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Kelly LE, Rieder MJ, Finkelstein Y. Medical cannabis for children: Evidence and recommendations. Paediatr Child Health 2024; 29:104-121. [PMID: 38586483 PMCID: PMC10996577 DOI: 10.1093/pch/pxad078] [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: 03/30/2022] [Accepted: 04/20/2023] [Indexed: 04/09/2024] Open
Abstract
Interest in using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer-term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug-drug interactions.
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Affiliation(s)
- Lauren E Kelly
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Michael J Rieder
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
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Kelly LE, Rieder MJ, Finkelstein Y. Les données probantes et les recommandations sur le cannabis à des fins médicales chez les enfants. Paediatr Child Health 2024; 29:104-121. [PMID: 38586491 PMCID: PMC10996578 DOI: 10.1093/pch/pxad077] [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: 03/30/2022] [Accepted: 04/20/2023] [Indexed: 04/09/2024] Open
Abstract
L'intérêt envers l'utilisation des produits du cannabis à des fins médicales chez les enfants de moins de 18 ans augmente. De nombreux produits du cannabis à des fins médicales contiennent du cannabidiol, du delta-9-tétrahydrocannabinol ou ces deux produits. Malgré les nombreuses prétentions thérapeutiques, peu d'études rigoureuses guident la posologie, l'innocuité et l'efficacité du cannabis à des fins médicales en pédiatrie clinique. Le présent document de principes passe en revue les données probantes à jour et expose les recommandations sur l'utilisation du cannabis à des fins médicales chez les enfants. Les rapports à plus long terme (deux ans) souscrivent à la tolérabilité et à l'efficacité soutenues d'un traitement au cannabidiol chez les patients ayant le syndrome de Lennox-Gastaut ou le syndrome de Dravet. Les extraits de cannabis enrichis de cannabidiol qui renferment de petites quantités de delta-9-tétrahydrocannabinol ont été évalués auprès d'un petit nombre de patients d'âge pédiatrique, et d'autres recherches devront être réalisées pour éclairer les guides de pratique clinique. Étant donné l'utilisation répandue du cannabis à des fins médicales au Canada, les pédiatres devraient être prêts à participer à des échanges ouverts et continus avec les familles au sujet de ses avantages potentiels et de ses risques, ainsi qu'à préparer des plans individuels en vue d'en surveiller l'efficacité, de réduire les méfaits et de limiter les interactions médicamenteuses.
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Affiliation(s)
- Lauren E Kelly
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
| | - Michael J Rieder
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
| | - Yaron Finkelstein
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
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Florin TA, Freedman SB, Xie J, Funk AL, Tancredi DJ, Kim K, Neuman MI, Yock-Corrales A, Bergmann KR, Breslin KA, Finkelstein Y, Ahmad FA, Avva UR, Lunoe MM, Chaudhari PP, Shah NP, Plint AC, Sabhaney VJ, Sethuraman U, Gardiner MA, Sartori LF, Wright B, Navanandan N, Mintegi S, Gangoiti I, Borland ML, Chong SL, Kwok MY, Eckerle M, Poonai N, Romero CMA, Waseem M, Nebhrajani JR, Bhatt M, Caperell K, Campos C, Becker SM, Morris CR, Rogers AJ, Kam AJ, Pavlicich V, Palumbo L, Dalziel SR, Morrison AK, Rino PB, Cherry JC, Salvadori MI, Ambroggio L, Klassen TP, Payne DC, Malley R, Simon NJ, Kuppermann N. Features Associated With Radiographic Pneumonia in Children with SARS-CoV-2. J Pediatric Infect Dis Soc 2024; 13:257-259. [PMID: 38391389 DOI: 10.1093/jpids/piae015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 02/24/2024]
Abstract
14% of children with SARS-CoV-2 infections had radiographic pneumonia. Hypoxemia, cough, higher temperature, and older age were associated with pneumonias. In children tested, SARS-CoV-2 test results were not associated with radiographic pneumonia.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, USA
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Canada
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York, USA
| | - Maren M Lunoe
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Michael A Gardiner
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, USA
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Meredith L Borland
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Perth, Australia
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Pediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, NY, New York, USA
| | - Michelle Eckerle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, USA
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | | | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, New York City, Bronx, New York, USA
| | | | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Kerry Caperell
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, USA
| | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah M Becker
- Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, USA
| | - Claudia R Morris
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor, USA
| | - April J Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Facultad de Medicina, Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Laura Palumbo
- Department of Pediatrics, ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Pedro B Rino
- Department of Pediatrics, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", RIDEPLA, Buenos Aires, Argentina
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Lilliam Ambroggio
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Norma-Jean Simon
- Data Analytics and Reporting and Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, USA
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Levine M, Finkelstein Y, Trautman WJ, Cao D, Schwarz E, Filip A, Cook L, Pathan SA, Obilom C, Liu J, Yanta J, Cohen N, Thomas SH. Is EGD Needed in all Patients after Suicidal or Exploratory Caustic Ingestions? J Med Toxicol 2024:10.1007/s13181-024-01003-2. [PMID: 38647997 DOI: 10.1007/s13181-024-01003-2] [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: 09/10/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions. METHODS This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded. RESULTS 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic. CONCLUSION In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA.
| | - Yaron Finkelstein
- Department of Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - William J Trautman
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dazhe Cao
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Evan Schwarz
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA
| | - Ari Filip
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University, St. Louis, MO, USA
| | - Leanne Cook
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA
| | | | - Cherie Obilom
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jim Liu
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Yanta
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Neta Cohen
- Department of Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
- Blizard Institute, Barts and The London School of Medicine, London, UK
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5
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Funk A, Florin TA, Kuppermann N, Finkelstein Y, Kazakoff A, Baldovsky M, Tancredi DJ, Breslin K, Bergmann KR, Gardiner M, Pruitt CM, Liu DR, Neuman MI, Wilkinson M, Ambroggio L, Pang XL, Cauchemez S, Malley R, Klassen TP, Lee BE, Payne DC, Mahmud SM, Freedman SB. Household Transmission Dynamics of Asymptomatic SARS-CoV-2-Infected Children: A Multinational, Controlled Case-Ascertained Prospective Study. Clin Infect Dis 2024:ciae069. [PMID: 38530249 DOI: 10.1093/cid/ciae069] [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: 11/01/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Asymptomatic SARS-CoV-2 infection in children is highly prevalent but its acute and chronic implications have been minimally described. METHODS In this controlled case-ascertained household transmission study, we recruited asymptomatic children <18 years with SARS-CoV-2 nucleic acid testing performed at 12 tertiary care pediatric institutions in Canada and the United States. We attempted to recruit all test-positive children and 1 to 3 test-negative, site-matched controls. After 14 days' follow-up we assessed the clinical (ie, symptomatic) and combined (ie, test-positive, or symptomatic) secondary attack rates (SARs) among household contacts. Additionally, post-COVID-19 condition (PCC) was assessed in SARS-CoV-2-positive participating children after 90 days' follow-up. RESULTS A total of 111 test-positive and 256 SARS-CoV-2 test-negative asymptomatic children were enrolled between January 2021 and April 2022. After 14 days, excluding households with co-primary cases, the clinical SAR among household contacts of SARS-CoV-2-positive and -negative index children was 10.6% (19/179; 95% CI: 6.5%-16.1%) and 2.0% (13/663; 95% CI: 1.0%-3.3%), respectively (relative risk = 5.4; 95% CI: 2.7-10.7). In households with a SARS-CoV-2-positive index child, age <5 years, being pre-symptomatic (ie, developed symptoms after test), and testing positive during Omicron and Delta circulation periods (vs earlier) were associated with increased clinical and combined SARs among household contacts. Among 77 asymptomatic SARS-CoV-2-infected children with 90-day follow-up, 6 (7.8%; 95% CI: 2.9%-16.2%) reported PCC. CONCLUSIONS Asymptomatic SARS-CoV-2-infected children, especially those <5 years, are important contributors to household transmission, with 1 in 10 exposed household contacts developing symptomatic illness within 14 days. Asymptomatic SARS-CoV-2-infected children may develop PCC.
