with persistent symptoms, albeit differently by sex and age. In the largest neuroimaging study to date, post-acute regional network metrics distinguished concussion from mild orthopaedic injury and predicted symptom recovery 1-month post-injury. Regional network parameters alterations were more robust and widespread at chronic timepoints than post-acutely after concussion. Results suggest that increased regional and local subnetwork segregation (modularity) and inefficiency occurs across time after concussion, emerging after post-concussive symptom resolve in most children. These differences persist up to 6 months after concussion, especially in children who showed persistent symptoms. While prognostic, the small to modest effect size of group differences and the moderating effects of sex likely would preclude effective clinical application in individual patients.
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Affiliation(s)
- Ashley L Ware
- Correspondence to: Ashley L. Ware, PhD Department of Psychology, Georgia State University 140 Decatur Street SE, Atlanta, GA 30303, USA E-mail:
| | - Adrian I Onicas
- Department of Psychology, University of Calgary, Calgary, AB T2N 0V2, Canada
- Computer Vision Group, Sano Centre for Computational Medicine, Kraków 30-054, Poland
| | - Nishard Abdeen
- Department of Radiology, Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa,Ottawa, ON, Canada K1H 8L1
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, QC, Canada H3C 3J7
| | - Christian Beaulieu
- Department of Biomedical Engineering, 1098 Research Transition Facility, University of Alberta, Edmonton, AB, Canada T6G 2V2
| | - Bruce H Bjornson
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6H 3V4
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada V6H 3V4
| | - William Craig
- University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada T6G 1C9
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada H3T1J4
- CHU Sainte-Justine Research Center, Montréal, QC, Canada H3T1C5
| | - Sylvain Deschenes
- CHU Sainte-Justine Research Center, Montréal, QC, Canada H3T1C5
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montréal, QC, CHU Sainte-Justine Research Center, Montréal, QC, Canada H3T1C5
| | - Quynh Doan
- Department of Pediatrics University of British Columbia, BC Children’s Hospital Research Institute, Vancouver, BC, Canada V5Z 4H4
| | - Stephen B Freedman
- Departments of Pediatric and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T3B 6A8
| | - Bradley G Goodyear
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, AB T2N 0V2, Canada
- Department of Radiology, University of Calgary, Calgary, AB T2N 0V2, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montréal, QC H3T1C5, Canada
- Department of Pediatric, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Andrée-Anne Ledoux
- Department of Cellular Molecular Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada K1H8L1
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada K1H8L1
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10
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Freedman SB, Schnadower D, Estes M, Casper TC, Goldstein SL, Grisaru S, Pavia AT, Wilfond BS, Metheney M, Kimball K, Tarr PI. Hyperhydration to Improve Kidney Outcomes in Children with Shiga Toxin-Producing E. coli Infection: a multinational embedded cluster crossover randomized trial (the HIKO STEC trial). Trials 2023; 24:359. [PMID: 37245030 DOI: 10.1186/s13063-023-07379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Shiga toxin-producing E. coli (STEC) infections affect children and adults worldwide, and treatment remain solely supportive. Up to 15-20% of children infected by high-risk STEC (i.e., E. coli that produce Shiga toxin 2) develop hemolytic anemia, thrombocytopenia, and kidney failure (i.e., hemolytic uremic syndrome (HUS)), over half of whom require acute dialysis and 3% die. Although no therapy is widely accepted as being able to prevent the development of HUS and its complications, several observational studies suggest that intravascular volume expansion (hyperhydration) may prevent end organ damage. A randomized trial is needed to confirm or refute this hypothesis. METHODS We will conduct a pragmatic, embedded, cluster-randomized, crossover trial in 26 pediatric institutions to determine if hyperhydration, compared to conservative fluid management, improves outcomes in 1040 children with high-risk STEC infections. The primary outcome is major adverse kidney events within 30 days (MAKE30), a composite measure that includes death, initiation of new renal replacement therapy, or persistent kidney dysfunction. Secondary outcomes include life-threatening, extrarenal complications, and development of HUS. Pathway eligible children will be treated per institutional allocation to each pathway. In the hyperhydration pathway, all eligible children are hospitalized and administered 200% maintenance balanced crystalloid fluids up to targets of 10% weight gain and 20% reduction in hematocrit. Sites in the conservative fluid management pathway manage children as in- or outpatients, based on clinician preference, with the pathway focused on close laboratory monitoring, and maintenance of euvolemia. Based on historical data, we estimate that 10% of children in our conservative fluid management pathway will experience the primary outcome. With 26 clusters enrolling a mean of 40 patients each with an intraclass correlation coefficient of 0.11, we will have 90% power to detect a 5% absolute risk reduction. DISCUSSION HUS is a devastating illness with no treatment options. This pragmatic study will determine if hyperhydration can reduce morbidity associated with HUS in children with high-risk STEC infection. TRIAL REGISTRATION ClinicalTrials.gov NCT05219110 . Registered on February 1, 2022.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Childrens Hospital, Alberta Childrens Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children, s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Myka Estes
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children, s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Silviu Grisaru
- Section of Nephrology, Department of Pediatrics, Alberta Children, s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin S Wilfond
- Divisions of Bioethics and Palliative Care and Pulmonary and Sleep Medicine, Department of Pediatrics and Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Melissa Metheney
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kadyn Kimball
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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11
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La PL, Joyce JM, Bell TK, Mauthner M, Craig W, Doan Q, Beauchamp MH, Zemek R, Yeates KO, Harris AD. Brain metabolites measured with magnetic resonance spectroscopy in pediatric concussion and orthopedic injury: An Advancing Concussion Assessment in Pediatrics (A-CAP) study. Hum Brain Mapp 2023; 44:2493-2508. [PMID: 36763547 PMCID: PMC10028643 DOI: 10.1002/hbm.26226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/18/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Millions of children sustain a concussion annually. Concussion disrupts cellular signaling and neural pathways within the brain but the resulting metabolic disruptions are not well characterized. Magnetic resonance spectroscopy (MRS) can examine key brain metabolites (e.g., N-acetyl Aspartate (tNAA), glutamate (Glx), creatine (tCr), choline (tCho), and myo-Inositol (mI)) to better understand these disruptions. In this study, we used MRS to examine differences in brain metabolites between children and adolescents with concussion versus orthopedic injury. Children and adolescents with concussion (n = 361) or orthopedic injury (OI) (n = 184) aged 8 to 17 years were recruited from five emergency departments across Canada. MRS data were collected from the left dorsolateral prefrontal cortex (L-DLPFC) using point resolved spectroscopy (PRESS) at 3 T at a mean of 12 days post-injury (median 10 days post-injury, range 2-33 days). Univariate analyses for each metabolite found no statistically significant metabolite differences between groups. Within each analysis, several covariates were statistically significant. Follow-up analyses designed to account for possible confounding factors including age, site, scanner, vendor, time since injury, and tissue type (and interactions as appropriate) did not find any metabolite group differences. In the largest sample of pediatric concussion studied with MRS to date, we found no metabolite differences between concussion and OI groups in the L-DLPFC. We suggest that at 2 weeks post-injury in a general pediatric concussion population, brain metabolites in the L-DLPFC are not specifically affected by brain injury.
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Affiliation(s)
- Parker L La
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Julie M Joyce
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany K Bell
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Ste Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Childrens' Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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12
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Convergent Validity of Myheartsmap: A Pediatric Psychosocial Health Screening Tool. Child Psychiatry Hum Dev 2023; 54:66-75. [PMID: 34350505 DOI: 10.1007/s10578-021-01221-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 01/25/2023]
Abstract
Recognition of pediatric mental health concerns often depends on assessment by parents, educators, and primary care professionals. Therefore, a psychosocial screening instrument suitable for routine use in schools and primary care is needed. The Pediatric Quality of Life (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ) are widely used for screening but lack adolescent-specific mental health measures. MyHEARTSMAP is an instrument assessing aspects of youth psychosocial health via four domains: Psychiatry, Function, Social, and Youth Health. We evaluated MyHEARTSMAP convergent validity with PedsQL and SDQ among 122 child-parent dyads participating in a larger concussion study. Convergent validity was assessed via correlations: MyHEARTSMAP Psychiatry and Function domains correlated strongly (r ≥ 0.44) and Social domain correlated weakly (r ≤ 0.25) to corresponding PedsQL and SDQ subscales, while Youth Health domain correlated moderately (r ≥ 0.31) to the tools' total scales. In conclusion, MyHEARTSMAP converges with PedsQL and SDQ, and benefits from the inclusion of adolescent-specific psychosocial measures.
