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Chapur J, Meckler G, Doan Q, Bone JN, Burstein B, Sabhaney V. National Survey on the Emergency Department Management of Febrile Infants 29 to 60 Days Old With an Abnormal Urinalysis. Pediatr Emerg Care 2024; 40:341-346. [PMID: 37972994 DOI: 10.1097/pec.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Recent clinical practice guidelines recommend that decisions regarding lumbar puncture (LP) for febrile infants older than 28 days should no longer be based on urinalysis results, but rather independently determined by inflammatory markers and sometimes guided by shared decision-making (SDM). This study sought to assess management decisions for febrile infants aged 29 to 60 days with an abnormal urinalysis. METHODS A scenario-based survey was sent to emergency department physicians at all 15 Canadian tertiary pediatric centers. Participants were asked questions regarding management decisions when presented with a well-appearing febrile infant in the second month of life with either an abnormal or normal urinalysis. RESULTS Response rate was 50.2% (n = 116/231). Overall, few respondents would perform an LP based on either an abnormal or normal urinalysis alone (10.3% and 6.0%, respectively). However, regression analysis demonstrated that decisions regarding LP were influenced by urinalysis results ( P < 0.001), with respondents more likely to defer to inflammatory marker results for infants with a normal urinalysis result (57.8%) compared with those with an abnormal urinalysis (28.4%). Hospitalization (62.1%) and empiric antibiotic treatment by intravenous route (87.9%) were both frequent for low-risk infants with an abnormal urinalysis. Nearly half of respondents reported rarely (<25% of encounters) engaging families in SDM regarding LP decisions. CONCLUSIONS Knowledge translation initiatives reflecting current evidence should target use of inflammatory markers rather than urinalysis results to guide decisions regarding LP. Efforts emphasizing outpatient management with oral antibiotics and SDM for low-risk infants with an abnormal urinalysis could also further align management with current evidence and guidelines.
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Affiliation(s)
- Jeronimo Chapur
- From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Schober T, Wong K, DeLisle G, Caya C, Brendish NJ, Clark TW, Dendukuri N, Doan Q, Fontela PS, Gore GC, Li P, McGeer AJ, Noël KC, Robinson JL, Suarthana E, Papenburg J. Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:528-536. [PMID: 38436951 PMCID: PMC10913011 DOI: 10.1001/jamainternmed.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
Importance Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear. Objective To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment. Data Sources Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022. Study Selection Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Main Outcomes and Measures Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs. Results Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, -0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kimberly Wong
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Gaëlle DeLisle
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathan J. Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Tristan W. Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Nandini Dendukuri
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia S. Fontela
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Genevieve C. Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Allison J. McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Kim Chloe Noël
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan L. Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Health Technology Assessment Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Gill C, Chui C, Goldfarb DM, Meckler G, Doan Q. Molecular Point-of-Care Testing in the Emergency Department for Group A Streptococcus Pharyngitis: A Randomized Trial. Pediatr Emerg Care 2024:00006565-990000000-00420. [PMID: 38498934 DOI: 10.1097/pec.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To compare clinical and health systems outcomes of rapid molecular testing versus throat culture recovery for the management of group A Streptococcus (GAS) pharyngitis in a pediatric emergency department (PED). METHODS We conducted a single-center randomized trial of children (3-17 years) presenting to a PED with suspected GAS pharyngitis. A single dual-headed throat swab was collected, and participants were randomized to 1 of 2 parallel treatment groups with 1:1 allocation: point-of-care (POC) nucleic acid amplification testing or standard throat culture. The primary outcomes were time to throat pain +/- fever resolution. Secondary outcomes included absenteeism, length of stay, return visits to care, and antibiotic prescriptions and utilization. RESULTS A total of 227 children were randomly assigned to culture (n = 115) or POC (n = 112) testing. Antibiotics were initiated earlier in the POC group by approximately 1 day (95% confidence interval, -0.40 to -1.58). No associated difference in time to throat pain or fever resolution was observed between groups. There was a decrease in the proportion of prescribed antibiotics in the POC group (0.35) compared with the culture group (0.79; P < 0.001). Otherwise, no significant differences in secondary outcomes were observed. CONCLUSIONS Establishing a POC nucleic acid amplification testing program for GAS in a PED facilitates earlier treatment and fewer antibiotic prescriptions. Although this did not translate to improved clinical and health systems outcomes in our study, it may serve as an important tool amid evolving pediatric febrile illnesses and growing antimicrobial resistance patterns.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lee K, Doan Q, Thompson GC, Sandhu A, Bone JN, Ting DK. "The Cost in the Individual": Longitudinal Burnout Prevalence Among Pediatric Emergency Physicians Through 9 Months of the COVID-19 Pandemic. Pediatr Emerg Care 2024; 40:76-81. [PMID: 37011228 DOI: 10.1097/pec.0000000000002936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Emergency medicine (EM) confers a high risk of burnout that may be exacerbated by the COVID-19 pandemic. We aimed to determine the longitudinal prevalence of burnout in pediatric EM (PEM) physicians/fellows working in tertiary PEM departments across Canada and its fluctuation during the pandemic. METHODS A national mixed-methods survey using a validated 2-question proxy for burnout was distributed monthly through 9 months. The primary outcome was the trajectory in probability of burnout, which was examined as both emotional exhaustion (EE) and depersonalization (DP), EE alone, and DP alone. Secondary outcomes investigated burnout and its association with demographic variables. Quantitative data were analyzed using logistic regression for primary outcomes and subanalyses for secondary outcomes. Conventional content analysis was used to analyze qualitative data and generate themes. RESULTS From February to October 2021, 92 of 98 respondents completed at least 1 survey, 78% completed at least 3 consecutive surveys, and 48% completed at least 6 consecutive surveys. Predicted probability of EE was bimodal with peaks in May (25%) and October (22%) 2021. Rates of DP alone or having both EE and DP were approximately 1% and stable over the study period. Mid-career physicians were at lower risk of EE (odds ratio, 0.02; 95% confidence interval, 0-0.22) compared with early-career physicians. Underlying drivers of burnout were multifaceted. CONCLUSIONS Our study suggests that increased COVID-19 case burden was correlated with EE levels during the third and fourth waves of the pandemic. Emotional exhaustion was worsened by systemic factors, and interventions must target common themes of unsustainable workloads and overwhelming lack of control.
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Affiliation(s)
- Kenneth Lee
- From the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, UCalgary, Calgary, Alberta, Canada
| | - Ash Sandhu
- Biostatistics, Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Biostatistics, Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel K Ting
- Department of Emergency Medicine, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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8
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Hassan A, Brooks BL, McArthur BA, Beauchamp MH, Craig W, Doan Q, Zemek R, Yeates KO. Dynamic Relations Between Psychological Resilience and Post-Concussion Symptoms in Children With Mild Traumatic Brain Injury Versus Orthopedic Injury: An A-CAP Study. J Neurotrauma 2024; 41:135-146. [PMID: 37485612 DOI: 10.1089/neu.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Higher psychological resilience is correlated with less severe post-concussion symptoms (PCS) after mild traumatic brain injury (mTBI) in children, but the directional nature of this relationship remains uncertain. Although traditionally regarded as a stable, trait-like construct, resilience may be malleable and potentially influenced by mTBI and post-concussive symptoms. The current study sought to examine the stability of resilience, elucidate the dynamic nature of the resilience-PCS relation, and determine whether resilience-symptom associations are specific to mTBI or applicable to traumatic injury in general. Participants were children aged 8-16.99 years with either mTBI (n = 633) or orthopedic injury (OI; n = 334) recruited to participate in a prospective cohort study after presenting acutely to five Canadian pediatric emergency departments (EDs). Symptoms and psychological resilience were assessed at 1 week, 3 months, and 6 months post-injury. Group differences in resilience over time were examined using a mixed linear model, and associations between resilience and symptoms over time were examined using random intercepts cross-lagged panel modeling (RI-CLPM). The mTBI group reported significantly lower resilience than the OI group, but the difference was significantly larger 1 week post-injury (d = 0.50) than at 3 months (d = 0.08) and 6 months (d = 0.10). Cross-lagged panel models indicated that resilience had both stable and dynamic aspects, and both affected and was affected by PCS, although their association varied by time post-injury, symptom measure, and reporter (parent vs. child). Higher parent-reported cognitive symptom severity at 1 week was significantly associated with higher resilience at 3 months (β = 0.23, p = 0.001). Higher resilience at 3 months was associated with lower levels of parent-reported somatic symptom severity (β = -0.14, p = 0.004) and fewer total symptoms (β = -0.135, p = 0.029) at 6 months. Higher resilience at 3 months was associated with fewer child-reported symptoms at 6 months (β = -0.11, p = 0.030) and, reciprocally, fewer child-reported symptoms at 3 months were associated with higher resilience at 6 months (β = -0.22, p = 0.001). Notably, injury group was not a significant moderator in cross-lagged models, suggesting that resilience-symptom associations are not specific to mTBI. Psychological resilience and symptoms have bidirectional relationships after injury. Interventions designed to foster resilience have the potential to promote recovery after mTBI specifically and injury more generally.