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Affiliation(s)
- Anna Funk
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alissa Kazakoff
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Baldovsky
- Division of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Kristen Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C., USA
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Michael Gardiner
- Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California, USA
- Division of Emergency Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Christopher M Pruitt
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Deborah R Liu
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck USC School of Medicine, Los Angeles, California, USA
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Wilkinson
- Department of Pediatrics, University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, France
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel C Payne
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Salaheddin M Mahmud
- Dept of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Pollak U, Avniel-Aran A, Binshtok AM, Bar-Yosef O, Bronicki RA, Checchia PA, Finkelstein Y. Exploring the Possible Role of Cannabinoids in Managing Post-Cardiac Surgery Complications: A Narrative Review of Preclinical Evidence and a Call for Future Research Directions. J Cardiovasc Pharmacol 2024:00005344-990000000-00298. [PMID: 38498618 DOI: 10.1097/fjc.0000000000001560] [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
Open-heart surgery with cardiopulmonary bypass (CPB) often leads to complications including pain, systemic inflammation, and organ damage. Traditionally managed with opioids, these pain relief methods bring potential long-term risks, prompting the exploration of alternative treatments. The legalization of cannabis in various regions has reignited interest in cannabinoids, such as CBD, known for their anti-inflammatory, analgesic, and neuroprotective properties. Historical and ongoing research acknowledges the endocannabinoid system's crucial role in managing physiological processes, suggesting cannabinoids could offer therapeutic benefits in post-surgical recovery. Specifically, CBD has shown promise in managing pain, moderating immune responses, and mitigating ischemia/reperfusion injury, underscoring its potential in postoperative care. However, the translation of these findings into clinical practice faces challenges, highlighting the need for extensive research to establish effective, safe cannabinoid-based therapies for patients undergoing open-heart surgery. This narrative review advocates for a balanced approach, considering both the therapeutic potential of cannabinoids and the complexities of their integration into clinical settings.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Avniel-Aran
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexander M Binshtok
- Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Bar-Yosef
- Pediatric Neurology and Child Development, The Edmond and Lily Safra Children's Hospital; The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronald A Bronicki
- Department of Pediatrics, Critical Care Medicine and Cardiology, Baylor College of Medicine, Houston, TX, USA
- Pediatric Cardiovascular Intensive Care Unit, Texas Children's Hospital, Houston, TX, USA
| | - Paul A Checchia
- Department of Pediatrics, Critical Care Medicine and Cardiology, Baylor College of Medicine, Houston, TX, USA
- Pediatric Cardiovascular Intensive Care Unit, Texas Children's Hospital, Houston, TX, USA
| | - Yaron Finkelstein
- Faculty of Medicine, Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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7
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Huntsman RJ, Elliott J, Lewis E, Moore-Hepburn C, Alcorn J, Mansell H, Appendino JP, Bélanger RE, Corley S, Crooks B, Denny AM, Finkelstein Y, Finley A, Fung R, Gilpin A, Litalien C, Jacobs J, Oberlander TF, Palm A, Palm J, Polewicz M, Quinn D, Rassekh SR, Repetski A, Rieder MJ, Robson-McKay A, Seifert B, Shackelford A, Siden H, Szafron M, ‘t Jong G, Vaillancourt R, Kelly LE. Removing barriers to accessing medical cannabis for paediatric patients. Paediatr Child Health 2024; 29:12-16. [PMID: 38332979 PMCID: PMC10848115 DOI: 10.1093/pch/pxac129] [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] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2024] Open
Abstract
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
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Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesse Elliott
- Independent Researcher, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Evan Lewis
- Neurology Center of Toronto and Division of Pediatric Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan P Appendino
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Richard E Bélanger
- Départment de Pédiatrie, Faculté de medicine, Université de Laval, Québec, Québec, Canada
| | - Scott Corley
- Cannabinoid Research Initiative of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bruce Crooks
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - AnneMarie M Denny
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allen Finley
- Departments of Anesthesia and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Fung
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Andrea Gilpin
- The Rosalind and Morris Goodman Family Pediatrics Formulation Centre of the CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Catherine Litalien
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, and The Rosalind and Morris Goodman Family Pediatric Formulation Centre of the CHU Sainte Justine, Montréal, Québec, Canada
| | - Julia Jacobs
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Timothy F Oberlander
- Department of Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Jacob Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Monika Polewicz
- Division of Pediatric Research, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Declan Quinn
- Division of Pediatric Psychiatry, Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Repetski
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Michael J Rieder
- Division of Pediatric Pharmacology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Amy Robson-McKay
- Division of Pediatric Psychiatry, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Blair Seifert
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Hal Siden
- Division of Palliative Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geert ‘t Jong
- Departments of Pediatrics and Pharmacology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Régis Vaillancourt
- Department of Pediatric Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- George and Fay Yee Centre for Health Care Innovation and Children’s Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Myran DT, Gaudreault A, McCarthy SDS, Pugliese M, Tanuseputro P, Finkelstein Y. Unintentional pediatric poisonings before and during the COVID-19 pandemic: A population-based study. Am J Emerg Med 2024; 76:185-192. [PMID: 38086185 DOI: 10.1016/j.ajem.2023.11.042] [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: 08/16/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES The impact of coronavirus disease 2019 (COVID-19) on unintentional pediatric poisonings is unclear. We examined changes in emergency department (ED) visits and hospitalizations for poisonings before and during the COVID-19 pandemic. We compared changes in cannabis vs non-cannabis poisoning events given the recent legalization of cannabis in October 2018 and cannabis edibles in January 2020. STUDY DESIGN Interrupted time-series (ITS) analyses of changes in population-level ED visits and hospitalizations for poisonings in children aged 0-9 years in Ontario, Canada (annual population of 1.4 million children), over two time periods: pre-pandemic (January 2010-March 2020) and pandemic (April 2020-December 2021). RESULTS Overall, there were 28,292 ED visits and 2641 hospitalizations for unintentional poisonings. During the pandemic, poisonings per 100,000 person-years decreased by 14.6% for ED visits (40.15 pre- vs. 34.29 during) and increased by 35.9% for hospitalizations (3.48 pre- vs. 4.73 during). ED visits dropped immediately (Incidence Rate Ratio [IRR], 0.76; 95% CI, 0.70-0.82) at the onset of the pandemic, followed by a gradual return to baseline (quarterly change, IRR 1.04, 95%CI 1.03-1.06), while hospitalizations had an immediate increase (IRR 1.34; 95% CI, 1.08-1.66) and no gradual change. The only increase in poisonings was for cannabis which had a 10.7-fold for ED visits (0.45 to 4.83 per 100,000 person-years) and a 12.1-fold increase for hospitalizations (0.16 to 1.91 per 100,000 person-years). Excluding cannabis, there was no overall increase in poisoning hospitalizations. CONCLUSIONS The COVID-19 pandemic was not associated with increases in any type of unintentional pediatric poisonings, with the exception of cannabis poisonings. Increased cannabis poisonings may be explained by the legalization of non-medical cannabis edibles in Canada in January 2020.