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Alqurashi W, Shaker M, Wells GA, Collins GS, Greenhawt M, Curran JA, Zemek R, Schuh S, Ellis A, Gerdts J, Kreviazuk C, Dixon A, Eltorki M, Freedman SB, Gravel J, Poonai N, Worm M, Plint AC. Canadian Anaphylaxis Network-Predicting Recurrence after Emergency Presentation for Allergic REaction (CAN-PREPARE): a prospective, cohort study protocol. BMJ Open 2022; 12:e061976. [PMID: 36316072 PMCID: PMC9628530 DOI: 10.1136/bmjopen-2022-061976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Anaphylaxis is a severe, potentially fatal multiorgan system manifestation of an allergic reaction. The highest incidence of anaphylaxis is in children and adolescents. Biphasic anaphylaxis (BA) is defined as the recurrence of allergic symptoms after resolution of an initial reaction. It has been reported to occur in 10%-20% of cases within 1-48 hours from the onset of the initial reaction. The dilemma for physicians is determining which patients with resolved anaphylaxis should be observed for BA and for how long. Guidelines for duration of postanaphylaxis monitoring vary, are based on limited evidence and can have unintended negative impacts on patient safety, quality of life and healthcare resources. The objectives of this study are to derive a prognostic model for BA and to develop a risk-scoring system that informs disposition decisions of children who present to emergency departments (ED) with anaphylaxis. METHODS AND ANALYSIS This prospective multicentre cohort study will enrol 1682 patients from seven paediatric EDs that are members of the Paediatric Emergency Research Canada network. We will enrol patients younger than 18 years of age with an allergic reaction meeting anaphylaxis diagnostic criteria. Trained ED research assistants will screen, obtain consent and prospectively collect study data. Research assistants will follow patients during their ED visit and ascertain, in conjunction with the medical team, if the patient develops BA. A standardised follow-up survey conducted following study enrolment will determine if a biphasic reaction occurred after ED disposition. Model development will conform to the broad principles of the PROGRESS (Prognosis Research Strategy) framework and reporting will follow the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis Statement. ETHICS AND DISSEMINATION Ethics approval has been received from all participating centres. Our dissemination plan focuses on informing clinicians, policy makers and parents of the results through publication in peer-reviewed journals and broadcasting on multiple media platforms. TRIAL REGISTRATION NUMBER NCT05135377.
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Affiliation(s)
- Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire, USA
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Stephen Collins
- Centre for Statistics in Medicine, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Janet A Curran
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Suzanne Schuh
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Ellis
- Division of Allergy and Immunology, Queen's University, Kingston, Ontario, Canada
| | | | - Cheryl Kreviazuk
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Andrew Dixon
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Centre Hospitalier Universitaire Sainte-Justine, Universite de Montreal, Montreal, Québec, Canada
| | - Naveen Poonai
- Departments of Paediatrics, Internal Medicine, Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Amy C Plint
- Department of Pediatrics and Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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14
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Factor structure and measurement invariance of post-concussion symptom ratings on the Health and Behaviour Inventory across time, raters, and groups: An A-CAP study. J Int Neuropsychol Soc 2022; 29:346-359. [PMID: 35924559 DOI: 10.1017/s1355617722000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To validate the two-factor structure (i.e., cognitive and somatic) of the Health and Behaviour Inventory (HBI), a widely used post-concussive symptom (PCS) rating scale, through factor analyses using bifactor and correlated factor models and by examining measurement invariance (MI). METHODS PCS ratings were obtained from children aged 8-16.99 years, who presented to the emergency department with concussion (n = 565) or orthopedic injury (OI) (n = 289), and their parents, at 10-days, 3-months, and 6-months post-injury. Item-level HBI ratings were analyzed separately for parents and children using exploratory and confirmatory factor analyses (CFAs). Bifactor and correlated models were compared using various fit indices and tested for MI across time post-injury, raters (parent vs. child), and groups (concussion vs. OI). RESULTS CFAs showed good fit for both a three-factor bifactor model, consisting of a general factor with two subfactors (i.e., cognitive and somatic), and a correlated two-factor model with cognitive and somatic factors, at all time points for both raters. Some results suggested the possibility of a third factor involving fatigue. All models demonstrated strict invariance across raters and time. Group comparisons showed at least strong or strict invariance. CONCLUSIONS The findings support the two symptom dimensions measured by the HBI. The three-factor bifactor model showed the best fit, suggesting that ratings on the HBI also can be captured by a general factor. Both correlated and bifactor models showed substantial MI. The results provide further validation of the HBI, supporting its use in childhood concussion research and clinical practice.
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Onicas AI, Ware AL, Harris AD, Beauchamp MH, Beaulieu C, Craig W, Doan Q, Freedman SB, Goodyear BG, Zemek R, Yeates KO, Lebel C. Multisite Harmonization of Structural DTI Networks in Children: An A-CAP Study. Front Neurol 2022; 13:850642. [PMID: 35785336 PMCID: PMC9247315 DOI: 10.3389/fneur.2022.850642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
The analysis of large, multisite neuroimaging datasets provides a promising means for robust characterization of brain networks that can reduce false positives and improve reproducibility. However, the use of different MRI scanners introduces variability to the data. Managing those sources of variability is increasingly important for the generation of accurate group-level inferences. ComBat is one of the most promising tools for multisite (multiscanner) harmonization of structural neuroimaging data, but no study has examined its application to graph theory metrics derived from the structural brain connectome. The present work evaluates the use of ComBat for multisite harmonization in the context of structural network analysis of diffusion-weighted scans from the Advancing Concussion Assessment in Pediatrics (A-CAP) study. Scans were acquired on six different scanners from 484 children aged 8.00–16.99 years [Mean = 12.37 ± 2.34 years; 289 (59.7%) Male] ~10 days following mild traumatic brain injury (n = 313) or orthopedic injury (n = 171). Whole brain deterministic diffusion tensor tractography was conducted and used to construct a 90 x 90 weighted (average fractional anisotropy) adjacency matrix for each scan. ComBat harmonization was applied separately at one of two different stages during data processing, either on the (i) weighted adjacency matrices (matrix harmonization) or (ii) global network metrics derived using unharmonized weighted adjacency matrices (parameter harmonization). Global network metrics based on unharmonized adjacency matrices and each harmonization approach were derived. Robust scanner effects were found for unharmonized metrics. Some scanner effects remained significant for matrix harmonized metrics, but effect sizes were less robust. Parameter harmonized metrics did not differ by scanner. Intraclass correlations (ICC) indicated good to excellent within-scanner consistency between metrics calculated before and after both harmonization approaches. Age correlated with unharmonized network metrics, but was more strongly correlated with network metrics based on both harmonization approaches. Parameter harmonization successfully controlled for scanner variability while preserving network topology and connectivity weights, indicating that harmonization of global network parameters based on unharmonized adjacency matrices may provide optimal results. The current work supports the use of ComBat for removing multiscanner effects on global network topology.