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Affiliation(s)
- Ali Hassan
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, and Alberta Children's Hospital Research Institute, University of Calgary, Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
| | - Brae Anne McArthur
- Departments of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Sainte-Justine Hospital Research Center, Montreal, Quebec, 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, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 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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Leung S, McDonald E, Watson A, Doan Q, Desai N. Community healthcare appointments as an alternative to emergency department assessment: an exploration of family acceptability and preferences. CAN J EMERG MED 2023; 25:984-991. [PMID: 37851318 DOI: 10.1007/s43678-023-00605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Pediatric emergency departments are overcrowded, in part due to many non-emergent visits. We aimed to assess the proportion of parents interested in leaving the pediatric emergency department (ED) prior to physician assessment if they could be offered a scheduled community healthcare appointment. We explored differences in care children received in the ED stratified by interest in a community healthcare appointment and parents' reasons when they were not interested. METHODS We conducted a 14-item survey within the pediatric ED at a Canadian tertiary care teaching hospital to assess parents' interest if a program offered community healthcare appointments and we determined preferred appointment characteristics. All parents presenting with children triaged as CTAS 2-5 who met eligibility criteria were approached by a research assistant prior to physician assessment. Surveys were paired with the medical chart outlining the care received. Descriptive statistics and a regression model were used to describe characteristics of families and care received among those who were and were not interested in a community healthcare appointment. RESULTS In total, 403 surveys were completed. Overall, 236 participants (58.6%; 95% CI 53.8-63.4) were interested in a community healthcare appointment. In general, parents who were interested in a community healthcare appointment were younger and presented with younger children compared to those who were not interested. Among those interested, there was a preference to have the appointment with a pediatrician or family physician, timely access to an appointment, and appointments scheduled outside of regular business hours. CONCLUSION Our study provides evidence that there is interest in an alternative care access model positioned to reduce pediatric ED congestion. We found that parents would be interested in leaving the pediatric ED in favor of a community healthcare appointment, provided it was with a physician and available in a timely manner.
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Affiliation(s)
- Steve Leung
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Erica McDonald
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada.
| | - Amy Watson
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Quynh Doan
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Neil Desai
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
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Virk P, Doan Q, Karim ME. Chronic physical conditions and suicidal ideation: a population-level analysis of Canadian school-attending young adults. J Ment Health 2023:1-8. [PMID: 37724374 DOI: 10.1080/09638237.2023.2245904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/19/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Students who identify with a chronic physical condition are a growing population and their conditions may be associated with poor mental well-being. AIM To compare suicidal ideation prevalence between Canadian school-attending young adults with and without a chronic physical condition. We hypothesized that students living with a chronic condition have a higher likelihood of experiencing suicidal ideation. METHODS A cross-sectional study was conducted using a nationally representative sample of 2297 Canadian school-attending young adults (ages 15-29 years) from the 2012-13 Canadian Community Health Survey-Mental Health (CCHS-MH). Survey-weighted logistic regression and sensitivity analyses were performed to estimate the likelihood of experiencing suicidal ideation between students with and without a chronic physical condition. RESULTS Approximately 14.3% (n = 329) students experienced suicidal ideation at some point. Students living with a physical chronic condition demonstrated 1.65 (95% CI: 1.14, 2.39) times higher odds of experiencing suicidal ideation, compared to students not living with a chronic physical condition. CONCLUSIONS Suicide prevention and health promotion are important considerations for campus health providers and administrators when planning services and accommodations for students living with chronic physical conditions.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
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Poonai N, Freedman SB, Newton AS, Sawyer S, Gaucher N, Ali S, Wright B, Miller MR, Mater A, Fitzpatrick E, Jabbour M, Zemek R, Eltorki M, Doan Q. Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic. CMAJ 2023; 195:E1221-E1230. [PMID: 37722746 PMCID: PMC10506508 DOI: 10.1503/cmaj.220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had profound effects on the mental wellbeing of adolescents. We sought to evaluate pandemic-related changes in health care use for suicidal ideation, self-poisoning and self-harm. METHODS We obtained data from the Canadian Institute for Health Information on emergency department visits and hospital admissions from April 2015 to March 2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly percentage of emergency department visits and hospital admissions for a composite outcome comprising suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits and hospital admissions. We used interrupted time-series methods to compare changes in levels and trends of these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic (Apr. 1, 2020-Mar. 31, 2022) periods. RESULTS The average quarterly percentage of emergency department visits for suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits was 2.30% during the prepandemic period and 3.52% during the pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not change significantly between periods. The average quarterly percentage of hospital admissions for the composite outcome relative to all-cause admissions was 7.18% during the prepandemic period and 8.96% during the pandemic period. This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%). INTERPRETATION The quarterly change in the percentage of hospital admissions for suicidal ideation, self-poisoning and self-harm increased among adolescent females in Canada during the first 2 years of the COVID-19 pandemic. This underscores the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.
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Affiliation(s)
- Naveen Poonai
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Stephen B Freedman
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Amanda S Newton
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Scott Sawyer
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Nathalie Gaucher
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Samina Ali
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Bruce Wright
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Michael R Miller
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Ahmed Mater
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Eleanor Fitzpatrick
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mona Jabbour
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Roger Zemek
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mohamed Eltorki
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Quynh Doan
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
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Park JM, McDonald E, Buren Y, McInnes G, Doan Q. Assessing the reliability of pediatric emergency medicine billing code assignment for future consideration as a proxy workload measure. PLoS One 2023; 18:e0290679. [PMID: 37624824 PMCID: PMC10456198 DOI: 10.1371/journal.pone.0290679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES Prediction of pediatric emergency department (PED) workload can allow for optimized allocation of resources to improve patient care and reduce physician burnout. A measure of PED workload is thus required, but to date no variable has been consistently used or could be validated against for this purpose. Billing codes, a variable assigned by physicians to reflect the complexity of medical decision making, have the potential to be a proxy measure of PED workload but must be assessed for reliability. In this study, we investigated how reliably billing codes are assigned by PED physicians, and factors that affect the inter-rater reliability of billing code assignment. METHODS A retrospective cross-sectional study was completed to determine the reliability of billing code assigned by physicians (n = 150) at a quaternary-level PED between January 2018 and December 2018. Clinical visit information was extracted from health records and presented to a billing auditor, who independently assigned a billing code-considered as the criterion standard. Inter-rater reliability was calculated to assess agreement between the physician-assigned versus billing auditor-assigned billing codes. Unadjusted and adjusted logistic regression models were used to assess the association between covariables of interest and inter-rater reliability. RESULTS Overall, we found substantial inter-rater reliability (AC2 0.72 [95% CI 0.64-0.8]) between the billing codes assigned by physicians compared to those assigned by the billing auditor. Adjusted logistic regression models controlling for Pediatric Canadian Triage and Acuity scores, disposition, and time of day suggest that clinical trainee involvement is significantly associated with increased inter-rater reliability. CONCLUSIONS Our work identified that there is substantial agreement between PED physician and a billing auditor assigned billing codes, and thus are reliably assigned by PED physicians. This is a crucial step in validating billing codes as a potential proxy measure of pediatric emergency physician workload.