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephen D S McCarthy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Pediatrics and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Myran DT, Harrison LD, Pugliese M, Solmi M, Anderson KK, Fiedorowicz JG, Perlman CM, Webber C, Finkelstein Y, Tanuseputro P. Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use With and Without Psychosis. JAMA Psychiatry 2023; 80:1169-1174. [PMID: 37755727 PMCID: PMC10535000 DOI: 10.1001/jamapsychiatry.2023.3582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/13/2023] [Accepted: 07/28/2023] [Indexed: 09/28/2023]
Abstract
Importance Episodes of substance-induced psychosis are associated with increased risk of developing a schizophrenia spectrum disorder. However, there are limited data on the transition risk for substance use without psychosis. Objectives To quantify the risk of transition to schizophrenia spectrum disorder following an incident emergency department (ED) visit for (1) substance-induced psychosis and (2) substance use without psychosis and to explore factors associated with transition. Design, Settings, and Participants A population-based retrospective cohort study (January 2008 to March 2022) of all individuals, aged 14 to 65 years, in Ontario, Canada, with no history of a psychotic disorder. Individuals with incident ED visits for substance use with and without psychosis were compared with members of the general population. Main Outcomes and Measures Transition to schizophrenia spectrum disorder using a chart-validated algorithm. Associations between ED visits for substance use and subsequent transition were estimated using cause-specific hazard models. Results The study included 9 844 497 individuals, aged 14 to 65 years (mean [SD] age, 40.2 [14.7] years; 50.2% female) without a history of psychosis. There were 407 737 individuals with an incident ED visit for substance use, of which 13 784 (3.4%) ED visits were for substance-induced psychosis. Individuals with substance-induced psychosis were at a 163-fold (age- and sex-adjusted hazard ratio [aHR], 163.2; 95% CI, 156.1-170.5) increased risk of transitioning, relative to the general population (3-year risk, 18.5% vs 0.1%). Individuals with an ED visit for substance use without psychosis had a lower relative risk of transitioning (aHR, 9.8; 95% CI, 9.5-10.2; 3-year risk, 1.4%), but incurred more than 3 times the absolute number of transitions (9969 vs 3029). Cannabis use had the highest transition risk among visits with psychosis (aHR, 241.6; 95% CI, 225.5-258.9) and the third-highest risk among visits without psychosis (aHR, 14.3; 95% CI, 13.5-15.2). Younger age and male sex were associated with a higher risk of transition, and the risk of male sex was greater in younger compared with older individuals, particularly for cannabis use. Conclusions and Relevance The findings of this cohort study suggest that ED visits for substance use were associated with an increased risk of developing a schizophrenia spectrum disorder. Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions. Several factors were associated with higher transition risk, with implications for counseling and early intervention.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Lyndsay D. Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marco Solmi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Kelly K. Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- ICES Western, London, Ontario, Canada
| | - Jess G. Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Neurosciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Schuh S, Coates AL, Sweeney J, Rumantir M, Eltorki M, Alqurashi W, Plint AC, Zemek R, Poonai N, Parkin PC, Soares D, Moineddin R, Finkelstein Y. Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2337810. [PMID: 37856126 PMCID: PMC10587796 DOI: 10.1001/jamanetworkopen.2023.37810] [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: 07/05/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023] Open
Abstract
Importance Although nasal suctioning is the most frequently used supportive management for bronchiolitis, its benefit remains unknown. Objective To evaluate the effectiveness of enhanced vs minimal nasal suctioning in treating infants with bronchiolitis after discharge from the emergency department (ED). Design, Setting, and Participants This single-blind, parallel-group, randomized clinical trial was conducted from March 6, 2020, to December 15, 2022, at 4 tertiary-care Canadian pediatric EDs. Participants included otherwise healthy infants aged 1 to 11 months with a diagnosis of bronchiolitis who were discharged home from the ED. Interventions Participants were randomized to minimal suctioning via bulb or enhanced suctioning via a battery-operated device before feeding for 72 hours. Main Outcomes and Measures The primary outcome was additional resource use, a composite of unscheduled revisits for bronchiolitis or use of additional suctioning devices for feeding and/or breathing concerns. Secondary outcomes included health care utilization, feeding and sleeping adequacy, and satisfaction. Results Of 884 screened patients, 352 were excluded for criteria, 79 declined participation, 81 were otherwise excluded, 372 were randomized (185 to the minimal suction group and 187 to the enhanced suction group), and 367 (median [IQR] age, 4 [2-6] months; 221 boys [60.2%]) completed the trial (184 in the minimal suction and 183 in the enhanced suction group). Additional resource use occurred for 68 of 184 minimal suction participants (37.0%) vs 48 of 183 enhanced suction participants (26.2%) (absolute risk difference, 0.11; 95% CI, 0.01 to 0.20; P = .03). Unscheduled revisits occurred for 47 of 184 minimal suction participants (25.5%) vs 40 of 183 enhanced suction participants (21.9%) (absolute risk difference, 0.04; 95% CI, -0.05 to 0.12; P = .46). A total of 33 of 184 parents in the minimal suction group (17.9%) used additional suctioning devices vs 11 of 183 parents in the enhanced suction group (6.0%) (absolute risk difference, 0.12; 95% CI, 0.05 to 0.19; P < .001). No significant between-group differences were observed for all bronchiolitis revisits (absolute risk difference, 0.07; 95% CI, -0.02 to 0.16; P = .15), ED revisits (absolute risk difference, 0.04; 95% CI, -0.03 to 0.12; P = .30), parental care satisfaction (absolute risk difference, -0.02; 95% CI, -0.10 to 0.06; P = .70), and changes from baseline to 72 hours in normal feeding (difference in differences, 0.03; 95% CI, -0.10 to 0.17; P = .62), normal sleeping (difference in differences, 0.05; 95% CI, -0.08 to 0.18; P = .47), or normal parental sleeping (difference in differences, 0.10; 95% CI, -0.02 to 0.23; P = .09). Parents in the minimal suction group were less satisfied with the assigned device (62 of 184 [33.7%]) than parents in the enhanced suction group (145 of 183 [79.2%]) (risk difference, 0.45; 95% CI, 0.36 to 0.54; P < .001). Conclusions and Relevance Compared with minimal suctioning, enhanced suctioning after ED discharge with bronchiolitis did not alter the disease course because there were no group differences in revisits or feeding and sleeping adequacy. Minimal suctioning resulted in higher use of nonassigned suctioning devices and lower parental satisfaction with the assigned device. Trial Registration ClinicalTrials.gov Identifier: NCT03361371.