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Affiliation(s)
- Adrian I. Onicas
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
- *Correspondence: Adrian I. Onicas
| | - Ashley L. Ware
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley D. Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Miriam H. Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Quynh Doan
- Department of Pediatrics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Stephen B. Freedman
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bradley G. Goodyear
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Catherine Lebel
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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16
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Ware AL, Yeates KO, Tang K, Shukla A, Onicas AI, Guo S, Goodrich-Hunsaker N, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson B, Craig W, Dehaes M, Doan Q, Deschenes S, Freedman SB, Goodyear BG, Gravel J, Ledoux AA, Zemek R, Lebel C. Longitudinal white matter microstructural changes in pediatric mild traumatic brain injury: An A-CAP study. Hum Brain Mapp 2022; 43:3809-3823. [PMID: 35467058 PMCID: PMC9294335 DOI: 10.1002/hbm.25885] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/07/2023] Open
Abstract
In the largest sample studied to date, white matter microstructural trajectories and their relation to persistent symptoms were examined after pediatric mild traumatic brain injury (mTBI). This prospective, longitudinal cohort study recruited children aged 8–16.99 years with mTBI or mild orthopedic injury (OI) from five pediatric emergency departments. Children's pre‐injury and 1‐month post‐injury symptom ratings were used to classify mTBI with or without persistent symptoms. Children completed diffusion‐weighted imaging at post‐acute (2–33 days post‐injury) and chronic (3 or 6 months via random assignment) post‐injury assessments. Mean diffusivity (MD) and fractional anisotropy (FA) were derived for 18 white matter tracts in 560 children (362 mTBI/198 OI), 407 with longitudinal data. Superior longitudinal fasciculus FA was higher in mTBI without persistent symptoms relative to OI, d (95% confidence interval) = 0.31 to 0.37 (0.02, 0.68), across time. In younger children, MD of the anterior thalamic radiations was higher in mTBI with persistent symptoms relative to both mTBI without persistent symptoms, 1.43 (0.59, 2.27), and OI, 1.94 (1.07, 2.81). MD of the arcuate fasciculus, −0.58 (−1.04, −0.11), and superior longitudinal fasciculus, −0.49 (−0.90, −0.09) was lower in mTBI without persistent symptoms relative to OI at 6 months post‐injury. White matter microstructural changes suggesting neuroinflammation and axonal swelling occurred chronically and continued 6 months post injury in children with mTBI, especially in younger children with persistent symptoms, relative to OI. White matter microstructure appears more organized in children without persistent symptoms, consistent with their better clinical outcomes.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ken Tang
- Independent Statistical Consulting, Richmond, British Columbia, Canada
| | - Ayushi Shukla
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Adrian I Onicas
- Department of Psychology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Sunny Guo
- Department of Psychology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Nishard Abdeen
- Department of Radiology, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Bjornson
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; 2. BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Quynh Doan
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sylvain Deschenes
- CHU Sainte-Justine Research Center; Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
| | - Stephen B Freedman
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, University of Montréal, Montréal, Québec, Canada
| | - Andrée-Anne Ledoux
- Department of Cellular and Molecular Medicine, University of Ottawa, & Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Catherine Lebel
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Eltorki M, Busse JW, Freedman SB, Thompson G, Beattie K, Serbanescu C, Carciumaru R, Thabane L, Ali S. Intravenous ketorolac versus morphine in children presenting with suspected appendicitis: a pilot single-centre non-inferiority randomised controlled trial. BMJ Open 2022; 12:e056499. [PMID: 35383071 PMCID: PMC8984007 DOI: 10.1136/bmjopen-2021-056499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Despite a lack of evidence demonstrating superiority to non-steroidal anti-inflammatory drugs, like ketorolac, that are associated with lower risk of harms, opioids remain the most prescribed analgesic for acute abdominal pain. In this pilot trial, we will assess the feasibility of a definitive trial comparing ketorolac with morphine in children with suspected appendicitis. We hypothesise that our study will be feasible based on a 40% consent rate. METHODS AND ANALYSIS A single-centre, non-inferiority, blinded (participant, clinician, investigators and outcome assessors), double-dummy randomised controlled trial of children aged 6-17 years presenting to a paediatric emergency department with ≤5 days of moderate to severe abdominal pain (≥5 on a Verbal Numerical Rating Scale) and are investigated for appendicitis. We will use variable randomised blocks of 4-6 and allocate participants in 1:1 ratio to receive either intravenous (IV) ketorolac 0.5 mg/kg+IV morphine placebo or IV morphine 0.1 mg/kg+IV ketorolac placebo. Analgesic co-intervention will be limited to acetaminophen (commonly used as first-line therapy). Participants in both groups will be allowed rescue therapy (morphine 0.5 mg/kg) within 60 min of our intervention. Our primary feasibility outcome is the proportion of eligible patients approached who provide informed consent and are enrolled in our trial. Our threshold for feasibility will be to achieve a ≥40% consent rate, and we will enrol 100 participants into our pilot trial. ETHICS AND DISSEMINATION Our study has received full approval by the Hamilton integrated Research Ethics Board. We will disseminate our study findings at national and international paediatric research conferences to garner interest and engage sites for a future multicentre definitive trial. TRIAL REGISTRATION NCT04528563, Pre-results.
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Affiliation(s)
- Mohamed Eltorki
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Thompson
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Karen Beattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Redjana Carciumaru
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Pediatrics, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Research Institute, St Joseph's Health Care, Hamilton, Ontario, Canada
| | - Samina Ali
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
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18
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Knisley L, Hartling L, Jabbour M, Johnson DW, Lang ES, MacPhee S, Reid S, Scott SD, Sinclair D, Stang AS, Vincent M, Klassen TP. Translating Emergency Knowledge for Kids (TREKK): using research evidence to improve outcomes for children and families in emergency departments across Canada. CAN J EMERG MED 2022; 24:12-15. [PMID: 34625916 PMCID: PMC8500264 DOI: 10.1007/s43678-021-00205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Lisa Knisley
- Children's Hospital Research Institute of Manitoba, 532-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, Edmonton, AB, Canada
| | - Mona Jabbour
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy S Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon MacPhee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sarah Reid
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Doug Sinclair
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthieu Vincent
- Department of Paediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Faculty of Medicine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, 532-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
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19
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Examining brain white matter after pediatric mild traumatic brain injury using neurite orientation dispersion and density imaging: An A-CAP study. Neuroimage Clin 2021; 32:102887. [PMID: 34911193 PMCID: PMC8633364 DOI: 10.1016/j.nicl.2021.102887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022]
Abstract
We examined white matter microstructure after pediatric mTBI using NODDI and DTI. Children with mTBI did not significantly differ from those with OI on any metrics. Minor alterations, if any, may be present in children at the post-acute stage after mTBI. Large longitudinal studies are needed to understand long-term brain changes post injury.
Background Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods Children (mTBI n = 320, OI n = 176) aged 8–16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3 T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions Overall, there were no significant differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.