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Affiliation(s)
- Justin M. Park
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Erica McDonald
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Yijinmide Buren
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Gord McInnes
- Department of Emergency Medicine, University of British Columbia, Kelowna, Canada
| | - Quynh Doan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Virk P, Arora R, Burt H, Finnamore C, Gadermann A, Barbic S, Doan Q. Evaluating the Psychometric Properties and Clinical Utility of a Digital Psychosocial Self-Screening Tool (HEARTSMAP-U) for Postsecondary Students: Prospective Cohort Study. JMIR Ment Health 2023; 10:e48709. [PMID: 37556180 PMCID: PMC10448294 DOI: 10.2196/48709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Existing screening tools for mental health issues among postsecondary students have several challenges, including a lack of standardization and codevelopment by students. HEARTSMAP-U was adapted to address these issues. OBJECTIVE This study aimed to evaluate the suitability of HEARTSMAP-U as a self-screening tool for psychosocial issues among postsecondary students by evaluating its validity evidence and clinical utility. METHODS A prospective cohort study was conducted with University of British Columbia Vancouver students to evaluate HEARTSMAP-U's predictive validity and convergent validity. Participating students completed baseline and 3-month follow-up assessments via HEARTSMAP-U and a clinician-administered interview. RESULTS In a diverse student sample (n=100), HEARTSMAP-U demonstrated high sensitivity (95%-100%) in identifying any psychiatric concerns that were flagged by a research clinician, with lower specificity (21%-25%). Strong convergent validity (r=0.54-0.68) was demonstrated when relevant domains and sections of HEARTSMAP-U were compared with those of other conceptually similar instruments. CONCLUSIONS This preliminary evaluation suggests that HEARTSMAP-U may be suitable for screening in the postsecondary educational setting. However, a larger-scale evaluation is necessary to confirm and expand on these findings.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ravia Arora
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Heather Burt
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Anne Gadermann
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Quynh Doan
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Paediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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15
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Ware AL, McLarnon MJW, Lapointe AP, Brooks BL, Bacevice A, Bangert BA, Beauchamp MH, Bigler ED, Bjornson B, Cohen DM, Craig W, Doan Q, Freedman SB, Goodyear BG, Gravel J, Mihalov HLK, Minich NM, Taylor HG, Zemek R, Yeates KO. IQ After Pediatric Concussion. Pediatrics 2023:e2022060515. [PMID: 37455662 PMCID: PMC10389777 DOI: 10.1542/peds.2022-060515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This study investigated IQ scores in pediatric concussion (ie, mild traumatic brain injury) versus orthopedic injury. METHODS Children (N = 866; aged 8-16.99 years) were recruited for 2 prospective cohort studies from emergency departments at children's hospitals (2 sites in the United States and 5 in Canada) ≤48 hours after sustaining a concussion or orthopedic injury. They completed IQ and performance validity testing postacutely (3-18 days postinjury; United States) or 3 months postinjury (Canada). Group differences in IQ scores were examined using 3 complementary statistical approaches (linear modeling, Bayesian, and multigroup factor analysis) in children performing above cutoffs on validity testing. RESULTS Linear models showed small group differences in full-scale IQ (d [95% confidence interval] = 0.13 [0.00-0.26]) and matrix reasoning (0.16 [0.03-0.30]), but not in vocabulary scores. IQ scores were not related to previous concussion, acute clinical features, injury mechanism, a validated clinical risk score, pre- or postinjury symptom ratings, litigation, or symptomatic status at 1 month postinjury. Bayesian models provided moderate to very strong evidence against group differences in IQ scores (Bayes factor 0.02-0.23). Multigroup factor analysis further demonstrated strict measurement invariance, indicating group equivalence in factor structure of the IQ test and latent variable means. CONCLUSIONS Across multisite, prospective study cohorts, 3 complementary statistical models provided no evidence of clinically meaningful differences in IQ scores after pediatric concussion. Instead, overall results provided strong evidence against reduced intelligence in the first few weeks to months after pediatric concussion.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, Georgia State University, Atlanta, Georgia
- Department of Neurology, University of Utah, Salt Lake City, Utah
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J W McLarnon
- Department of General Management and Human Resources, Bissett School of Business, Mount Royal University, Calgary, Alberta, Canada
| | - Andrew P Lapointe
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Neurosciences Program, Alberta Children's Hospital, Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Bruce Bjornson
- Division of Neurology
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel M Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, 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 Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine; CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Montréal, Québec, Canada
| | - H Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Nori Mercuri Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
- Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Black TR, Virk P, Woodward ML, Stea JN, Doan Q. Commentary: School closures, the pandemic, and pediatric mental health: Scrutinizing the evidence. J Can Acad Child Adolesc Psychiatry 2023; 32:71-78. [PMID: 37181442 PMCID: PMC10168612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/09/2023] [Indexed: 05/16/2023]
Abstract
The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children's mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as "online learning is harmful," should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence.
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Affiliation(s)
- Tyler R Black
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Melissa L Woodward
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Jonathan N Stea
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta
| | - Quynh Doan
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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19
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Virk P, Woodward ML, Doan Q, Black TR. Response to Rejoinders: The importance of balanced, clear, and specific science communication. J Can Acad Child Adolesc Psychiatry 2023; 32:93-96. [PMID: 37181437 PMCID: PMC10168624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa L Woodward
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler R Black
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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20
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Sader N, Gobbi D, Goodyear B, Frayne R, Ware AL, Beauchamp MH, Craig WR, Doan Q, Zemek R, Riva-Cambrin J, Yeates KO. Can quantitative susceptibility mapping help diagnose and predict recovery of concussion in children? An A-CAP study. J Neurol Neurosurg Psychiatry 2023; 94:227-235. [PMID: 36517039 DOI: 10.1136/jnnp-2022-329487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) is an MRI technique that is a potential biomarker for concussion. We performed QSM in children following concussion or orthopaedic injury (OI), to assess QSM performance as a diagnostic and prognostic biomarker. METHODS Children aged 8-17 years with either concussion (N=255) or OI (N=116) were recruited from four Canadian paediatric emergency departments and underwent QSM postacutely (2-33 days postinjury) using 3 Tesla MRI. QSM Z-scores within nine regions of interest (ROI) were compared between groups. QSM Z-scores were also compared with the 5P score, the current clinical benchmark for predicting persistent postconcussion symptoms (PPCS), at 4 weeks postinjury, with PPCS defined using reliable change methods based on both participant and parent reports. RESULTS Concussion and OI groups did not differ significantly in QSM Z-scores for any ROI. Higher QSM Z-scores within frontal white matter (WM) independently predicted PPCS based on parent ratings of cognitive symptoms (p=0.001). The combination of frontal WM QSM Z-score and 5P score was better at predicting PPCS than 5P score alone (p=0.004). The area under the curve was 0.72 (95% CI 0.63 to 0.81) for frontal WM susceptibility, 0.69 (95% CI 0.59 to 0.79) for the 5P score and 0.74 (95% CI 0.65 to 0.83) for both. CONCLUSION The findings suggest that QSM is a potential MRI biomarker that can help predict PPCS in children with concussion, over and above the current clinical benchmark, and thereby aid in clinical management. They also suggest a frontal lobe substrate for PPCS, highlighting the potential for QSM to clarify the neurophysiology of paediatric concussion.
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Affiliation(s)
- Nicholas Sader
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - David Gobbi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Brad Goodyear
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Seaman Family MR Research Centre and Calgary Image Processing and Analysis Centre (CIPAC), Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada.,Department of Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Ashley L Ware
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Georgia State University, Atlanta, Georgia, USA.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William R Craig
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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22
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van Ierssel JJ, Tang K, Beauchamp M, Bresee N, Cortel-LeBlanc A, Craig W, Doan Q, Gravel J, Lyons T, Mannix R, Orr S, Zemek R, Yeates KO. Association of Posttraumatic Headache With Symptom Burden After Concussion in Children. JAMA Netw Open 2023; 6:e231993. [PMID: 36884251 PMCID: PMC9996395 DOI: 10.1001/jamanetworkopen.2023.1993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/22/2023] [Indexed: 03/09/2023] Open
Abstract
Importance Headache is the most common symptom after pediatric concussion. Objectives To examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion. Design, Setting, and Participants This was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (<48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022. Exposure Posttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury. Main Outcomes and Measures Self-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory-Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings. Results Of 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, -0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, -4.67; 95% CI, -7.86 to -1.48). Conclusions and Relevance In this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.