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Affiliation(s)
- Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Allan L. Coates
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Judy Sweeney
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maggie Rumantir
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Amy C. Plint
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Naveen Poonai
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Patricia C. Parkin
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Diane Soares
- Department of Respiratory Therapy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Xie J, Kuppermann N, Florin TA, Tancredi DJ, Funk AL, Kim K, Salvadori MI, Yock-Corrales A, Shah NP, Breslin KA, Chaudhari PP, Bergmann KR, Ahmad FA, Nebhrajani JR, Mintegi S, Gangoiti I, Plint AC, Avva UR, Gardiner MA, Malley R, Finkelstein Y, Dalziel SR, Bhatt M, Kannikeswaran N, Caperell K, Campos C, Sabhaney VJ, Chong SL, Lunoe MM, Rogers AJ, Becker SM, Borland ML, Sartori LF, Pavlicich V, Rino PB, Morrison AK, Neuman MI, Poonai N, Simon NJE, Kam AJ, Kwok MY, Morris CR, Palumbo L, Ambroggio L, Navanandan N, Eckerle M, Klassen TP, Payne DC, Cherry JC, Waseem M, Dixon AC, Ferre IB, Freedman SB. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children. Open Forum Infect Dis 2023; 10:ofad485. [PMID: 37869403 PMCID: PMC10588618 DOI: 10.1093/ofid/ofad485] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. Methods We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. Results We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Conclusions Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
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Affiliation(s)
| | - Nathan Kuppermann
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Todd A Florin
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Daniel J Tancredi
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Anna L Funk
- University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Nipam P Shah
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Fahd A Ahmad
- Washington University School of Medicine, St.Louis, Missouri, USA
| | | | - Santiago Mintegi
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Amy C Plint
- University of Ottawa, Ottawa, Ontario, Canada
| | - Usha R Avva
- Montefiore-Nyack Hospital, Nyack, NewYork, New York, USA
| | | | | | | | | | - Maala Bhatt
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Carmen Campos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Shu-Ling Chong
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Maren M Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah M Becker
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Laura F Sartori
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Pedro B Rino
- Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” RIDEPLA, Buenos Aires, Argentina
| | | | | | - Naveen Poonai
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Norma-Jean E Simon
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - April J Kam
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maria Y Kwok
- Columbia University Irving Medical Center, NewYork, New York, USA
| | - Claudia R Morris
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Palumbo
- ASST Spedali Civili di Brescia—Pronto Soccorso Pediatrico, Brescia, Italy
| | | | | | - Michelle Eckerle
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Levine M, Beuhler M, Brent J, Finkelstein Y. Response to Ok S-H, Wiedmer SK, Sohn J-T. Comment on "Lipid emulsion therapy during management of the critically-ill poisoned patient: a prospective cohort study". Clin Toxicol (Phila) 2023; 61:711-712. [PMID: 37988120 DOI: 10.1080/15563650.2023.2276669] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
| | - Michael Beuhler
- NC Poison Control System - North Carolina Poison Control System, Charlotte, NC (USA)
| | - Jeffrey Brent
- Department of Medicine, University of CO Anschutz Medical Campus School of Medicine, Denver, CO (USA)
| | - Yaron Finkelstein
- Department of Emergency Medicine London, Hospital for Sick Children Toronto, ON, Canada
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13
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Levine M, Brent J, Wiegand T, Maguire B, Cohen N, Vaerrier D, Beuhler M, Leikin JB, Ganetsky M, Stellpflug S, Ruha AM, Carey J, Geib AJ, Cao DJ, Kleinschmidt K, Vohra R, Riley BD, Moore P, Schwarz E, Neavyn M, Rusyniak DE, Greene S, Nogar J, Manini A, Wermuth M, Pizon A, Hendrickson RG, Griswold M, Aldy K, Wax P, Spyres MB, Campleman S, Macdonald E, Finkelstein Y. Lipid emulsion therapy during management of the critically-ill poisoned patient: a prospective cohort study. Clin Toxicol (Phila) 2023; 61:584-590. [PMID: 37655788 DOI: 10.1080/15563650.2023.2248372] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Despite conflicting data, intravenous lipid emulsion has emerged as a potential antidote. The "lipid sink" theory suggests that following intravenous administration of lipid, lipophilic drugs are sequestered in the vascular compartment, thereby reducing their tissue concentrations. This study sought to determine if survival is associated with the intoxicant's degree of lipophilicity. METHODS We reviewed all cases in the Toxicology Investigators Consortium's lipid sub-registry between May 2012 through December 2018. Information collected included demographics, exposure circumstances, clinical course, management, disposition, and outcome. The primary outcome was survival after lipid emulsion therapy. Survival was stratified by the log of the intoxicant's octanol-water partition coefficient. We also assessed the association between intoxicant lipophilicity and an increase in systolic blood pressure after lipid emulsion administration. RESULTS We identified 134 patients, including 81 (60.4%) females. The median age was 40 years (interquartile range 21-75). One hundred and eight (80.6%) patients survived, including 45 (33.6%) with cardiac arrest during their intoxication. Eighty-two (61.2%) were hypotensive, and 98 (73.1%) received mechanical ventilation. There was no relationship between survival and the log of the partition coefficient of the intoxicant on linear analysis (P = 0.89) or polynomial model (P = 0.10). Systolic blood pressure increased in both groups. The median (interquartile range) systolic blood pressure before lipid administration was 68 (60-78) mmHg for those intoxicants with a log partition coefficient < 3.6 compared with 89 (76-104) mmHg after lipid administration. Among those drugs with a log partition coefficient > 3.6, the median (interquartile range) was 69 (60-84) mmHg before lipid and 89 (80-96) mmHg after lipid administration. CONCLUSION Most patients in this cohort survived. Lipophilicity was not correlated with survival or the observed changes in blood pressure. The study did not address the efficacy of lipid emulsion.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
| | | | - Timothy Wiegand
- Department of Emergency Medicine, Division of Medical Toxicology, University of Rochester, Rochester, NY, USA
| | - Bryan Maguire
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Neta Cohen
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David Vaerrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Jerrold B Leikin
- Division of Environmental and Occupational Health Science and the Occupational and Environmental Medicine Service of UI Health, University of Illinois Chicago, Chicago, IL, USA
| | - Michael Ganetsky
- Department of Emergency Medicine, Division of Medical Toxicology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samuel Stellpflug
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, AZ, USA
| | - Jennifer Carey
- Department of Emergency Medicine, University of Massachusetts, Worchester, MA, USA
| | | | - Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kurt Kleinschmidt
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rais Vohra
- Department of Emergency Medicine, Division of Medical Toxicology, University of California San Francisco-Fresno Medical Center, Fresno, CA, USA
| | - Brad D Riley
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Phillip Moore
- Department of Emergency Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Evan Schwarz
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University, St. Louis, MO, USA
| | - Mark Neavyn
- Department of Emergency Medicine, Hartford Hospital, Hartford, CT, USA
| | - Daniel E Rusyniak
- Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Spencer Greene
- Department of Emergency Medicine, HCA Houston Healthcare - Kingwood, University of Houston College of Medicine, Houston, TX, USA
| | - Joshua Nogar
- Department of Emergency Medicine, North Shore University, Manhasset, NY, USA
| | - Alex Manini
- Department of Emergency Medicine, Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY, USA
| | - Mary Wermuth
- Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony Pizon
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health Science University, Portland, OR, USA
| | - Matthew Griswold
- Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Paul Wax
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Meghan Beth Spyres
- Department of Medical Toxicology, Banner University Medical Center, Phoenix, AZ, USA
| | | | - Erin Macdonald
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yaron Finkelstein
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Cohen N, Mathew M, Brent J, Wax P, Davis AL, Obilom C, Burns MM, Canning J, Baumgartner K, Koons AL, Wiegand TJ, Judge B, Hoyte C, Chenoweth JA, Froberg B, Farrar H, Carey JL, Hendrickson RG, Hodgman M, Caravati EM, Christian MR, Wolk BJ, Seifert SA, Bentur Y, Levine M, Farrugia LA, Vearrier D, Minns AB, Kennedy JM, Kirschner RI, Aldy K, Schuh S, Campleman S, Li S, Myran DT, Feng L, Freedman SB, Finkelstein Y. Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry. Clin Toxicol (Phila) 2023; 61:591-598. [PMID: 37603042 DOI: 10.1080/15563650.2023.2238121] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. RESULTS One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; P < 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9-15.9; P = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than >10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2-221.2; P < 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6-6.7). CONCLUSIONS Severe outcomes occurred for different reasons and were largely associated with the patient's age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.