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20
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Bressan S, Klassen TP, Dalziel SR, Babl FE, Benito J, Chamberlain J, Chang TP, Freedman SB, Kohn Loncarica G, Lyttle MD, Mintegi S, Mistry RD, Nigrovic LE, Plint AC, Rino P, Roland D, Van De Mosselaer G, Oostenbrink R, Kuppermann N. The Pediatric Emergency Research Network: a decade old and growing. Eur J Emerg Med 2021; 28:341-343. [PMID: 34433789 DOI: 10.1097/mej.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Silvia Bressan
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
- Research in European Pediatric Emergency Medicine (REPEM)
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Pediatric Emergency Research Canada (PERC)
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
- Paediatric Research in Emergency Departments International Collaborative (PREDICT)
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT)
- Departments of Paediatrics and Critical Care, University of Melbourne
- Emergency Research, Murdoch Children's Research Institute
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Javier Benito
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces; University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG)
| | - James Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Pediatric Emergency Care Applied Research Network (PECARN)
| | - Todd P Chang
- Pediatric Emergency Care Applied Research Network (PECARN)
- Division of Emergency Medicine & Transport, Children's Hospital Los Angeles and Keck School of Medicine at University of Southern California, Los Angeles, California, USA
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC)
| | - Stephen B Freedman
- Pediatric Emergency Research Canada (PERC)
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Guillermo Kohn Loncarica
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI)
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces; University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG)
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC)
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - Lise E Nigrovic
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC)
- Division of Emergency Medicine, Boston Children's Hospital
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy C Plint
- Pediatric Emergency Research Canada (PERC)
- Children's Hospital of Eastern Ontario
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Pedro Rino
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Damian Roland
- Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI)
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group; Children's Emergency Department, Leicester Royal Infirmary & SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
| | - Gregory Van De Mosselaer
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Translating Emergency Knowledge for Kids (TREKK)
| | - Rianne Oostenbrink
- Research in European Pediatric Emergency Medicine (REPEM)
- Department General Pediatrics, ErasmusMC - Sophia, Rotterdam, The Netherlands
| | - Nathan Kuppermann
- Pediatric Emergency Care Applied Research Network (PECARN)
- Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
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21
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O'Brien H, Minich NM, Langevin LM, Taylor HG, Bigler ED, Cohen DM, Beauchamp MH, Craig WR, Doan Q, Zemek R, Bacevice A, Mihalov LK, Yeates KO. Normative and Psychometric Characteristics of the Health and Behavior Inventory Among Children With Mild Orthopedic Injury Presenting to the Emergency Department: Implications for Assessing Postconcussive Symptoms Using the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). Clin J Sport Med 2021; 31:e221-e228. [PMID: 33973883 PMCID: PMC8416708 DOI: 10.1097/jsm.0000000000000943] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study sought to present normative and psychometric data and reliable change formulas for the Health and Behavior Inventory (HBI), a postconcussive symptom rating scale embedded in the Child Sport Concussion Assessment Tool 5th edition (Child SCAT5). DESIGN Prospective cohort study with longitudinal follow-up. SETTING Pediatric emergency departments (EDs). PARTICIPANTS As part of 3 studies conducted in the United States and Canada between 2001 and 2019, 450 children aged 8 to 16 years with mild orthopedic injuries were recruited during ED visits and assessed postacutely (M = 9.38 days, SD = 3.31) and 1 month and 3 months postinjury. Independent variables were rater (child vs parent), sex, and age at injury. MAIN OUTCOME MEASURE HBI ratings. METHODS Children and parents rated children's symptoms at each time point; parents also rated children's preinjury symptoms retrospectively. Normative data (mean, SD, skewness, kurtosis, and percentiles) were computed for child and parent ratings. Internal consistency was assessed using Cronbach alpha (α), and test-retest reliability and interrater agreement were assessed with intraclass correlations (ICCs). Reliable change formulas were computed using linear regression and mixed models. RESULTS HBI ratings were positively skewed. Mean ratings and percentiles were stable over time. Child and parent ratings demonstrated good-to-excellent internal consistency (α 0.76-0.94) and moderate-to-good test-retest reliability (ICC 0.51-0.76 between adjacent assessments). However, parent-child agreement was poor to moderate (ICC 0.31-0.69). CONCLUSIONS The HBI demonstrates acceptable normative and psychometric characteristics. Modest parent-child agreement highlights the importance of multiple informants when assessing postconcussive symptoms. The results will facilitate the use of the HBI in research and clinical practice.
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Affiliation(s)
- Heidi O'Brien
- Werklund School of Education, University of Calgary, Calgary, AB
| | - Nori M Minich
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | | | - H Gerry Taylor
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, Utah
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Miriam H Beauchamp
- Department of Psychology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC
| | - William R Craig
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON; and
| | - Ann Bacevice
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Leslie K Mihalov
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB
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Management of pediatric allergic reaction: Practice patterns of Canadian pediatric emergency physicians. CAN J EMERG MED 2021; 22:802-810. [PMID: 33448918 DOI: 10.1017/cem.2020.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Anaphylaxis is a severe allergic reaction that can be life-threatening. The literature indicates that the incidence of anaphylaxis is increasing and that there are deficiencies in both recognition and management. We aimed to examine the magnitude of these gaps in Canadian pediatric emergency medicine (PEM). METHODS We conducted a self-administered survey of the Pediatric Emergency Research Canada (PERC) physician database. The survey tool was developed through a literature review to identify recurring themes of gaps in anaphylaxis diagnosis and management. The final tool contained four scenarios; three scenarios featured each of the National Institute of Allergy and Infectious Diseases (NIAID) anaphylaxis criteria, separately, and a fourth case of non-anaphylactic allergy. Multiple-choice questions associated with each scenario addressed diagnosis, management, and disposition. Additional questions focused on epinephrine prescribing, observation durations, and respondent demographics. RESULTS Of the 214 members invited to participate in the survey, 152 (71%) responded. Anaphylaxis was accurately recognized 93%, 82%, and 99% of the time for the NIAID criteria one through three, respectively. When anaphylaxis was recognized, epinephrine was prescribed for each case 96%, 95%, and 72% of the time, respectively. Of all respondents, 115 (76%) accurately diagnosed all three cases of anaphylaxis and 82 (54%) treated anaphylaxis with epinephrine each time it was indicated. CONCLUSION Most respondents recognized cases of anaphylaxis; however, a substantial number demonstrated gaps in management that may adversely impact this vulnerable population. The recognition of anaphylaxis without urticaria or pulmonary findings and treatment of anaphylaxis with epinephrine, where indicated, were the main gaps identified.
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Knisley L, Le A, Scott SD. An online survey to assess parents' preferences for learning about child health research. Nurs Open 2021; 8:3143-3151. [PMID: 34390222 PMCID: PMC8510747 DOI: 10.1002/nop2.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/07/2021] [Accepted: 07/25/2021] [Indexed: 11/11/2022] Open
Abstract
Aim Ethical and logistical issues often exacerbate recruitment problems in child health studies. This study aims: (a) to provide new knowledge on how parents want to hear about child health research and (b) to inform the KidsCAN PERC iPCT initiative's re‐examination of recruitment and retention strategies for pediatric emergency department research studies. Design We employed a cross‐sectional, survey design. Methods An online survey was distributed to participants (i.e., parents) through partner organizations' advisory group mailing lists. Frequencies and measures of central tendency guided data analysis. Results Parents are interested in hearing about child health research opportunities, particularly during general practitioner, pediatrician or walk‐in clinic visits. Most parents wanted updates on the research team, progress and results and support to participate, such as reimbursement of travel and childcare costs. Results can inform research teams in the planning of communications to effectively share research opportunities, progress and results with parents.
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Affiliation(s)
- Lisa Knisley
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Anne Le
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Finkelstein Y, Maguire B, Zemek R, Osmanlliu E, Kam AJ, Dixon A, Desai N, Sawyer S, Emsley J, Lynch T, Mater A, Schuh S, Rumantir M, Freedman SB. Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study. Pediatr Emerg Care 2021; 37:427-434. [PMID: 34074990 PMCID: PMC8327936 DOI: 10.1097/pec.0000000000002484] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes. METHODS This study is an interrupted-time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018-January 27, 2020), peripandemic (January 28, 2020-March 10, 2020), and early pandemic (March 11, 2020-April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns. RESULTS There were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [-58%; 95% confidence interval (CI), -63% to -51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32-1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01-1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45-1.56). Mental health-related visits in children declined in the early-pandemic period (in <10 years, -60%; 95% CI, -67% to -51%; in children ≥10 years: -56%; 95% CI, -63% to -47%) relative to the pre-COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change: -55%; 95% CI, -61% to -49%; P < 0.001). CONCLUSIONS After the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children's health and acute care needs.
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Affiliation(s)
- Yaron Finkelstein
- From the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology
| | - Bryan Maguire
- Biostatistical Design and Analysis team, The Hospital for Sick Children, University of Toronto, Toronto
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Montreal Children’s Hospital, McGill University, Montreal, Quebec
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario
| | - Andrew Dixon
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Neil Desai
- Division of Pediatric Emergency Medicine, British Columbia Children’s Hospital, Vancouver, British Columbia
| | - Scott Sawyer
- Department of Pediatrics and Emergency Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Jason Emsley
- Department of Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
| | - Tim Lynch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Schulich School of Medicine, Western University, London, Ontario
| | - Ahmed Mater
- Division Pediatric Emergency Medicine, Jim Pattison Children’s Hospital, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Maggie Rumantir
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Klassen TP, Dalziel SR, Babl FE, Benito J, Bressan S, Chamberlain J, Chang TP, Freedman SB, Kohn Loncarica G, Lyttle MD, Mintegi S, Mistry RD, Nigrovic LE, Oostenbrink R, Plint AC, Rino P, Roland D, Van de Mosselaer G, Kuppermann N. The Pediatric Emergency Research Network (PERN): A decade of global research cooperation in paediatric emergency care. Emerg Med Australas 2021; 33:900-910. [PMID: 34218513 DOI: 10.1111/1742-6723.13801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in paediatric emergency care to organise globally for the conduct of collaborative research across networks. METHODS PERN has grown from five to eight member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS Beginning as a pandemic response studying H1N1 influenza risk factors in children, PERN research has progressed to multiple observational studies and ongoing global randomised controlled trials (RCTs). As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current COVID-19 pandemic. CONCLUSIONS Following its success with developing global research, the PERN goal now is to promote the implementation of scientific advances into everyday clinical practice by: (i) expanding the capacity for global RCTs; (ii) deepening the focus on implementation science; (iii) increasing attention to healthcare disparities; and (iv) expanding PERN's reach into resource-restricted regions. Through these actions, PERN aims to meet the needs of acutely ill and injured children throughout the world.