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Affiliation(s)
| | - Ken Tang
- Independent statistical consultant
| | - Miriam Beauchamp
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Hospital Research Centre, Montreal, Québec, Canada
| | - Natalie Bresee
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - William Craig
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Stollery Children’s Hospital, Edmonton, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute , Vancouver, Canada
| | - Jocelyn Gravel
- CHU Sainte-Justine Hospital Research Centre, Montreal, Québec, Canada
- Department of Pediatric Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Todd Lyons
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Serena Orr
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Roger Zemek
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Keith Owen Yeates
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Canada
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23
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Sparanese S, Yeates KO, Bone J, Beauchamp MH, Craig W, Zemek R, Doan Q. Concurrent Psychosocial Concerns and Post-Concussive Symptoms Following Pediatric mTBI: An A-CAP Study. J Pediatr Psychol 2023; 48:156-165. [PMID: 36308773 DOI: 10.1093/jpepsy/jsac076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To measure the association between psychosocial problems and persistent post-concussive symptoms (PCS) in youth who were seen in the emergency department with mild traumatic brain injury (mTBI) or orthopedic injury (OI). METHODS From a larger prospective cohort study, Advancing Concussion Assessment in Pediatrics (A-CAP), 122 child-guardian pairs who presented to the emergency department with mTBI (N = 70) or OI (N = 52) were recruited for this cross-sectional sub-study. Each pair completed 2 measures assessing PCS burden at 2 weeks, 3 months, and 6 months post-injury. At one visit, pairs concurrently completed MyHEARTSMAP, a comprehensive, psychosocial self-assessment tool to evaluate 4 domains of mental wellness. RESULTS When measured at the same visit, children who self-reported moderate or severe Psychiatry domain concerns concurrently experienced a greater burden of cognitive symptoms (β = 5.49; 0.93-10.05) and higher overall PCS count (β = 2.59; 0.70-4.48) after adjusting for covariables, including retrospective pre-injury symptoms and injury group. Additionally, reports indicating mild Function domain severity were associated with increased cognitive (β = 3.34; 95% CI: 0.69-5.99) and somatic symptoms (β = 6.79; 2.15-11.42) and total symptom count (β = 1.29; 0.18-2.39). CONCLUSION Increasing severity in multiple domains of mental health is associated with more PCS in youth. While the differences in PCS between the mTBI and OI groups appeared somewhat larger for children with more mental health concerns, the interaction was not statistically significant; larger sample sizes are needed to evaluate the moderating effect of psychosocial difficulties on post-concussion symptoms.
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Affiliation(s)
| | | | - Jeffrey Bone
- BC Children's Hospital Research Institute, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Canada
| | - Quynh Doan
- BC Children's Hospital Research Institute, Canada
- Department of Pediatrics, University of British Columbia Faculty of Medicine, Canada
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24
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Stewart SE, Best J, Selles R, Naqqash Z, Lin B, Lu C, Au A, Snell G, Westwell-Roper C, Vallani T, Ewing E, Dogra K, Doan Q, Samji H. Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study. Child Adolesc Psychiatry Ment Health 2023; 17:20. [PMID: 36747252 PMCID: PMC9901839 DOI: 10.1186/s13034-023-00560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. METHODS The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive-compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19-29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. RESULTS Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. INTERPRETATION Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.
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Affiliation(s)
- S. Evelyn Stewart
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - John Best
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Robert Selles
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Zainab Naqqash
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Boyee Lin
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Cynthia Lu
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Antony Au
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Gaelen Snell
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Clara Westwell-Roper
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Tanisha Vallani
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Elise Ewing
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Kashish Dogra
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Quynh Doan
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Hasina Samji
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, BC Canada
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25
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Meckler GD, Cheung KW, Chun A, Velmurugiah N, Gill GGK, Ivsins A, Chang D, Doan Q. Equity, diversity, and inclusion in the emergency medicine workforce: benefits, barriers, and strategies. CAN J EMERG MED 2023; 25:269-273. [PMID: 36626116 DOI: 10.1007/s43678-023-00451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Garth D Meckler
- Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Ka Wai Cheung
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alaina Chun
- Health Economics, Policy and Law, ESHPM, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Niresha Velmurugiah
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ginjeet Gina K Gill
- Department of Emergency Medicine, University of British Columbia, Victoria, BC, Canada
| | - Averil Ivsins
- Department of Emergency Medicine, University of British Columbia, North Vancouver, BC, Canada
| | - Diana Chang
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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26
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La PL, Bell TK, Craig W, Doan Q, Beauchamp MH, Zemek R, Yeates KO, Harris AD. Comparison of different approaches to manage multi-site magnetic resonance spectroscopy clinical data analysis. Front Psychol 2023; 14:1130188. [PMID: 37151330 PMCID: PMC10157208 DOI: 10.3389/fpsyg.2023.1130188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The effects caused by differences in data acquisition can be substantial and may impact data interpretation in multi-site/scanner studies using magnetic resonance spectroscopy (MRS). Given the increasing use of multi-site studies, a better understanding of how to account for different scanners is needed. Using data from a concussion population, we compare ComBat harmonization with different statistical methods in controlling for site, vendor, and scanner as covariates to determine how to best control for multi-site data. Methods The data for the current study included 545 MRS datasets to measure tNAA, tCr, tCho, Glx, and mI to study the pediatric concussion acquired across five sites, six scanners, and two different MRI vendors. For each metabolite, the site and vendor were accounted for in seven different models of general linear models (GLM) or mixed-effects models while testing for group differences between the concussion and orthopedic injury. Models 1 and 2 controlled for vendor and site. Models 3 and 4 controlled for scanner. Models 5 and 6 controlled for site applied to data harmonized by vendor using ComBat. Model 7 controlled for scanner applied to data harmonized by scanner using ComBat. All the models controlled for age and sex as covariates. Results Models 1 and 2, controlling for site and vendor, showed no significant group effect in any metabolites, but the vendor and site were significant factors in the GLM. Model 3, which included a scanner, showed a significant group effect for tNAA and tCho, and the scanner was a significant factor. Model 4, controlling for the scanner, did not show a group effect in the mixed model. The data harmonized by the vendor using ComBat (Models 5 and 6) had no significant group effect in both the GLM and mixed models. Lastly, the data harmonized by the scanner using ComBat (Model 7) showed no significant group effect. The individual site data suggest there were no group differences. Conclusion Using data from a large clinical concussion population, different analysis techniques to control for site, vendor, and scanner in MRS data yielded different results. The findings support the use of ComBat harmonization for clinical MRS data, as it removes the site and vendor effects.
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Affiliation(s)
- Parker L. La
- Department of Radiology, 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
- *Correspondence: Parker L. La,
| | - Tiffany K. Bell
- Department of Radiology, 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
| | - William Craig
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Quynh Doan
- Department of Pediatrics, BC Children’s Hospital, 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
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Ashley D. Harris
- Department of Radiology, 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
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27
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Woodward ML, Hossain A, Chun A, Liu C, Kilyk K, Bone JN, Meckler G, Black T, Stewart SE, Samji H, Barbic S, Doan Q. Evaluating the psychosocial status of BC children and youth during the COVID-19 pandemic: A MyHEARTSMAP cross-sectional study. PLoS One 2023; 18:e0281083. [PMID: 37000793 PMCID: PMC10065280 DOI: 10.1371/journal.pone.0281083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Understanding the psychosocial status of children and adolescents during the COVID-19 pandemic is vital to the appropriate and adequate allocation of social supports and mental health resources. This study evaluates the burden of mental health concerns and the impact of demographic factors while tracking mental health service recommendations to inform community service needs. METHODS MyHEARTSMAP is a digital self-assessment mental health evaluation completed by children and their guardian throughout British Columbia between August 2020 to July 2021. Severity of mental health concerns was evaluated across psychiatric, social, functioning, and youth health domains. Proportional odds modelling evaluated the impact of demographic factors on severity. Recommendations for support services were provided based on the evaluation. RESULTS We recruited 541 families who completed 424 psychosocial assessments on individual children. Some degree of difficulty across the psychiatric, social, or functional domains was reported for more than half of children and adolescents. Older youth and those not attending any formal school or education program were more likely to report greater psychiatric difficulty. Girls experienced greater social concerns, and children attending full-time school at-home were more likely to identify difficulty within the youth health domain but were not more likely to have psychiatric difficulties. Considerations to access community mental health service were triggered in the majority (74%) of cases. CONCLUSIONS Psychosocial concerns are highly prevalent amongst children and adolescents during the COVID-19 pandemic. Based on identified needs of this cohort, additional community health supports are required, particularly for higher risk groups.