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Affiliation(s)
- Neta Cohen
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mathew Mathew
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Toxicology Associates, Littleton, USA
| | - Paul Wax
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Adrienne L Davis
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Cherie Obilom
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joshua Canning
- Department of Medical Toxicology, Banner - University Medical Center, Phoenix, AZ, USA
| | - Kevin Baumgartner
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew L Koons
- Department of Emergency Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | - Timothy J Wiegand
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bryan Judge
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - James A Chenoweth
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA, USA
| | - Blake Froberg
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henry Farrar
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Michael Hodgman
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA
| | - E Martin Caravati
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Brian J Wolk
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Steven A Seifert
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Yedidia Bentur
- Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Levine
- Department of Emergency Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lynn A Farrugia
- UF Health Shands Hospital, University of Florida College of Medicine, Gainesville, FL, USA
| | - David Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alicia B Minns
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA
| | - Joseph M Kennedy
- Department of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | | | - Kim Aldy
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Suzanne Schuh
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | - Shao Li
- American College of Medical Toxicology, Phoenix, AZ, USA
| | | | - Lisa Feng
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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15
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Johnson MD, Barney BJ, Rower JE, Finkelstein Y, Zorc JJ. Intravenous Magnesium: Prompt Use for Asthma in Children Treated in the Emergency Department (IMPACT-ED): Protocol for a Multicenter Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48302. [PMID: 37459153 PMCID: PMC10391520 DOI: 10.2196/48302] [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: 04/18/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Children managed for asthma in an emergency department (ED) may be less likely to be hospitalized if they receive intravenous magnesium sulfate (IVMg). Asthma guidelines recommend IVMg for severely sick children but note a lack of evidence to support this recommendation. All previous trials of IVMg in children with asthma have been too small to answer whether IVMg is effective and safe. A few major questions remain about IVMg. First, it has not been tested early in the course of ED treatment, when the impact on hospitalization would be greatest. Second, the clinical impact of hypotension, a known adverse effect of IVMg, has not been well characterized in previous research. Third, no trials have compared different IVMg doses or serial serum magnesium (total and ionized) concentrations to optimize dosing, so the most effective dose is unknown. A large, conclusive, randomized, placebo-controlled clinical trial of IVMg might be challenging due to the need to enroll and complete study procedures quickly, a lack of understanding of blood pressure changes after IVMg, and a lack of pharmacologic information to guide the optimal doses of IVMg to be tested. Therefore, a pilot study to inform the above gaps is warranted before conducting a definitive trial. OBJECTIVE The objectives of this study are to (1) demonstrate the feasibility of enrolling children with severe acute asthma in the ED in a multicenter, randomized controlled trial of a placebo, low-dose IVMg, or high-dose IVMg; (2) demonstrate the feasibility of timely delivery of study medication, assessment of blood pressure, and evaluation of adverse events in a standardized protocol; and (3) externally validate a previously constructed pharmacokinetic model and develop a combined pharmacokinetic/pharmacodynamic model for IVMg using magnesium (total and ionized) serum concentrations and their correlation with measures of efficacy and safety. METHODS This pilot trial tests procedures and gathers information to plan a definitive trial. The pilot trial will enroll as many as 90 children across 3 sites, randomize each child to 1 of 3 study arms, measure blood pressure frequently, and collect 3 blood samples from each participant with corresponding clinical asthma scores. RESULTS The project was funded by the National Heart, Lung, and Blood Institute (1 R34HL152047-2) in March 2022. Enrollment began in September 2022, and 43 children have been enrolled as of April 2023. We will submit the results for publication in late 2023. CONCLUSIONS The results of this study will guide the planning of a large, definitive, multicenter trial powered to evaluate if IVMg reduces hospitalization. Blood pressure measurements will inform a monitoring plan for the larger trial, and blood samples and asthma scores will be used to validate pharmacologic models to select the optimal dose of IVMg to be evaluated in the definitive trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05166811; https://clinicaltrials.gov/ct2/show/NCT05166811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48302.
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Affiliation(s)
- Michael D Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Bradley J Barney
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Joseph E Rower
- Department of Pharmacology and Toxicology, University of Utah College of Pharmacy, Salt Lake City, UT, United States
| | - Yaron Finkelstein
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joseph J Zorc
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
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16
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Qiu Y, Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Poonai N, Schuh S, Finkelstein Y, Xie J, Lee BE, Chui L, Pang X, On Behalf Of The Pediatric Emergency Research Canada Probiotic Regimen For Outpatient Gastroenteritis Utility Of Treatment Progut Trial Group. Significantly Longer Shedding of Norovirus Compared to Rotavirus and Adenovirus in Children with Acute Gastroenteritis. Viruses 2023; 15:1541. [PMID: 37515227 PMCID: PMC10386448 DOI: 10.3390/v15071541] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Worldwide, acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children under 5 years of age. Viruses, including norovirus, rotavirus, and enteric adenovirus, are the leading causes of pediatric AGE. In this prospective cohort study, we investigated the viral load and duration of shedding of norovirus, rotavirus, and adenovirus in stool samples collected from 173 children (median age: 15 months) with AGE who presented to emergency departments (EDs) across Canada on Day 0 (day of enrollment), and 5 and 28 days after enrollment. Quantitative RT-qPCR was performed to assess the viral load. On Day 0, norovirus viral load was significantly lower compared to that of rotavirus and adenovirus (p < 0.001). However, on Days 5 and 28, the viral load of norovirus was higher than that of adenovirus and rotavirus (p < 0.05). On Day 28, norovirus was detected in 70% (35/50) of children who submitted stool specimens, while rotavirus and adenovirus were detected in 52.4% (11/24) and 13.6% (3/22) of children (p < 0.001), respectively. Overall, in stool samples of children with AGE who presented to EDs, rotavirus and adenovirus had higher viral loads at presentation compared to norovirus; however, norovirus was shed in stool for the longest duration.
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Affiliation(s)
- Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Sarah Williamson-Urquhart
- Paediatric Emergency Research Team, Alberta Children's Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Serge Gouin
- Division of Paediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, London, ON N6A 5W9, Canada
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Alberta Precision Laboratory, Public Health Laboratory, Edmonton, AB T6G 2J2, Canada
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17
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Simone L, Zemek R, Roland D, Lyttle MD, Craig S, Dalziel SR, Gravel J, Finkelstein Y, Curtis S, Freedman SB, Plint AC, Schuh S. International practice patterns of IV magnesium in paediatric acute asthma. Emerg Med J 2023; 40:200-201. [PMID: 36344238 DOI: 10.1136/emermed-2022-212642] [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] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Laura Simone
- Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Damian Roland
- Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
| | - Simon Craig
- Division of Pediatric Emergency Medicine, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Medicine, Starship Children's Hospital, Auckland, New Zealand
| | - Jocelyn Gravel
- Department of Pediatrics, CHU SainteJustine, Montreal, Québec, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Curtis
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy C Plint
- Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Rached-d'Astous S, Finkelstein Y, Bailey B, Marquis C, Lebel D, Desjardins MP, Trottier ED. Intranasal ketamine for procedural sedation in children: An open-label multicenter clinical trial. Am J Emerg Med 2023; 67:10-16. [PMID: 36774905 DOI: 10.1016/j.ajem.2023.01.046] [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: 06/21/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are limited options for pain and distress management in children undergoing minor procedures, without the burden of an intravenous line insertion. Prior to this study, we conducted a dose-escalation study and identified 6 mg/kg as a potentially optimal initial dose of intranasal ketamine. OBJECTIVE To assess the efficacy and safety of intranasal ketamine at a dose of 6 mg/kg for procedural sedation to repair lacerations with sutures in children in the emergency department. METHODS We conducted a single-arm, open-label multicenter clinical trial for intranasal ketamine for laceration repair with sutures in children aged 1 to 12 years. A convenience sample of 30 patients received 6 mg/kg of intranasal ketamine for their procedural sedation. The primary outcome was the proportion (95% CI) of patients who achieved an effective procedural sedation. RESULTS We recruited 30 patients from April 2018 to December 2019 in two pediatric emergency departments in Canada. Lacerations repaired were mostly facial in 21(70%) patients and longer than 2 cm in 20 (67%) patients. Sedation was effective in 18/30 (60% [95% CI 45, 80]) children and was suboptimal in 5 (17%) patients but procedure was completed in them with minimal difficulties. Sedation was poor in the remaining 7 (23%) patients, with 3 (10%) of them required additional sedative agents. No serious adverse events were reported. CONCLUSIONS Using a single dose of 6 mg/kg of intranasal Ketamine for laceration repair led to successful sedation in 60% of patients according to our a priori definition. An additional 17% of patients were considered suboptimal, but their procedure was still completed with minimal difficulty. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03053947).