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Affiliation(s)
- Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Pediatric Emergency Research Canada (PERC)
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Children's Emergency Department, Starship Children's Health, Auckland, New Zealand.,Paediatric Research in Emergency Departments International Collaborative (PREDICT)
| | - Franz E Babl
- Departments of Paediatrics and Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Javier Benito
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain.,Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG)
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Research in European Pediatric Emergency Medicine (REPEM)
| | - James Chamberlain
- Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Pediatric Emergency Care Applied Research Network (PECARN)
| | - Todd P Chang
- Pediatric Emergency Care Applied Research Network (PECARN).,Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California, USA.,Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC)
| | - Stephen B Freedman
- Pediatric Emergency Research Canada (PERC).,Departments of Pediatrics and Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Guillermo Kohn Loncarica
- Latin American Pediatric Emergency Medicine Society, University of Buenos Aires, Buenos Aires, Argentina.,Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI)
| | - Santiago Mintegi
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG).,Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC).,Department of Paediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Lise E Nigrovic
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC).,Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rianne Oostenbrink
- Research in European Pediatric Emergency Medicine (REPEM).,General Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amy C Plint
- Pediatric Emergency Research Canada (PERC).,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro Rino
- Latin American Pediatric Emergency Medicine Society, University of Buenos Aires, Buenos Aires, Argentina.,Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Damian Roland
- Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI).,Children's Emergency Department, University of Leicester, Leicestershire, UK
| | - Greg Van de Mosselaer
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Translating Emergency Knowledge for Kids, Winnipeg, Manitoba, Canada
| | - Nathan Kuppermann
- Pediatric Emergency Care Applied Research Network (PECARN).,Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
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Klassen T, Dalziel SR, Babl FE, Benito J, Bressan S, Chamberlain J, Chang TP, Freedman SB, Kohn-Loncarica G, Lyttle MD, Mintegi S, Mistry RD, Nigrovic LE, Oostenbrink R, Plint AC, Rino P, Roland D, Van De Mosselaer G, Kuppermann N. The Pediatric Emergency Research Network: A Decade of Global Research Cooperation in Pediatric Emergency Care. Pediatr Emerg Care 2021; 37:389-396. [PMID: 34091572 PMCID: PMC8244934 DOI: 10.1097/pec.0000000000002466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in pediatric emergency care to organize globally for the conduct of collaborative research across networks. METHODS The Pediatric Emergency Research Network has grown from 5- to 8-member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed, and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS Beginning as a pandemic response with a high-quality retrospective case-controlled study of H1N1 influenza risk factors, PERN research has progressed to multiple observational studies and ongoing global randomized controlled trials. As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current coronavirus disease 2019 pandemic. In light of the ongoing need for translation of research knowledge into equitable clinical practice and to promote health equity, PERN is committed to a coordinated international effort to increase the uptake of evidence-based management of common and treatable acute conditions in all emergency department settings. CONCLUSIONS The Pediatric Emergency Research Network's successes with global research, measured by prospective observational and interventional studies, mean that the network can now move to improve its ability to promote the implementation of scientific advances into everyday clinical practice. Achieving this goal will involve focus in 4 areas: (1) expanding the capacity for global randomized controlled trials; (2) deepening the focus on implementation science; (3) increasing attention to healthcare disparities and their origins, with growing momentum toward equity; and (4) expanding PERN's global reach through addition of sites and networks from resource-restricted regions. Through these actions, PERN will be able to build on successes to face the challenges ahead and meet the needs of acutely ill and injured children throughout the world.
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Affiliation(s)
- Terry Klassen
- From the Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Pediatric Emergency Research Canada
| | - Stuart R. Dalziel
- Departments of Surgery
- Paediatrics: Child and Youth Health, University of Auckland
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
- Paediatric Research in Emergency Departments International Collaborative
| | - Franz E. Babl
- Paediatric Research in Emergency Departments International Collaborative
- Departments of Paediatrics
- Critical Care, University of Melbourne, Australia
- Emergency Research, Murdoch Children's Research Institute, Melbourne
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Javier Benito
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo
- University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group
| | - Silvia Bressan
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
- Research in European Pediatric Emergency Medicine
| | - James Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
- Pediatric Emergency Care Applied Research Network
| | - Todd P. Chang
- Pediatric Emergency Care Applied Research Network
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Calgary, AB, Canada
- Division of Pediatric Emergency Medicine, Pediatric Emergency Care Applied Research Network (PECARN), Los Angeles, CA
| | - Stephen B. Freedman
- Pediatric Emergency Research Canada
- Section of Pediatric Emergency Medicine, Department of Pediatrics
- Section of Gastroenterology, Department of Emergency Medicine, Cumming School of Medicine, University of Calgary
- Division of Pediatric Emergency Medicine, Pediatric Emergency Research Canada (PERC), Calgary, AB, Canada
| | - Guillermo Kohn-Loncarica
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children
- Faculty of Health and Applied Sciences, University of the West of England
- Paediatric Emergency Research in the United Kingdom and Ireland, Bristol, United Kingdom
| | - Santiago Mintegi
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo
- University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - Rakesh D. Mistry
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine
- Division of Pediatric Emergency Medicine, Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Denver, CO
| | - Lise E. Nigrovic
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Emergency Medicine, Boston Children's Hospital
- Department of Emergency Medicine, Harvard Medical School
- Division of Pediatric Emergency Medicine, Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Boston, MA
| | - Rianne Oostenbrink
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
- Department of General Pediatrics, ErasmusMC–Sophia
- Division of Pediatric Emergency Medicine, Research in European Pediatric Emergency Medicine, Rotterdam, the Netherlands
| | - Amy C. Plint
- Pediatric Emergency Research Canada
- Children's Hospital of Eastern Ontario
- Pediatrics
- Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pedro Rino
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica
| | - Damian Roland
- Faculty of Health and Applied Sciences, University of the West of England
- Paediatric Emergency Medicine Leicester Academic Group
- Children's Emergency Department, Leicester Royal Infirmary
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, United Kingdom
| | - Gregory Van De Mosselaer
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Translating Emergency Knowledge for Kids
| | - Nathan Kuppermann
- Pediatric Emergency Care Applied Research Network
- Departments of Emergency Medicine
- Pediatrics, University of California Davis School of Medicine, Sacramento, CA
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DesPain AW, Gutman CK, Cruz AT, Aronson PL, Chamberlain JM, Chang TP, Florin TA, Kaplan RL, Nigrovic LE, Pruitt CM, Thompson AD, Gonzalez VM, Mistry RD. Research environment and resources to support pediatric emergency medicine fellow research. AEM EDUCATION AND TRAINING 2021; 5:e10585. [PMID: 34124527 PMCID: PMC8171771 DOI: 10.1002/aet2.10585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a need for pediatric emergency medicine (PEM) researchers, but the current state of PEM fellow research training is not well described. We sought to (1) describe resources and gaps in PEM fellowship research training and (2) assess agreement between fellow and program director (PD) perceptions of these in fellow research experience. METHODS Surveys were distributed electronically to U.S. PEM fellows and PDs from March to April 2020. Fellows and PDs were queried on program research infrastructure and current gaps in fellow research experience. For programs that had at least one fellow and PD response, each fellow response was compared to their PD's corresponding response (reference standard). For each binary survey item, we determined the percent of responses with agreement between the fellow and PD. RESULTS Of 79 fellowship programs, 70 (89%) were represented with at least one response, including responses from 59 PDs (75%) and 218 fellows (39% of all fellows, representing 80% of programs). Fellows and PDs identified mentorship and faculty engagement as the most important needs for successful fellowship research; for every one fellow there was a median of 0.8 potential faculty mentors in the division. Twenty percent of fellows were not satisfied with mentorship opportunities. There was no association between fellow career research intent (high, defined as ≥20% dedicated time, or low) with current year of training (p = 0.88), program size (p = 0.67), and area of research focus (p = 0.40). Fellows were often unaware of research being performed by division faculty. CONCLUSION PEM fellows were not consistently aware of resources available to support research training. To better support PEM fellows' research training, many programs may need to expand mentorship and increase fellows' awareness of local and external resources and opportunities.