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Affiliation(s)
- Melissa L Woodward
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Abrar Hossain
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alaina Chun
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cindy Liu
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kaitlyn Kilyk
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Garth Meckler
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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28
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Siu C, Farrell S, Schaeffer EK, Doan Q, Dobbe A, Bone J, Reilly CW, Mulpuri K. Long-Arm Splinting Versus Above-Elbow Casting for Type 1 Supracondylar Fractures of the Humerus in Children: a Randomized Controlled Trial. SN Compr Clin Med 2023; 5:72. [PMID: 36776416 PMCID: PMC9896433 DOI: 10.1007/s42399-023-01417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
Type 1 supracondylar humerus (SCH) fractures tend to heal well when immobilized by above-elbow casting or long-arm splinting. There is no consensus as to whether one treatment method is more effective than the other for this injury. The purpose of this study was to compare the radiographic and functional outcomes of long-arm splinting and above-elbow casting as the definitive treatment for children with type 1 SCH fractures. The study was set up as a randomized controlled non-inferiority trial. Patients between three and 12 years old presenting with a type 1 SCH fracture were randomized into splint or cast groups, or an observational arm. Baumann's angle, functional assessment scores, and Flynn's criteria score were measured at initial injury and at six months post-injury. In total, 34 patients were enrolled in the study with 13 in the randomized arm and 21 in the observational arm. Due to lack of follow-up data at 6 months post-injury, five splint patients and 10 cast patients were included in the final cohort for data analysis. The average change in Baumann's angle at 6-month follow-up was 3° or less for each treatment arm. The splint group obtained excellent Flynn's criteria scores while the cast group reported good and excellent scores. Complications reported in the splint group included device breakdown, a conversion to above-arm cast, and significant itchiness. Preliminary findings suggest functional and radiological outcomes with splinting are non-inferior to casting; however, a larger sample size is required to more accurately compare the two modalities. This study was registered with the U.S. National Institutes of Health (ClinicalTrials.gov, #NCT01912365).
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Affiliation(s)
- Caitlyn Siu
- Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Sarah Farrell
- Department of Orthopaedics, Children’s Hospital Queensland, South Brisbane, QLD Australia
| | - Emily K. Schaeffer
- Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Quynh Doan
- Department of Emergency Medicine, BC Children’s Hospital, Vancouver, BC Canada
| | - Ashlee Dobbe
- Department of Orthopaedic Surgery, Kelowna General Hospital, Kelowna, BC Canada
| | - Jeffrey Bone
- Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Christopher W. Reilly
- Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
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Cairncross M, Yeates KO, Tang K, Madigan S, Beauchamp MH, Craig W, Doan Q, Zemek R, Kowalski K, Silverberg ND. Early Postinjury Screen Time and Concussion Recovery. Pediatrics 2022; 150:189740. [PMID: 36250231 DOI: 10.1542/peds.2022-056835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To determine the association between early screen time (7-10 days postinjury) and postconcussion symptom severity in children and adolescents with concussion, as compared to those with orthopedic injury (OI). METHODS This was a planned secondary analysis of a prospective longitudinal cohort study. Participants were 633 children and adolescents with acute concussion and 334 with OI aged 8 to 16, recruited from 5 Canadian pediatric emergency departments. Postconcussion symptoms were measured using the Health and Behavior Inventory at 7 to 10 days, weekly for 3 months, and biweekly from 3 to 6 months postinjury. Screen time was measured by using the Healthy Lifestyle Behavior Questionnaire. Generalized least squares models were fit for 4 Health and Behavior Inventory outcomes (self- and parent-reported cognitive and somatic symptoms), with predictors including screen time, covariates associated with concussion recovery, and 2 3-way interactions (self- and parent-reported screen time with group and time postinjury). RESULTS Screen time was a significant but nonlinear moderator of group differences in postconcussion symptom severity for parent-reported somatic (P = .01) and self-reported cognitive symptoms (P = .03). Low and high screen time were both associated with relatively more severe symptoms in the concussion group compared to the OI group during the first 30 days postinjury but not after 30 days. Other risk factors and health behaviors had stronger associations with symptom severity than screen time. CONCLUSIONS The association of early screen time with postconcussion symptoms is not linear. Recommending moderation in screen time may be the best approach to clinical management.
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Affiliation(s)
- Molly Cairncross
- Department of Psychology, Simon Fraser University; Burnaby, British Columbia, Canada.,Departments of Psychology.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Keith Owen Yeates
- Department of Psychology.,Alberta Children's Hospital Research Institute.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Sheri Madigan
- Department of Psychology.,Alberta Children's Hospital Research Institute.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Ste-Justine Hospital Research Center, Quebec, Canada
| | - William Craig
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Quynh Doan
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | | | - Noah D Silverberg
- Departments of Psychology.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Dissanayake A, MacLellan A, Doan Q, Sabhaney V, Virk P. Improving research personnel's hand hygiene adherence in the pediatric acute care setting during the COVID-19 pandemic: a quality improvement initiative. Pediatr Qual Saf 2022; 7:e609. [PMID: 38585505 PMCID: PMC10997291 DOI: 10.1097/pq9.0000000000000609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/04/2022] [Indexed: 04/09/2024] Open
Abstract
Introduction Hand hygiene is critical in preventing the spread of healthcare-associated infections. Routine hand hygiene surveillance and education are common for clinical staff in pediatric acute care settings. However, nonclinical staff, including research personnel, are often excluded from these programs and therefore represent a gap in ongoing infection control efforts. This project aimed to evaluate the impact of evidence-based interventions on improving hand hygiene adherence among research personnel in the pediatric emergency department to meet provincial targets set for clinical staff. Methods We used a Plan-Do-Study-Act approach to carry out a peer-driven, multimodal hand hygiene improvement strategy involving education, surveillance, and feedback targeted to research assistants working in a pediatric emergency department. Two anonymous peer evaluators observed hand hygiene practices in several specific instances (eg, before/after patient interactions) and determined adherence a priori. Results In an open sample of clinical research assistants (Ntotal = 22), hand hygiene adherence increased from 12.5% to 89.1% over 11 months. Increases in adherence were particularly notable before entering the patient environment compared to exiting. Conclusions Hand hygiene interventions targeting research personnel show potential success in acute care. Further quality improvement initiatives in larger research personnel samples must robustly evaluate the framework's effectiveness.
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Affiliation(s)
- Ashini Dissanayake
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Vikram Sabhaney
- Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
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Poonai N, Freedman S, Newton A, Sawyer S, Gaucher N, Ali S, Miller M, Mater A, Fitzpatrick E, Jabbour M, Zemek R, Eltorki M, Doan Q. 1 Ambulatory care visits and admissions for suicidal ideation and self-harm in Canadian adolescents during the COVID-19 pandemic: a population-based analysis. Paediatr Child Health 2022. [PMCID: PMC9586102 DOI: 10.1093/pch/pxac100.000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background The COVID-19 pandemic has challenged the resiliency of Canada’s adolescent population. Understanding changes in mental healthcare utilization can shed light on the impact the pandemic has had on Canada’s youth. Objectives To assess if during the pandemic there has been an increase in the proportion of ambulatory care visits and admissions for suicidal ideation and self-harm among adolescents. Design/Methods This was a population-based, interrupted time-series analysis of adolescents 10-18 years presenting to an ambulatory care facility (including emergency department) or admitted to a healthcare facility with R458 (suicidal ideation and emotional symptoms), X60-69 (intentional self-poisoning), and X70-84 (intentional self-harm) codes based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA). We used the National Ambulatory Care Reporting System, Discharge Abstract Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). Results From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1; 95% CI: 0.02, 0.18; p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7; 95% CI: 0.43, 0.97; p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13; 95% CI: -0.02, 0.28; p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26; 95% CI: -0.16, 0.68; p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99; 95% CI: 0.57, 3.41; p=0.017). Conclusion The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.