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Affiliation(s)
- Soha Rached-d'Astous
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Benoit Bailey
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Christopher Marquis
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Denis Lebel
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Marie-Pier Desjardins
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Evelyne D Trottier
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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19
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Myran DT, Tanuseputro P, Auger N, Konikoff L, Talarico R, Finkelstein Y. Pediatric Hospitalizations for Unintentional Cannabis Poisonings and All-Cause Poisonings Associated With Edible Cannabis Product Legalization and Sales in Canada. JAMA Health Forum 2023; 4:e225041. [PMID: 36637814 PMCID: PMC9857209 DOI: 10.1001/jamahealthforum.2022.5041] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Importance Canada legalized cannabis in October 2018 but initially prohibited the sale of edibles (eg, prepackaged candies). Starting in January 2020, some provinces permitted the sale of commercial cannabis edibles. The association of legalizing cannabis edibles with unintentional pediatric poisonings is uncertain. Objective To evaluate changes in proportions of all-cause hospitalizations for poisoning due to cannabis in children during 3 legalization policy periods in Canada's 4 most populous provinces (including 3.4 million children aged 0-9 years). Design, Setting, and Participants This repeated cross-sectional study included all hospitalizations in children aged 0 to 9 years in Ontario, Alberta, British Columbia, and Quebec between January 1, 2015, and September 30, 2021. Exposures Prelegalization (January 2015 to September 2018); period 1, in which dried flower only was legalized in all provinces (October 2018 to December 2019); and period 2, in which edibles were legalized in 3 provinces (exposed provinces) and restricted in 1 province (control province) (January 2020 to September 2021). Main Outcomes and Measures The primary outcome was the proportion of hospitalizations due to cannabis poisoning out of all-cause poisoning hospitalizations. Data analysis was performed using descriptive statistics and Poisson regression models. Results During the 7-year study period, there were 581 pediatric hospitalizations for cannabis poisoning (313 [53.9%] boys; 268 [46.1%] girls; mean [SD] age, 3.6 [2.5] years) and 4406 hospitalizations for all-cause poisonings. Of all-cause poisoning hospitalizations, the rate per 1000 due to cannabis poisoning before legalization was 57.42 in the exposed provinces and 38.50 in the control province. During period 1, the rate per 1000 poisoning hospitalizations increased to 149.71 in the exposed provinces (incidence rate ratio [IRR], 2.55; 95% CI, 1.88-3.46) and to 117.52 in the control province (IRR, 3.05; 95% CI, 1.82-5.11). During period 2, the rate per 1000 poisoning hospitalizations due to cannabis more than doubled to 318.04 in the exposed provinces (IRR, 2.16; 95% CI, 1.68-2.80) but remained similar at 137.93 in the control province (IRR, 1.18; 95% CI, 0.71-1.97). Conclusions and Relevance This cross-sectional study found that following cannabis legalization, provinces that permitted edible cannabis sales experienced much larger increases in hospitalizations for unintentional pediatric poisonings than the province that prohibited cannabis edibles. In provinces with legal edibles, approximately one-third of pediatric hospitalizations for poisonings were due to cannabis. These findings suggest that restricting the sale of legal commercial edibles may be key to preventing pediatric poisonings after recreational cannabis legalization.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada,ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada,ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie Auger
- University of Montreal Hospital Centre, Montreal, Quebec, Canada,Institut national de santé publique du Quebec, Montreal, Quebec, Canada,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lauren Konikoff
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada,Departments of Paediatrics and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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20
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Lirette MP, Kuppermann N, Finkelstein Y, Zemek R, Plint AC, Florin TA, Babl FE, Dalziel S, Freedman S, Roland D, Lyttle MD, Schnadower D, Steele D, Fernandes RM, Stephens D, Kharbanda A, Johnson DW, Macias C, Benito J, Schuh S. International variation in evidence-based emergency department management of bronchiolitis: a retrospective cohort study. BMJ Open 2022; 12:e059784. [PMID: 36600373 PMCID: PMC9730363 DOI: 10.1136/bmjopen-2021-059784] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the international variation in the use of evidence-based management (EBM) in bronchiolitis. We hypothesised that management consistent with full-EBM practices is associated with the research network of care, adjusted for patient-level characteristics. Secondary objectives were to determine the association between full-EBM and (1) hospitalisation and (2) emergency department (ED) revisits resulting in hospitalisation within 21 days. DESIGN A secondary analysis of a retrospective cohort study. SETTING 38 paediatric EDs belonging to the Paediatric Emergency Research Network in Canada, USA, Australia/New Zealand UK/Ireland and Spain/Portugal. PATIENTS Otherwise healthy infants 2-11 months old diagnosed with bronchiolitis between 1 January 2013 and 31 December, 2013. OUTCOME MEASURES Primary outcome was management consistent with full-EBM, that is, no bronchodilators/corticosteroids/antibiotics, no chest radiography or laboratory testing. Secondary outcomes included hospitalisations during the index and subsequent ED visits. RESULTS 1137/2356 (48.3%) infants received full-EBM (ranging from 13.2% in Spain/Portugal to 72.3% in UK/Ireland). Compared with the UK/Ireland, the adjusted ORs (aOR) of full-EBM receipt were lower in Spain/Portugal (aOR 0.08, 95% CI 0.02 to 0.29), Canada (aOR 0.13 (95% CI 0.06 to 0.31) and USA (aOR 0.16 (95% CI 0.07 to 0.35). EBM was less likely in infants with dehydration (aOR 0.49 (95% CI 0.33 to 0.71)), chest retractions (aOR 0.69 (95% CI 0.52 to 0.91)) and nasal flaring (aOR 0.69 (95% CI 0.52 to 0.92)). EBM was associated with reduced odds of hospitalisation at the index visit (aOR 0.77 (95% CI 0.60 to 0.98)) but not at revisits (aOR 1.17 (95% CI 0.74 to 1.85)). CONCLUSIONS Infants with bronchiolitis frequently do not receive full-EBM ED management, particularly those outside of the UK/Ireland. Furthermore, there is marked variation in full-EBM between paediatric emergency networks, and full-EBM delivery is associated with lower likelihood of hospitalisation. Given the global bronchiolitis burden, international ED-focused deimplementation of non-indicated interventions to enhance EBM is needed.
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Affiliation(s)
- Marie-Pier Lirette
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kuppermann
- The Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
- University of California Davis Health System, Sacramento, California, USA
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Roger Zemek
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Todd Adam Florin
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Franz E Babl
- Emergency Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne/The Royal Children's Hospital CICH, Parkville, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Stephen Freedman
- Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, UK
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dale Steele
- Pediatric Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Departments of Emergency Medicine, Pediatrics and Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa Instituto de Medicina Molecular, Lisboa, Portugal
| | - Derek Stephens
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anupam Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - David W Johnson
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Charles Macias
- Division of Pediatric Emergency Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Suzanne Schuh
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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21
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Levine M, Brent J, Maguire B, Cohen N, Wiegand T, Vearrier D, Beuhler M, Leikin J, Wax P, Finkelstein Y. 106 Lipid Emulsion Therapy During Resuscitation of the Critically-Ill Poisoned Patient: A Prospective Cohort Study. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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22
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Upton JEM, Hoang JA, Leon-Ponte M, Finkelstein Y, Du YJ, Adeli K, Eiwegger T, Grunebaum E, Vadas P. Platelet-activating factor acetylhydrolase is a biomarker of severe anaphylaxis in children. Allergy 2022; 77:2665-2676. [PMID: 35396721 DOI: 10.1111/all.15308] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 10/13/2021] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is limited ability to predict the severity of allergic reactions in children. Data derived predominantly from adults have implicated the platelet-activating factor pathway as a potential contributor to severe anaphylaxis. In this study, we sought to prospectively assess involvement of key components of the platelet-activating factor pathway in pediatric patients with anaphylaxis. METHODS Forty-six pediatric patients (<18 years) presenting with acute anaphylaxis were assessed. Anaphylaxis severity was graded and serum anaphylaxis markers were measured acutely and in 36 children who returned for follow-up >4 weeks after their acute presentation. These markers were compared with pediatric laboratory reference sera. RESULTS Severe anaphylaxis was experienced by 12/46 (26%) and mild-moderate anaphylaxis in 34/46 (74%) children. Platelet-activating factor acetylhydrolase (PAF-AH) activity was inversely associated with severe anaphylaxis: 9/12 children with severe anaphylaxis had reduced PAF-AH activity as compared with 14/34 with mild-moderate anaphylaxis (p < .05). Furthermore, 3/3 children who required intensive care had markedly reduced mean PAF-AH (nmol/ml/min) (13.73, 95%CI: 7.42-20.03) versus 20/23 who required ward/emergency department care (17.81, 95%CI: 16.80-18.83; p < .05). In children with anaphylaxis, PAF-AH during acute anaphylaxis was unchanged relative to the child's basal levels (mean, 17.26, 95%CI: 16.10-18.42 vs 17.50, 95%CI: 16.21-18.78, p = .63) and was lower than healthy pediatric controls (mean 19.21; 95%CI:18.21-20.21; p < .05). CONCLUSION Decreased serum PAF-AH activity is a biomarker of severe anaphylaxis. Levels of this enzyme do not change from basal levels during acute anaphylaxis. Our results show that PAF-AH is a biomarker of anaphylaxis severity in children. This key regulatory enzyme may modulate susceptibility to severe anaphylaxis.