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Affiliation(s)
- Angelica W. DesPain
- Division of Emergency MedicineChildren’s National HospitalThe George Washington University School of MedicineWashingtonDCUSA
| | - Colleen K. Gutman
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Andrea T. Cruz
- Sections of Emergency Medicine & Infectious DiseasesDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Paul L. Aronson
- Section of Pediatric Emergency MedicineDepartments of Pediatrics and Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - James M. Chamberlain
- Division of Emergency MedicineChildren’s National HospitalThe George Washington University School of MedicineWashingtonDCUSA
| | - Todd P. Chang
- Division of Emergency Medicine & TransportChildren’s Hospital Los Angeles/University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Todd A. Florin
- Division of Emergency MedicineAnn and Robert H. Lurie Children’s Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ron L. Kaplan
- Department of PediatricsDivision of Emergency MedicineUniversity of Washington School of MedicineSeattle Children’s HospitalSeattleWashingtonUSA
| | - Lise E. Nigrovic
- Division of Emergency MedicineBoston Children’s HospitalBostonMassachusettsUSA
| | - Christopher M. Pruitt
- Department of PediatricsMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Amy D. Thompson
- Department of PediatricsDivision of Emergency MedicineSydney Kimmel Medical College of Thomas Jefferson UniversityNemours/Alfred I duPont Hospital for ChildrenWilmingtonDelawareUSA
| | - Victor M. Gonzalez
- Section of Emergency MedicineDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Rakesh D. Mistry
- Section of Emergency MedicineChildren's Hospital ColoradoAuroraColoradoUSA
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Funk AL, Florin TA, Dalziel SR, Mintegi S, Salvadori MI, Tancredi DJ, Neuman MI, Payne DC, Plint AC, Klassen TP, Malley R, Ambroggio L, Kim K, Kuppermann N, Freedman SB. Prospective cohort study of children with suspected SARS-CoV-2 infection presenting to paediatric emergency departments: a Paediatric Emergency Research Networks (PERN) Study Protocol. BMJ Open 2021; 11:e042121. [PMID: 33452195 PMCID: PMC7813043 DOI: 10.1136/bmjopen-2020-042121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Relatively limited data are available regarding paediatric COVID-19. Although most children appear to have mild or asymptomatic infections, infants and those with comorbidities are at increased risk of experiencing more severe illness and requiring hospitalisation due to COVID-19. The recent but uncommon association of SARS-CoV-2 infection with development of a multisystem inflammatory syndrome has heightened the importance of understanding paediatric SARS-CoV-2 infection. METHODS AND ANALYSIS The Paediatric Emergency Research Network-COVID-19 cohort study is a rapid, global, prospective cohort study enrolling 12 500 children who are tested for acute SARS-CoV-2 infection. 47 emergency departments across 12 countries on four continents will participate. At enrolment, regardless of SARS-CoV-2 test results, all children will have the same information collected, including clinical, epidemiological, laboratory, imaging and outcome data. Interventions and outcome data will be collected for hospitalised children. For all children, follow-up at 14 and 90 days will collect information on further medical care received, and long-term sequelae, respectively. Statistical models will be designed to identify risk factors for infection and severe outcomes. ETHICS AND DISSEMINATION Sites will seek ethical approval locally, and informed consent will be obtained. There is no direct risk or benefit of study participation. Weekly interim analysis will allow for real-time data sharing with regional, national, and international policy makers. Harmonisation and sharing of investigation materials with WHO, will contribute to synergising global efforts for the clinical characterisation of paediatric COVID-19. Our findings will enable the implementation of countermeasures to reduce viral transmission and severe COVID-19 outcomes in children. TRIAL REGISTRATION NUMBER NCT04330261.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Todd A Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Auckland, New Zealand
- Children's Emergency Department, Starship Children's Health, Newmarket, Auckland, New Zealand
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel C Payne
- National Center for Emerging Zoonotic Infectious Diseases, Division of Foodborne Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy C Plint
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Malley
- Division of Infectious Disease, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilliam Ambroggio
- Sections of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Denver, Colorado, USA
| | - Kelly Kim
- Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Stephen B Freedman
- Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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McKee RS, Schnadower D, Tarr PI, Xie J, Finkelstein Y, Desai N, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Rominger A, Powell EC, Kilgar J, Michelson KA, Beer D, Bitzan M, Pruitt CM, Yen K, Meckler GD, Plint AC, Bradin S, Abramo TJ, Gouin S, Kam AJ, Schuh A, Balamuth F, Hunley TE, Kanegaye JT, Jones NE, Avva U, Porter R, Fein DM, Louie JP, Freedman SB. Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children. Clin Infect Dis 2021; 70:1643-1651. [PMID: 31125419 DOI: 10.1093/cid/ciz432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. METHODS We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. RESULTS Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14-5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18-6.21]). CONCLUSIONS The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
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Affiliation(s)
- Ryan S McKee
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Ontario
| | - Neil Desai
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Roni D Lane
- Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Ron L Kaplan
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital
| | - Selena Hariharan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital and Ohio State University, Columbus
| | - Andrew Dixon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Stollery Children's Hospital, Women and Children's Research Institute, University of Alberta, Edmonton, Canada
| | - Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital, Pennsylvania
| | - Annie Rominger
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Kentucky
| | - Elizabeth C Powell
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Kilgar
- Department of Pediatrics and Division of Emergency Medicine, Children's Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Darcy Beer
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Martin Bitzan
- Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Christopher M Pruitt
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health, Dallas
| | - Garth D Meckler
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Stuart Bradin
- Departments of Pediatrics and Emergency Medicine, University of Michigan Health System, Ann Arbor
| | - Thomas J Abramo
- Departments of Pediatrics and Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital Research Institute, Little Rock
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine and Pediatrics, Université de Montréal, Québec
| | - April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Abigail Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Fran Balamuth
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia
| | - Tracy E Hunley
- Division of Pediatric Nephrology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John T Kanegaye
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla.,Rady Children's Hospital San Diego, California
| | - Nicholas E Jones
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Georgia
| | - Usha Avva
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, New Jersey
| | - Robert Porter
- Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey P Louie
- Department of Pediatrics, Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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An environmental scan of emergency medicine research support, training, and infrastructure across Canada. CAN J EMERG MED 2020; 22:477-485. [PMID: 32390584 DOI: 10.1017/cem.2020.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Our study objective was to describe the Canadian emergency medicine (EM) research community landscape prior to the initiation of a nationwide network. METHODS A two-phase electronic survey was sent to 17 Canadian medical schools. The Phase 1 Environmental Scan was administered to department chairs/hospital EM chiefs, to identify EM physicians conducting clinical or educational research. The Phase 2 Survey was sent to the identified EM researchers to assess four themes: 1) geographic distribution, 2) training/career satisfaction, 3) time/financial compensation, and 4) research facilitators/barriers. Descriptive analyses were conducted, and results were stratified by Canadian regions. RESULTS A total of 92 EM researchers were identified in Phase 1; 67 (73%) responded to the Phase 2 Survey. Of those, 42 (63%) reported being clinical researchers, and 19 (45%) had a graduate degree. Three provinces encompassed most of the researchers (n = 35). Of the respondents, 61% had a research degree, 66% felt adequately trained for their research career, 73% had financial support, 83% had access to office spaces, 52% had no mentor during their first years of their career, 69% felt satisfied with their research career, and 82% suggested that they will still be conducting research in 5 years. CONCLUSION EM researchers reported being adequately trained, even though only a little over half had a graduate degree. Only two-thirds had financial support, and mentorship was lacking in one-third of the participants. Not all respondents had a form of infrastructure, but most felt optimistic about their careers. The Canadian EM research environment could be improved to ensure better research capacity.