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Affiliation(s)
| | - Stephen Freedman
- Alberta Children’s Hospital Research Institute, University of Calgary
| | | | | | | | | | | | - Ahmed Mater
- Jim Pattison Children’s Hospital, and University of Saskatchewan
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32
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, Calder LA. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf 2022; 31:806-817. [PMID: 35853646 PMCID: PMC9606537 DOI: 10.1136/bmjqs-2021-014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/02/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
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Affiliation(s)
- Amy C Plint
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Antonia Stang
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Zach Cantor
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Boutis
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Quynh Doan
- Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Gary Joubert
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Scott Sawyer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Tyrus Crawford
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Maala Bhatt
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Weldon
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Millar
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandy Tse
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Grewal
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Chan
- Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kevin Chan
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grant Yung
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Jennifer Kilgar
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Tim Lynch
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dale Dalgleish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken Farion
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - David W Johnson
- Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Objective: To explore parental perceptions of psychosocial screening in the paediatric emergency department and identify post-screening barriers to accessing mental health care. Methods: We conducted a qualitative study during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian first completed psychosocial self/proxy-screening using the MyHEARTSMAP tool and then received a standardized clinical mental health assessment. If the MyHEARTSMAP assessment provided youth with mental health resources recommendations, their parents were invited to a follow-up session. Thirty days (±5 days) after their ED visit, parents participated in a virtual interview to reflect and share their attitudes, perceptions and thoughts around the screening and mental health care-seeking process. Results: Of the 171 participants who received resource recommendations during their ED visit, 124 parents (72.5%; 95% CI 65.2-79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an 'eye-opening' process that 'sparked conversation'. Most participants (74.2%; 95% CI 65.6-81.6) agreed with the resource recommendations they received. In terms of resources-seeking, only 41 participants (33.1%; 95% CI 24.9-42.1) attempted to access recommended supports. Families generally felt identified concerns were mild and 'not serious enough' to warrant resource-seeking, though many expressed an intention to seek care if concerns escalated. Conclusion: Perceptions of psychosocial screening in the ED were favourable and encouraging among participating parents of youth screened positive for psychosocial issues. Despite positive attitudes, only a fraction of the families invited to follow-up attempted to access care. Mental health may be perceived as low priority for many families, signifying the need for improved education and awareness building on the importance of early intervention.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, 8166University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Amanbir Atwal
- Department of Pediatrics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Wright
- Department of Pediatrics, 3158University of Alberta, Edmonton, Alberta, British Columbia, Canada
| | - Quynh Doan
- School of Population and Public Health, 8166University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, 8166University of British Columbia, Vancouver, British Columbia, Canada
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Chun A, Panchmatia R, Doan Q, Meckler G, Narayan B. Twitter as a Knowledge Translation Tool to Increase Awareness of the OpenHEARTSMAP Psychosocial Assessment and Management Tool in the Field of Pediatric Emergency Mental Health. Cureus 2022; 14:e27597. [PMID: 36059355 PMCID: PMC9433791 DOI: 10.7759/cureus.27597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale The increasing prevalence of pediatric mental health presentations in pediatric emergency departments (PED) requires improved integration of evidence-based management strategies. Social media, specifically Twitter, has shown potential to aid in closing the knowledge translation (KT) gap between these evidence-based management strategies and pediatric emergency medicine (PEM) providers. Aims and objectives The primary outcome of this study is to evaluate the effectiveness of Twitter as a KT dissemination tool in PEM. The exploratory outcomes were to assess how to effectively implement Twitter in KT, explore ways in which Twitter can maximize the global reach of OpenHEARTSMAP and whether Twitter can lead to increased adoption of OpenHEARTSMAP. Methods A one-week prospective promotion on Twitter was conducted to disseminate the OpenHEARTSMAP tool using 15 topic-related hashtags (arm 1, 15 Tweets) versus one post wherein 15 different Twitter users were mentioned in 15 different comments (arm 2, 1 Tweet). A one-week control period immediately prior to posting was employed for comparisons. Results During the Twitter week, visits per day to OpenHEARTSMAP increased by 175%; mean time spent on the website increased by 212%; and mean page actions per visit increased by 130%. The greatest increase in visits occurred on the first day of Tweeting. Arm 2 received the greatest engagements. Within arm 1, the category of pediatrics received the most engagements (hashtag #Peds was most popular). Arm 1 received 455 impressions compared to 2071 in arm 2. No new users registered an account on the OpenHEARTSMAP website, which is required to physically use the tool. Conclusion Twitter can be an effective KT tool to increase awareness of research, the first step of KT, in the domain of PEM mental health care. Strategies for success include building a robust Twitter following; posting during peak healthcare-related Twitter traffic times; employing hashtags coinciding with current events; and targeting posts by tagging users who need not necessarily be generally well-known opinion leaders.
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Maki K, Doan Q, Sih K, Stillwell K, Chun A, Meckler G. A randomized controlled pilot study of intranasal lidocaine in acute management of paediatric migraine and migraine-like headache. Paediatr Child Health 2022; 27:340-345. [DOI: 10.1093/pch/pxac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
This study was aimed to determine the sample size required to conduct an efficacy randomized controlled trial (RCT) to evaluate superiority of intranasal (IN) lidocaine to placebo as an analgesic option for children presenting to the paediatric emergency department (PED) with migraine or posttraumatic headache with migraine features and to evaluate study protocol feasibility.
Study Design
This study is a double-blind RCT of children aged 7 to 16 years at a single-centre PED. Thirty-two participants were randomized to receive either IN 2% lidocaine or 0.9% sodium chloride. The primary outcome measure was the proportion of subjects with a Verbal Numeric Rating Scale pain score of <4 at 30 and 60 minutes post-IN therapy. Primary outcome data were analyzed using a test of differences between proportions. Secondary objectives included assessing the feasibility of our study protocol by evaluating recruitment rates, adverse drug events, and PED length of stay (LOS).
Results
Six of 17 participants in the lidocaine group and 2 of 15 in the placebo group were treated successfully. Using these proportions with 95% confidence intervals and 80% power, the sample size required to find a significant difference between proportions would be 67 participants per arm. Our enrolment rate was 55% and there were no serious adverse drug events. The median PED LOS was similar between groups.
Conclusion
We determined the sample size required to conduct a definitive RCT to evaluate the superiority of IN lidocaine to placebo and found the study protocol is feasible but identified important considerations in PED migraine trial design.
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Affiliation(s)
- Kate Maki
- Department of Pediatrics, University of British Columbia , Vancouver, British Columbia , Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia , Vancouver, British Columbia , Canada
- BC Children’s Hospital Research Institute , Vancouver, British Columbia , Canada
| | - Kendra Sih
- Department of Pediatrics, University of British Columbia , Vancouver, British Columbia , Canada
| | - Karly Stillwell
- BC Children’s Hospital Research Institute , Vancouver, British Columbia , Canada
| | - Alaina Chun
- BC Children’s Hospital Research Institute , Vancouver, British Columbia , Canada
| | - Garth Meckler
- Department of Pediatrics, University of British Columbia , Vancouver, British Columbia , Canada
- BC Children’s Hospital Research Institute , Vancouver, British Columbia , Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Burt H, Doan Q, Landry T, Wright B, McKinley KW. The Impact of Universal Mental Health Screening on Pediatric Emergency Department Flow. Acad Pediatr 2022; 22:210-216. [PMID: 34757025 DOI: 10.1016/j.acap.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE AND HYPOTHESIS Assess the impact of universal mental health screening with MyHEARTSMAP on emergency department (ED) flow, an important aspect of feasibility. We hypothesized that the difference in departmental level ED length of stay (LOS) for screening and matched nonscreening days is less than 30 minutes. METHODS We conducted a 2-center, retrospective cohort study between December 2017 and June 2019. At each center, random mental health screening days were assigned over the course of 15 consecutive months. We matched each 24-hour screening day to a unique nonscreening day based on: location (Center 1 or Center 2); day type (weekday: Monday-Thursday or weekend: Friday-Sunday); date (±28 days); and 24-hour volume (±15 patients). We collected retrospective patient flow data, including LOS, across all ED visits to determine the difference in departmental level median LOS between matched screening and nonscreening days. RESULTS There was not a statistically significant difference in departmental LOS between screening and nonscreening days. Overall, the difference in departmental LOS was -4.0 minutes (95% confidence interval, -9.8, 1.8) for screening days compared to nonscreening days, with a difference of -2.0 minutes (-9.0, 4.9) at Center 1 and -6.0 minutes (-15.4, 3.4) at Center 2. CONCLUSIONS Our findings show that universal mental health screening with MyHEARTSMAP can be implemented without a significant impact of ED LOS.