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Affiliation(s)
- Julia E M Upton
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medicine, Division of Clinical Immunology and Allergy, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Hoang
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Matilde Leon-Ponte
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yue Jennifer Du
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Khosrow Adeli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Eiwegger
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Health Sciences, University Hospital St. Poelten, Krems, Austria
| | - Eyal Grunebaum
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Vadas
- Department of Medicine, Division of Clinical Immunology and Allergy, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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23
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Affiliation(s)
| | | | - Nathalie Auger
- University of Montreal Hospital Centre, Montreal, QC, Canada
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24
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Freedman SB, Finkelstein Y, Pang XL, Chui L, Tarr PI, VanBuren JM, Olsen C, Lee BE, Hall-Moore CA, Sapien R, O’Connell K, Levine AC, Poonai N, Roskind C, Schuh S, Rogers A, Bhatt S, Gouin S, Mahajan P, Vance C, Hurley K, Powell EC, Farion KJ, Schnadower D. Pathogen-Specific Effects of Probiotics in Children With Acute Gastroenteritis Seeking Emergency Care: A Randomized Trial. Clin Infect Dis 2022; 75:55-64. [PMID: 34596225 PMCID: PMC9402642 DOI: 10.1093/cid/ciab876] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. METHODS Analysis of patient-level data from 2 multicenter randomized, placebo controlled trials conducted in pediatric emergency departments in Canada and the United States. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours and were symptomatic for <72 hours and <7 days in the Canadian and US studies, respectively. Participants received either placebo or a probiotic preparation (Canada-Lactobacillus rhamnosus R0011/Lactobacillus helveticus R0052; US-L. rhamnosus GG). The primary outcome was post-intervention moderate-to-severe disease (ie, ≥9 on the Modified Vesikari Scale [MVS] score). RESULTS Pathogens were identified in specimens from 59.3% of children (928/1565). No pathogen groups were less likely to experience an MVS score ≥9 based on treatment allocation (test for interaction = 0.35). No differences between groups were identified for adenovirus (adjusted relative risk [aRR]: 1.42; 95% confidence interval [CI]: .62, 3.23), norovirus (aRR: 0.98; 95% CI: .56, 1.74), rotavirus (aRR: 0.86; 95% CI: .43, 1.71) or bacteria (aRR: 1.19; 95% CI: .41, 3.43). At pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. Among adenovirus-infected children, those administered the L. rhamnosus R0011/L. helveticus R0052 product experienced fewer diarrheal episodes (aRR: 0.65; 95% CI: .47, .90). CONCLUSIONS Neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. The preponderance of evidence does not support the notion that there are pathogen specific benefits associated with probiotic use in children with acute gastroenteritis. CLINICAL TRIALS REGISTRATION NCT01773967 and NCT01853124.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Li Pang
- Alberta Precision Laboratories-Public Health Laboratory, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Alberta Precision Laboratories-Public Health Laboratory, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Women and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Carla A Hall-Moore
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Robert Sapien
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Karen O’Connell
- Departments of Pediatrics and Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Division of Emergency Medicine, Children’s National Hospital, Washington D.C., USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Hasbro Children’s Hospital and Brown University, Providence, Rhode Island, USA
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Cindy Roskind
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics. Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Prashant Mahajan
- Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl Vance
- Departments of Emergency Medicine and Pediatrics, UC Davis, School of Medicine, Sacramento, California, USA
| | - Katrina Hurley
- Department of Emergency Medicine, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth C Powell
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USAand
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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25
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Funk AL, Kuppermann N, Florin TA, Tancredi DJ, Xie J, Kim K, Finkelstein Y, Neuman MI, Salvadori MI, Yock-Corrales A, Breslin KA, Ambroggio L, Chaudhari PP, Bergmann KR, Gardiner MA, Nebhrajani JR, Campos C, Ahmad FA, Sartori LF, Navanandan N, Kannikeswaran N, Caperell K, Morris CR, Mintegi S, Gangoiti I, Sabhaney VJ, Plint AC, Klassen TP, Avva UR, Shah NP, Dixon AC, Lunoe MM, Becker SM, Rogers AJ, Pavlicich V, Dalziel SR, Payne DC, Malley R, Borland ML, Morrison AK, Bhatt M, Rino PB, Beneyto Ferre I, Eckerle M, Kam AJ, Chong SL, Palumbo L, Kwok MY, Cherry JC, Poonai N, Waseem M, Simon NJ, Freedman SB. Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Netw Open 2022; 5:e2223253. [PMID: 35867061 PMCID: PMC9308058 DOI: 10.1001/jamanetworkopen.2022.23253] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [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: 12/13/2022] Open
Abstract
IMPORTANCE Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. OBJECTIVES To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. EXPOSURE SARS-CoV-2 detected via nucleic acid testing. MAIN OUTCOMES AND MEASURES Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. RESULTS Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Kristen A Breslin
- Department of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Michael A Gardiner
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego
| | | | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nidhya Navanandan
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Children's Hospital of Michigan, Detroit
- Department of Pediatrics, Central Michigan University, Mt Pleasant
| | - Kerry Caperell
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, Norton Children's Hospital, Louisville, Kentucky
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Andrew C Dixon
- University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Maren M Lunoe
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah M Becker
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah
| | - Alexander J Rogers
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro B Rino
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan," RIDEPLA, Buenos Aires, Argentina
| | | | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - April J Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia-Pronto soccorso pediatrico, Brescia, Italy
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, New York, New York
| | - Norma-Jean Simon
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Myran D, Finkelstein Y. Wrong Study Window to Assess the Full Impacts of Legalization on Pediatric Cannabis Exposures. Pediatrics 2022; 150:188363. [PMID: 35765967 DOI: 10.1542/peds.2022-057638a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Newton AS, Prisnie K, Macdonald LA, Eltorki M, Finkelstein Y, Fitzpatrick E, Gagnon I, Greenfield B, Joubert GI, Katz LY, Lipman EL, Mater A, Plotnick LH, Porter R, Sawyer S, St John KA, Sukhera J, Szatmari P, Rasiah J, Steele M, Hall P, Thull-Freedman J, Taljaard M, Cappelli M, Clark SE, Cost KT, Round J, Cherry J, Monga S, Sareen J, Klassen TP, Freedman SB. An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:946-948. [PMID: 35772868 DOI: 10.1016/j.jaac.2022.04.001] [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] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.