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Gravel J, Ledoux AA, Tang K, Yeates KO, Craig W, Osmond M, Boutis K, Burns E, Sangha G, Dubrovsky AS, Beer D, Zemek R. Early versus delayed emergency department presentation following mild Traumatic Brain Injury and the presence of symptom at 1, 4 and 12 weeks in children. Emerg Med J 2020; 37:338-343. [PMID: 32139516 DOI: 10.1136/emermed-2019-209054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury. METHODS This was a secondary analysis of a prospective cohort study conducted in nine Canadian paediatric EDs in 2013-2015 (5P study). Participants were children who suffered a head injury within the preceding 48 hours and met Zurich consensus concussion diagnostic criteria. The exposure was the time between head injury and ED presentation. The primary outcome was the presence of PCS at 1 week defined by the presence of at least three symptoms on the Post-Concussion Symptom Inventory (PCSI). Secondary outcomes evaluated PCS at 4 and 12 weeks. Multivariable logistic regression analyses were adjusted for ED PCSI and other potential confounders. RESULTS There were 3041 patients with a concussion in which timing of the injury was known. 2287 (75%) participants sought care in the first 12 hours, 388 (13%) 12-24 hours after trauma and 366 (12%) between 24 and 48 hours. Compared with children who sought care >24 hours after trauma, children who sought care in the first 12 hours had a significantly lower incidence of PCS at 1 week (OR: 0.55 (95% CI 0.41 to 0.75)) and 4 weeks (OR: 0.74 (95% CI 0.56 to 0.99)) but not at 12 weeks (OR: 0.88 (95% CI 0.63 to 1.23)). CONCLUSIONS Patients who present early after a concussion appear to have a shorter duration of PCS than those presenting more than 12 hours later. Patients/families should be informed of the higher probability of PCS in children with delayed presentation.
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Affiliation(s)
- Jocelyn Gravel
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Québec, Canada .,Paediatrics, Universite de Montreal, Montreal, Québec, Canada
| | | | - Ken Tang
- CHEO Research Institute, Ottawa, Ontario, Canada
| | | | - William Craig
- Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Kathy Boutis
- Pediatrics, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Paediatrics, Children's Hospital, London, Ontario, Canada
| | - Emma Burns
- Emergency, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Darcy Beer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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Bressan S, Titomanlio L, Gomez B, Mintegi S, Gervaix A, Parri N, Da Dalt L, Moll HA, Waisman Y, Maconochie IK, Oostenbrink R. Research priorities for European paediatric emergency medicine. Arch Dis Child 2019; 104:869-873. [PMID: 31023707 PMCID: PMC6788884 DOI: 10.1136/archdischild-2019-316918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects. DESIGN AND SETTING We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic. RESULTS Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions 'fever', 'sepsis' and 'respiratory infections', and the processes/interventions 'biomarkers', 'risk stratification' and 'practice variation' as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research. CONCLUSIONS While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.
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Affiliation(s)
- Silvia Bressan
- Department of Pediatrics, University of Padova, Padova, Italy
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France,Inserm U1141, Paris, France
| | - Borja Gomez
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Alain Gervaix
- Pediatrics, University of Geneva, Geneva, Switzerland
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | - Liviana Da Dalt
- Department of Pediatrics, University of Padova, Padova, Italy
| | - Henriette A Moll
- General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Yehezkel Waisman
- Pediatric Emergency Department, Schneider Children’s Medical Center, Day Care Unit, Petah Tikva, Israel
| | - Ian K Maconochie
- Paediatric Emergency Department, Imperial College Hospital NHS Healthcare Trust, London, UK
| | - Rianne Oostenbrink
- General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Kelly LE, Richer L, Ali S, Plint AC, Poonai N, Freedman SB, Knisley L, Shimmin C, Hickes S, 't Jong GW, Pechlivanoglou P, Offringa M, Lacaze T, Klassen TP. Innovative approaches to investigator-initiated, multicentre paediatric clinical trials in Canada. BMJ Open 2019; 9:e029024. [PMID: 31253625 PMCID: PMC6609139 DOI: 10.1136/bmjopen-2019-029024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Data from clinical trials are needed to guide the safe and effective use of medicines in children. Clinical trials are challenging to design and implement in all populations, and children present additional considerations. Several regions including the UK, USA and Europe have established clinical trial infrastructure to capitalise on expertise and promote clinical trials enrolling children. Our objective is to describe the partnerships and operational considerations for the development of paediatric clinical trials infrastructure in Canada. We describe the design and conduct of four emergency room paediatric trials, with four separate sponsors, across four provinces in parallel. Operations discussed include multisite contract development, centralised risk-based data monitoring, ethical review and patient engagement. We conclude with lessons learnt, additional challenges and potential solutions to facilitate drug development for children in Canada.
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Affiliation(s)
- Lauren E Kelly
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Clinical Trials Platform, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Richer
- Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Paediatrics and Emergency Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Amy C Plint
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Departments of Paediatrics and Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Naveen Poonai
- Paediatrics and Internal Medicine, Schulich School of Medicine & Dentistry, London Health Sciences Centre, London, Ontario, Canada
| | | | - Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Shimmin
- Patient Engagement Lead, Knowledge Translation Platform, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Serena Hickes
- Parent Partner, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Geert W 't Jong
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Petros Pechlivanoglou
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Offringa
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thierry Lacaze
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Terry P Klassen
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Sweeny A, van den Berg L, Hocking J, Renaud J, Young S, Henshaw R, Foster K, Howell T. A Queensland research support network in emergency healthcare. J Health Organ Manag 2019; 33:93-109. [PMID: 30859915 DOI: 10.1108/jhom-02-2018-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe the structure and impact of a Queensland Research Support Network (RSN) in emergency medicine (EM). DESIGN/METHODOLOGY/APPROACH This paper presents a descriptive summary of EM networks, network evaluations and the structure and development of the Emergency Medicine Foundation's (EMF) RSN in Queensland, including an observational pre- and post-study of research metrics. FINDINGS In two years, the RSN supported 33 Queensland emergency departments (EDs), of which 14 developed research strategies. There was an increase in research active clinicians, from 23 in 2015 to 181 in 2017. Collaborator engagement increased from 9 in 2015 to 276 in 2017 as did the number of research presentations, from 6 in 2015 to 61 in 2017. EMF experienced a growth in new researchers, with new investigators submitting approximately 60 per cent of grant applications in 2016 and 2017. EMF also received new applications from a further three HHS (taking EMF-funded research activity from 8 to 11 HHS). RESEARCH LIMITATIONS/IMPLICATIONS This paper describes changes in KPIs and research metrics, which the authors attribute to the establishment of the RSN. However, it is possible that attribution bias plays a role in the KPI improvements. SOCIAL IMPLICATIONS This network has actively boosted and expanded EM research capacity and capability in Queensland. It provides services, in the form of on-the-ground managers, to develop novice clinician-researchers, new projects and engage entire EDs. This model may be replicated nationwide but requires funding commitment. ORIGINALITY/VALUE The RSN improves front-line clinician research capacity and capability and increases research activity and collaborations with clear community outcomes. Collaborations were extended to community, primary health networks, non-government organisations, national and international researchers and academic institutions. Evaluating and measuring a network's benefits are difficult, but it is likely that evaluations will help networks obtain funding.