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Affiliation(s)
- Heather Burt
- School of Population and Public Health, University of British Columbia (H Burt and Q Doan), Vancouver, British Columbia, Canada
| | - Quynh Doan
- School of Population and Public Health, University of British Columbia (H Burt and Q Doan), Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia (Q Doan), Vancouver, British Columbia, Canada
| | - Taryne Landry
- Faculty of Medicine, University of British Columbia (T Landry), Vancouver, British Columbia, Canada; Faculty of Medicine, University of Alberta (T Landry), Edmonton, Alberta, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta (B Wright), Edmonton, Alberta, Canada
| | - Kenneth W McKinley
- Emergency Medicine Section of Data Analytics, Children's National (KW McKinley), Washington, DC.
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Lee A, Davidson J, Black T, Kim GG, Doan Q. Youth mental health-related presentations at a quaternary centre: Who comes, What are their needs, and Can we meet their needs. Paediatr Child Health 2022; 27:147-153. [PMID: 35712040 PMCID: PMC9191912 DOI: 10.1093/pch/pxab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mental health issues are increasingly prevalent across Canada, reflected in rising presentations to emergency departments. To effectively address the needs of children and youth seeking mental health-related care in the emergency department and to judiciously use scarce mental health-related resources, we need to better identify the specific areas of psychosocial needs and accessibility of associated services. Objective To describe the types and severity of paediatric mental health-related presentations evaluated at a quaternary paediatric emergency department, and to explore the accessibility of community mental health-related resources. Methods We conducted a retrospective cohort study of children and youth presenting to a quaternary paediatric emergency department who were assessed using HEARTSMAP, a validated mental health assessment and management tool. We reported the proportion who sought care for a psychiatric, social, or youth health-related mental health complaint. We contacted community mental health-related resources for their estimated wait times to determine accessibility. Results Of 1,530 paediatric emergency presentations, 98.8% of patients had psychiatric issues (40.1% were severe), 78.0% of patients had social issues (17.1% were severe), and 71.5% had youth health issues (18.1% were severe). We contacted 123 community mental health-related resources. Community youth health and social services were somewhat accessible, with 50.0% and 38.7%, respectively, able to intake youth within a week of referral. Community psychiatric programs were least accessible, with 59.3% having wait times greater than 1 month. Conclusions Many psychiatric concerns presenting in paediatric emergency departments have complex psychosocial challenges requiring non-psychiatric support. A need exists for improved accessibility to community psychiatric programs.
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Affiliation(s)
- Alison Lee
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jana Davidson
- Department of Psychiatry., BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace G Kim
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Correspondence: Quynh Doan, Division of Pediatric Emergency Medicine, Department of Pediatrics, UBC, BC Children’s Hospital Research Institute., Emergency Department, 4480 Oak Street office B429, Vancouver, British Columbia, V6H 3N1, Canada. Telephone (778)-984-9914, fax (604)-875-2366, e-mail
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Manouzi A, Sanatani S, Doan Q. Electrocardiogram in Pediatric Syncope: Practice Variation Among Pediatric Emergency Physicians. Pediatr Emerg Care 2022; 38:e886-e890. [PMID: 34101684 DOI: 10.1097/pec.0000000000002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population. METHODS We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG. RESULTS The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope. CONCLUSIONS This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.
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Affiliation(s)
| | - Shubhayan Sanatani
- Children's Heart Centre, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Virk P, Arora R, Burt H, Gadermann A, Barbic S, Nelson M, Davidson J, Cornish P, Doan Q. HEARTSMAP-U: Adapting a Psychosocial Self-Screening and Resource Navigation Support Tool for Use by Post-secondary Students. Front Psychiatry 2022; 13:812965. [PMID: 35280181 PMCID: PMC8908908 DOI: 10.3389/fpsyt.2022.812965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health challenges are highly prevalent in the post-secondary educational setting. Screening instruments have been shown to improve early detection and intervention. However, these tools often focus on specific diagnosable conditions, are not always designed with students in mind, and lack resource navigational support. OBJECTIVE The aim of this study was to describe the adaptation of existing psychosocial assessment (HEARTSMAP) tools into a version that is fit-for-purpose for post-secondary students, called HEARTSMAP-U. METHODS We underwent a three-phase, multi-method tool adaptation process. First, a diverse study team proposed a preliminary version of HEARTSMAP-U and its conceptual framework. Second, we conducted a cross-sectional expert review study with Canadian mental health professionals (N = 28), to evaluate the clinical validity of tool content. Third, we conducted an iterative series of six focus groups with diverse post-secondary students (N = 54), to refine tool content and language, and ensure comprehensibility and relevance to end-users. RESULTS The adaptation process resulted in the HEARTSMAP-U self-assessment and resource navigational support tool, which evaluates psychosocial challenges across 10 sections. In Phase two, clinician experts expressed that HEARTSMAP-U's content aligned with their own professional experiences working with students. In Phase three, students identified multiple opportunities to improve the tool's end-user relevance by calling for more "common language," such as including examples, definitions, and avoiding technical jargon. CONCLUSIONS The HEARTSMAP-U tool is well-positioned for further studies of its quantitative psychometric properties and clinical utility in the post-secondary educational setting.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ravia Arora
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Heather Burt
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Anne Gadermann
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marna Nelson
- Student Health Service, University of British Columbia, Vancouver, BC, Canada
| | - Jana Davidson
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Cornish
- Student Counselling Services, University of California, Berkeley, Berkeley, CA, United States
| | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Doan Q, Barbic D. Are mood disorders associated with frequent emergency department visits? Question answered, or a dialogue just beginning? CAN J EMERG MED 2022; 24:3-4. [PMID: 35038154 PMCID: PMC8762438 DOI: 10.1007/s43678-021-00238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Quynh Doan
- Department of Pediatrics, UBC; BC Children's Hospital, Vancouver, BC, Canada
| | - David Barbic
- Department of Emergency Medicine, UBC, Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada.
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Ware AL, Yeates KO, Geeraert B, Long X, Beauchamp MH, Craig W, Doan Q, Freedman SB, Goodyear BG, Zemek R, Lebel C. Structural connectome differences in pediatric mild traumatic brain and orthopedic injury. Hum Brain Mapp 2021; 43:1032-1046. [PMID: 34748258 PMCID: PMC8764485 DOI: 10.1002/hbm.25705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023] Open
Abstract
Sophisticated network‐based approaches such as structural connectomics may help to detect a biomarker of mild traumatic brain injury (mTBI) in children. This study compared the structural connectome of children with mTBI or mild orthopedic injury (OI) to that of typically developing (TD) children. Children aged 8–16.99 years with mTBI (n = 83) or OI (n = 37) were recruited from the emergency department and completed 3T diffusion MRI 2–20 days postinjury. TD children (n = 39) were recruited from the community and completed diffusion MRI. Graph theory metrics were calculated for the binarized average fractional anisotropy among 90 regions. Multivariable linear regression and linear mixed effects models were used to compare groups, with covariates age, hemisphere, and sex, correcting for multiple comparisons. The two injury groups did not differ on graph theory metrics, but both differed from TD children in global metrics (local network efficiency: TD > OI, mTBI, d = 0.49; clustering coefficient: TD < OI, mTBI, d = 0.49) and regional metrics for the fusiform gyrus (lower degree centrality and nodal efficiency: TD > OI, mTBI, d = 0.80 to 0.96; characteristic path length: TD < OI, mTBI, d = −0.75 to −0.90) and in the superior and middle orbital frontal gyrus, paracentral lobule, insula, and thalamus (clustering coefficient: TD > OI, mTBI, d = 0.66 to 0.68). Both mTBI and OI demonstrated reduced global and regional network efficiency and segregation as compared to TD children. Findings suggest a general effect of childhood injury that could reflect pre‐ and postinjury factors that can alter brain structure. An OI group provides a more conservative comparison group than TD children for structural neuroimaging research in pediatric mTBI.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Bryce Geeraert
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Xiangyu Long
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, 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, University of Calgary, Calgary, Alberta, Canada
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Atwal A, Virk P, Wright B, Doan Q. 49 Exploring parental acceptability of universal psychosocial screening in the pediatric emergency department. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Mental Health
Background
Mental health concerns among children and adolescents presenting to the emergency department (ED) are on the rise. Universal screening can facilitate early identification and management of these concerns, mitigating significant long-term morbidity and mortality. The efficacy of psychosocial screening in the ED is not only determined by accurate identification of concerns, but by downstream resource-seeking behaviours to address these concerns. For many children and adolescents, parents hold a key role in determining their access to care. Thus, parental attitudes and perceptions of psychosocial screening may influence resource-seeking behaviours and predict a youth’s ability to access support.