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Affiliation(s)
- Amy Sweeny
- Emergency Department, Gold Coast University Hospital , Southport, Australia
| | | | - Julia Hocking
- Emergency Medicine Foundation Ltd, Brisbane, Australia.,Queensland University of Technology , Brisbane, Australia
| | - Julia Renaud
- Emergency Medicine Foundation Ltd, Brisbane, Australia
| | - Sharleen Young
- West Moreton Hospital and Health Service, Ipswich, Australia
| | - Richard Henshaw
- Darling Downs Hospital and Health Service, Toowoomba, Australia
| | - Kelly Foster
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Tegwen Howell
- Emergency Medicine Foundation Ltd, Brisbane, Australia
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Bialy L, Plint AC, Freedman SB, Johnson DW, Curran JA, Stang AS. Pediatric Emergency Research Canada (PERC): Patient/Family-informed Research Priorities for Pediatric Emergency Medicine. Acad Emerg Med 2018; 25:1365-1374. [PMID: 29873867 DOI: 10.1111/acem.13493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND A growing body of literature supports patient and public involvement in the design, prioritization, and dissemination of research and evidence-based medicine. The objectives of this project were to engage patients and families in developing a prioritized list of research topics for pediatric emergency medicine (PEM) and to compare results with prior research prioritization initiatives in the emergency department (ED) setting. METHODS We utilized a systematic process to combine administrative data on frequency of patient presentations to the ED with multiple stakeholder input including an initial stakeholder survey followed by a modified Delphi consensus methodology consisting of two Web-based surveys and a face-to-face meeting. RESULTS The prioritization process resulted in a ranked list of 15 research priorities. The top five priorities were mental health presentations, pain and sedation, practice tools, quality of care delivery, and resource utilization. Mental health, pain and sedation, clinical prediction rules, respiratory illnesses/wheeze, patient safety/medication error, and sepsis were identified as shared priorities with prior initiatives. Topics identified in our process that were not identified in prior work included resource utilization, ED communication, antibiotic stewardship, and patient/family adherence with recommendations. CONCLUSIONS This work identifies key priorities for research in PEM. Comparing our results with prior initiatives in the ED setting identified shared research priorities and opportunities for collaboration among PEM research networks. This work in particular makes an important contribution to the existing literature by including the patient/family perspective missing from prior work.
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Affiliation(s)
- Liza Bialy
- Department of Pediatrics University of Alberta, Alberta Research Centre for Health Evidence Edmonton Alberta Canada
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine University of Ottawa, Children's Hospital of Eastern Ontario Ottawa Ontario Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics University of Calgary Alberta Children's Hospital and Alberta Children's Hospital Research Institute Calgary Alberta Canada
| | - David W. Johnson
- Departments of Pediatrics, Emergency Medicine, and Pharmacology & Physiology University of Calgary Alberta Children's Hospital and Alberta Children's Hospital Research Institute Calgary Alberta Canada
| | - Janet A. Curran
- School of Nursing, Faculty of Health Professions Department of Emergency Medicine, Faculty of Medicine Dalhousie University Halifax Nova Scotia Canada
| | - Antonia S. Stang
- Department of Pediatrics, Emergency Medicine and Community Health Sciences University of Calgary Alberta Children's Hospital and Alberta Children's Hospital Research Institute Calgary Alberta Canada
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Stoner MJ, Mahajan P, Bressan S, Lam SH, Chumpitazi CE, Kornblith AE, Linakis SW, Roland D, Freedman SB, Nigrovic LE, Denninghoff K, Ishimine P, Kuppermann N. Pediatric Emergency Care Research Networks: A Research Agenda. Acad Emerg Med 2018; 25:1336-1344. [PMID: 30393902 DOI: 10.1111/acem.13656] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric emergency care research networks have evolved substantially over the past two decades. Some networks are specialized in specific areas (e.g., sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step is the development of a research priorities agenda to guide global research in emergency medical services for children (EMSC). OBJECTIVES An international group of pediatric emergency network research leaders was assembled to develop a list of research priorities for future collaborative endeavors within and between pediatric emergency research networks. METHODS Before an in-person meeting, we used a modified Delphi approach to achieve consensus around pediatric emergency research network topic priorities. Further discussions took place on May 15, 2018, in Indianapolis, Indiana, at the Academic Emergency Medicine (AEM) consensus conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." Here, a group of 40 organizers and participants met in a 90-minute "breakout" session to review and further develop the initial priorities. RESULTS We reached consensus on five clinical research priorities that would benefit from collaboration among the existing and future emergency networks focused on EMSC: sepsis, trauma, respiratory conditions, pharmacology of emergency conditions, and mental health emergencies. Furthermore, we identified nonclinical research priorities categorized under the domains of technology, knowledge translation, and organization/administration of pediatric emergency care. CONCLUSION The identification of pediatric emergency care network research priorities within the domains of clinical care, technology, knowledge translation and organization/administration of EMSC will facilitate and help focus collaborative research within and among research networks globally. Engagement of essential stakeholders including EMSC researchers, policy makers, patients, and their caregivers will stimulate advances in the delivery of emergency care to children around the globe.
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Affiliation(s)
- Michael J. Stoner
- Division of Emergency Medicine Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH
| | - Prashant Mahajan
- Department of Emergency Medicine C.S. Mott Children's Hospital of Michigan University of Michigan Medical School Ann Arbor MI
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Samuel H. F. Lam
- Department of Emergency Medicine Sutter Medical Center Sacramento Sacramento CA
| | | | - Aaron E. Kornblith
- Department of Emergency Medicine and Pediatrics University of California at San Francisco San Francisco CA
| | - Seth W. Linakis
- Division of Emergency Medicine Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH
| | - Damian Roland
- SAPPHIRE Group Health Sciences Leicester University Leicester UK & Paediatric Emergency Medicine Leicester Academic (PEMLA) group Children's Emergency Department Leicester Hospitals Leicester UK
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology Department of Pediatrics Alberta Children's Hospital and Alberta Children's Hospital Research Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Lise E. Nigrovic
- Division of Emergency Medicine Boston Children's Hospital Boston MA
| | - Kurt Denninghoff
- Department of Emergency Medicine University of Arizona College of Medicine Tucson AZ
| | - Paul Ishimine
- Departments of Emergency Medicine University of California at San Diego School of Medicine San Diego CA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics University of California at Davis School of Medicine, and UC Davis Health Sacramento CA
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Burstein B, Gravel J, Aronson PL, Neuman MI. Emergency department and inpatient clinical decision tools for the management of febrile young infants among tertiary paediatric centres across Canada. Paediatr Child Health 2018; 24:e142-e154. [PMID: 31110465 DOI: 10.1093/pch/pxy126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives With no nationally-endorsed guidelines and the emergence of newer diagnostic tools, there exists significant variation in the management of febrile infants <90 days. We sought to evaluate the prevalence and content of clinical decision tools (CDTs) for the emergency department (ED) and inpatient management of febrile young infants across Canada. Methods We undertook a cross-sectional analysis of febrile young infant CDTs from ED and inpatient units at all 16 Canadian tertiary paediatric hospitals. Additional data were collected using an electronic survey of ED and inpatient representatives, characterizing their clinical settings and diagnostic test availability. Content of all existent CDTs was independently reviewed using list items determined a priori. The primary outcome was the proportion of EDs and inpatient units with CDTs. Results Information regarding CDTs was gathered from all 16 EDs and 16 inpatient units. CDTs were infrequently available (9/32, 28%), and were more common in the ED than inpatient setting (8/16 versus 1/16, P=0.02). Review of existing CDTs revealed inter-centre differences for inclusion ages, treatment regimens, lumbar puncture recommendations, diagnostic testing and normal laboratory values. Despite availability reported at nearly all centres, C-reactive protein and respiratory virus testing were recommended in 3/9 and 5/9 CDTs, respectively. Procalcitonin testing was available at only 2/16 (13%) centres, and not incorporated into any CDTs. Conclusions CDTs for the management of febrile young infants are infrequently available among Canadian tertiary paediatric centres, and rarely incorporate newer diagnostic tests. Heterogeneity among existent CDTs highlights the need for evidence-based unified ED and inpatient national guidelines.
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Affiliation(s)
- Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec.,T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec
| | - Paul L Aronson
- Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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