Objectives
Given the limited understanding of parental perceptions of psychosocial screening in the ED, we aimed to qualitatively explore parents’ attitudes towards screening with MyHEARTSMAP, an electronic self/proxy administered psychosocial screening tool. We also quantified resource-seeking behaviours and explored barriers to seeking care.
Design/Methods
This was a nested qualitative study conducted during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian completed a self/proxy psychosocial screen using MyHEARTSMAP. Youth who screened positive were provided with recommendations and resources for support.
30 days (+ 5 days) after their ED visit, parents participated in semi-structured follow-up interviews to share their attitudes, perceptions, and thoughts around the screening and care-seeking process.
Results
Of the 171 participants requiring resources for support, 124 (72.5%; 95% CI 65.2-79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an “eye-opening” process that “sparked conversation”.74.2% (95% CI 65.6-81.6%) of participants also agreed with the support recommendations they received during their ED visit.
In terms of resource seeking, as displayed in Figure 1, only 41 participants (33.1%; 95% CI 24.9-42.1%) attempted to access support services. Other families felt identified concerns were mild and “not serious enough” to warrant resources, though many expressed an intention to seek care if the concerns escalated.
Conclusion
Parental perceptions of psychosocial screening in the ED were favourable and encouraging, with a majority of participants expressing an understanding and appreciation of the process. This lends support to the implementation of universal psychosocial screening in the ED. Despite positive attitudes towards screening, only a fraction actually attempted to access care. This incongruence may reflect the persisting view that mental health holds low priority and suggests a need for increased education on the importance of seeking timely mental health care.
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Virk P, Ellis J, Dhariwal A, Chapman A, Doan Q. The utility of universal screening for somatization in a pediatric emergency department: A prospective evaluation. Clin Child Psychol Psychiatry 2021; 26:1035-1045. [PMID: 34020565 PMCID: PMC8593319 DOI: 10.1177/13591045211017619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate clinical utility and feasibility of universal somatization screening in the pediatric emergency department (ED) using a standardized approach of (1) identifying potential somatizing symptoms within the ED, (2) introducing these patients and their caregivers to the concept of the 'mind-body connection', (3) corroborating the likelihood of a somatization diagnosis via brief psychiatric assessment, and (4) inviting families to a psychoeducational follow-up session. METHODS We conducted a cross-sectional study to carry out this approach with families visiting a pediatric ED. Our primary outcome of screening utility was measured as the proportion of youth who screened positive for somatization by the ED clinician. Our secondary outcome of screening feasibility was measured as the proportion of patients with positives who (1) agreed to meet with the study psychiatrist, (2) consented to an ED psychiatric assessment, (3) were assessed by the study psychiatrist as likely experiencing somatization, and (4) were invited for follow-up and attended. RESULTS Of the 344 screened patients, 27 (7.8%) screened positive for somatization. Of these, 25 (92.6%) families verbally consented to meet the study psychiatrist to learn about the mind-body connection, and 21 (77.8%) consented to further psychiatric assessment. Upon assessment, the somatization likelihood was supported for all 21 youth. Twenty families were invited to follow-up and ultimately two (10%) attended. CONCLUSIONS Somatization can be detected through ED-based universal screening. Few families attended psychoeducational follow-up. Further research is needed to determine appropriate ED-initiated pediatric somatization intervention.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jacob Ellis
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Amrit Dhariwal
- BC Children's Hospital Research Institute, Vancouver, Canada.,Division of Child & Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrea Chapman
- BC Children's Hospital Research Institute, Vancouver, Canada.,Division of Child & Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada.,Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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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: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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47
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Pernica JM, Smaill F, Kam AJ, Bartholomew A, Doan Q, Smieja M, Khan S, Sung M, Thabane L, Goldfarb DM. Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol. BMJ Open 2021; 11:e047271. [PMID: 34380724 PMCID: PMC8359528 DOI: 10.1136/bmjopen-2020-047271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Streptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing. METHODS AND ANALYSIS A randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3-5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed. ETHICS AND DISSEMINATION All study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines. TRIAL REGISTRATION NUMBER NCT04247243.
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Affiliation(s)
- Jeffrey M Pernica
- Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Fiona Smaill
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - April J Kam
- Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Amy Bartholomew
- Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Quynh Doan
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Khan
- Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Melani Sung
- Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David M Goldfarb
- Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Li BCM, Wright B, Black T, Newton AS, Doan Q. Utility of MyHEARTSMAP in Youth Presenting to the Emergency Department with Mental Health Concerns. J Pediatr 2021; 235:124-129. [PMID: 33819465 DOI: 10.1016/j.jpeds.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the utility of a digital psychological self-assessment tool, MyHEARTSMAP (scores on 10 sections: home, education and activities, alcohol and drugs, relationships and bullying, thoughts and anxiety, safety, sexual health, mood, abuse, and professional resources), in youth presenting to the pediatric emergency department (ED) with a mental health concern. STUDY DESIGN We conducted a prospective cohort study in 2 tertiary care pediatric EDs from December 2017 to October 2019. Youth 10-17 years old triaged for a mental health concern were screened and enrolled to complete MyHEARTSMAP on a mobile device. A clinician blinded to the MyHEARTSMAP assessment conducted their own assessment which was used as the reference standard. Utility was quantified as the sensitivity and specificity of MyHEARTSMAP in detecting psychiatric, social, youth health, and functional concerns. RESULTS Among 379 eligible youth, 351 were approached and 233 (66.4%) families were enrolled. Sensitivity for youth MyHEARTSMAP self-assessments ranged from 87.4% in the youth health domain to 99.5% in the psychiatric domain for identifying any concern, and 33.3% in the social domain to 74.6% in the psychiatric domain for severe concerns. Specificity ranged from 66.7% in the psychiatric domain to 98.2% in the youth health domain for no or only mild concerns. CONCLUSIONS Youth and guardian MyHEARTSMAP assessments are sensitive for detecting psychosocial concerns requiring follow-up beyond pediatric ED evaluation. Specificity for no or only mild concerns was high in the nonpsychiatric domains.
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Affiliation(s)
- Brian C M Li
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda S Newton
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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49
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Wan MM, Doan Q, Kissoon N. The knowledge needs for Canadian paediatric emergency physicians in the diagnosis and management of tropical diseases: A national physician survey. Paediatr Child Health 2021; 26:e138-e144. [PMID: 33936343 PMCID: PMC8077208 DOI: 10.1093/pch/pxaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the knowledge gaps and need for continuing medical education (CME) resources for Canadian paediatric emergency department (PED) physician management of common tropical diseases. METHODS A cross-sectional survey study of Canadian PED was performed from May to July 2017 using the Pediatric Emergency Research Canada (PERC) database. RESULTS The response rate was 56.4% (133/236). The mean performance on the case-based vignettes identifying clinical presentation of tropical illnesses ranged from 59.9% to 76.0%, with only 15.8% (n=21) to 31.1% (n=42) of participants scoring maximum points. Those who 'always' asked about fever performed better than those who only 'sometimes' asked (40.4% versus 23.8%). For management cases, the majority of the participants (59.4% to 89.5%) were able to interpret investigations; however, many were unsure of subsequent actions relating to initial treatment, discharge instructions, and reporting requirements. Many would consult infectious diseases (87.8% to 99.3%). Fifty-three per cent of the participants reported a low comfort level in diagnosing or managing these patients. They rated the importance of CME materials with a median of 50/100, via various modalities such as case studies (71.9%), emphasizing a need for PED-specific content. CONCLUSION This study identified a knowledge gap in the recognition and management of pediatric tropical diseases by Canadian PED physicians. There is a need for formal CME materials to supplement physician practice.
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Affiliation(s)
- Melissa Mengyan Wan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Division of Emergency Medicine, BC Children’s Hospital, Vancouver, British Columbia
- BC Children’s Hospital Research Institute, Vancouver, British Columbia
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- BC Children’s Hospital Research Institute, Vancouver, British Columbia
- Division of Critical Care, BC Children’s Hospital, Vancouver, British Columbia
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50
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Burstein B, Sabhaney V, Bone JN, Doan Q, Mansouri FF, Meckler GD. Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e214544. [PMID: 33978724 PMCID: PMC8116985 DOI: 10.1001/jamanetworkopen.2021.4544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial. OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required. DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included. STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTS The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.
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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, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vikram Sabhaney
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey N. Bone
- Department Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fahad F. Mansouri
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Garth D. Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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