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Affiliation(s)
| | - Kassi Prisnie
- Cumming School of Medicine, University of Calgary, Alberta
| | - Lee A Macdonald
- Planning and Performance, Alberta Health Services, Edmonton, Alberta
| | | | | | | | - Isabelle Gagnon
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec
| | - Brian Greenfield
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Gary I Joubert
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | | | | | - Ahmed Mater
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Laurie H Plotnick
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Robert Porter
- Memorial University of Newfoundland, St. John's, Newfoundland
| | - Scott Sawyer
- Rady Faculty of Health Sciences, Winnipeg, Manitoba
| | | | - Javeed Sukhera
- Institute of Living and Hartford Hospital, Hartford, Connecticut
| | - Peter Szatmari
- Hospital for Sick Children, University of Toronto, Ontario; The Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Margaret Steele
- Memorial University of Newfoundland, St. John's, Newfoundland
| | - Patricia Hall
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
| | - Mario Cappelli
- Ontario Centre of Excellence for Child & Youth Mental Health, Ottawa, Ontario
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia
| | - Katherine T Cost
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta
| | | | - Suneeta Monga
- Hospital for Sick Children, University of Toronto, Ontario
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Cohen N, Aldy K, Brent J, Wax P, Finkelstein Y. The authors reply - predictors of severe outcome following opioid intoxication in children. Clin Toxicol (Phila) 2022; 60:1084-1085. [PMID: 35735017 DOI: 10.1080/15563650.2022.2088380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Neta Cohen
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kim Aldy
- Southwestern School of Medicine, University of Texas, Dallas, TX, USA
| | - Jeffrey Brent
- Department of Internal Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Paul Wax
- Southwestern School of Medicine, University of Texas, Dallas, TX, USA
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Rasiah J, Freedman S, Macdonald L, Prisnie K, Eltorki M, Finkelstein Y, Hopkin G, Santana MJ, Thull-Freedman J, Stang A, Prebeg M, Gagnon IJ, Steele M, Mater A, Katz L, Greenfield B, Plotnick L, Monga S, Lipman EL, Wright B, Dimitropoulos G, Porter R, Hurley K, Al Hamarneh YN, Newton A. Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study. BMJ Open 2022; 12:e059689. [PMID: 35715176 PMCID: PMC9207895 DOI: 10.1136/bmjopen-2021-059689] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER NCT04902391.
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Affiliation(s)
- Jananee Rasiah
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen Freedman
- Departments of Pediatrics, Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, The Hospital for Sick Children, Calgary, Alberta, Canada
| | - Lee Macdonald
- Planning and Performance, Alberta Health Services, Calgary, Alberta, Canada
| | - Kassi Prisnie
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mohamed Eltorki
- Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Yaron Finkelstein
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Gareth Hopkin
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Trauma Department, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ahmed Mater
- Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laurence Katz
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ellen Louise Lipman
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bruce Wright
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Robert Porter
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Katrina Hurley
- Emergency Medicine Deparment, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Amanda Newton
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Horne RG, Freedman SB, Johnson-Henry KC, Pang XL, Lee BE, Farion KJ, Gouin S, Schuh S, Poonai N, Hurley KF, Finkelstein Y, Xie J, Williamson-Urquhart S, Chui L, Rossi L, Surette MG, Sherman PM. Intestinal Microbial Composition of Children in a Randomized Controlled Trial of Probiotics to Treat Acute Gastroenteritis. Front Cell Infect Microbiol 2022; 12:883163. [PMID: 35774405 PMCID: PMC9238408 DOI: 10.3389/fcimb.2022.883163] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Compositional analysis of the intestinal microbiome in pre-schoolers is understudied. Effects of probiotics on the gut microbiota were evaluated in children under 4-years-old presenting to an emergency department with acute gastroenteritis. Included were 70 study participants (n=32 placebo, n=38 probiotics) with stool specimens at baseline (day 0), day 5, and after a washout period (day 28). Microbiota composition and deduced functions were profiled using 16S ribosomal RNA sequencing and predictive metagenomics, respectively. Probiotics were detected at day 5 of administration but otherwise had no discernable effects, whereas detection of bacterial infection (P<0.001) and participant age (P<0.001) had the largest effects on microbiota composition, microbial diversity, and deduced bacterial functions. Participants under 1 year had lower bacterial diversity than older aged pre-schoolers; compositional changes of individual bacterial taxa were associated with maturation of the gut microbiota. Advances in age were associated with differences in gut microbiota composition and deduced microbial functions, which have the potential to impact health later in life.
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Affiliation(s)
- Rachael G. Horne
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Xiao-Li Pang
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Bonita E. Lee
- Women and Children’s Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ken J. Farion
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Serge Gouin
- Departments of Emergency Medicine and Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, London Children’s Hospital Health Science Centre, Department of Pediatrics, Western University, London, ON, Canada
| | - Katrina F. Hurley
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jianling Xie
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Sarah Williamson-Urquhart
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda Chui
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Laura Rossi
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Michael G. Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Philip M. Sherman
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- *Correspondence: Philip M. Sherman,
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Zhang EWJ, Davis A, Finkelstein Y, Rosenfield D. The effects of COVID-19 on poisonings in the paediatric emergency department. Paediatr Child Health 2022; 27:S4-S8. [PMID: 35620562 PMCID: PMC9126273 DOI: 10.1093/pch/pxab100] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/30/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives The purpose of this study is to describe the impact of the pandemic on poisoning in children under 18 years presenting to a tertiary care paediatric emergency department (ED) in Canada. Methods We utilized the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) surveillance data to identify children presenting to the Hospital for Sick Children for poisonings during two time periods: pre-pandemic (March 11 to December 31, 2018 and 2019) and pandemic (March 11 to December 31, 2020). Primary outcomes investigated the change in proportion for total poisonings, unintentional poisonings, recreational drug use, and intentional self-harm exposures over total ED visits. Secondarily, we examined the change in proportion of poisonings between age, sex, substance type, and admission requirement pre-pandemic versus during pandemic. Results The proportions significantly increased for total poisonings (122.5%), unintentional poisonings (127.8%), recreational drug use (160%), and intentional self-harm poisonings (104.2%) over total ED visits. The proportions over all poisoning cases also significantly increased for cannabis (44.3%), vaping (134.6%), other recreational drugs (54.5%), multi-substance use (29.3%), and admissions due to poisonings (44.3%) during the pandemic. Conclusion Despite an overall decrease in ED visits, there was a significant increase in poisoning presentations to our ED during the pandemic compared with pre-pandemic years. Our results will provide better insight into care delivery and public health interventions for paediatric poisonings.
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Affiliation(s)
| | - Adrienne Davis
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Zhang EWJ, Davis A, Finkelstein Y, Rosenfield D. Les effets de la COVID-19 sur les intoxications à l’urgence pédiatrique. Paediatr Child Health 2022; 27:S82-S87. [PMID: 36092297 PMCID: PMC9383995 DOI: 10.1093/pch/pxab108] [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: 07/30/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Objectifs Cette étude avait pour but de décrire l’impact de la pandémie sur les intoxications chez les enfants de moins de 18 ans s’étant présentés à un service d’urgence tertiaire pédiatrique du Canada. Méthodologie Nous avons utilisé les données de surveillance du Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT) pour identifier les enfants s’étant présentés à l’Hospital for Sick Children pour intoxication durant deux périodes: avant la pandémie (du 11 mars au 31 décembre 2018 et 2019) et durant la pandémie (du 11 mars au 31 décembre 2020). Les principaux paramètres d’évaluation étaient la variation par rapport au total des visites à l’urgence de la proportion des intoxications totales, des intoxications accidentelles, de l’usage de drogues récréatives et d’automutilation intentionnelle. Nous avons également examiné la variation entre avant et durant la pandémie de la proportion d’intoxications en fonction de l’âge, du sexe, du type de drogues et des exigences d’admission. Résultats La proportion par rapport au total des visites à l’urgence s’est significativement accrue pour ce qui est des intoxications totales (122,5 %), des intoxications accidentelles (127,8 %), de l’usage de drogues récréatives (160 %) et des intoxications intentionnelles (automutilation; 104,2 %). La proportion de tous les cas d’intoxication s’est aussi significativement accrue durant la pandémie pour ce qui est du cannabis (44,3 %), du vapotage (134,6 %), des autres drogues récréatives (54,5 %), de l’usage de plusieurs drogues (29,3 %) et des admissions pour intoxication (44,3 %). Conclusion Malgré une baisse généralisée des visites à l’urgence durant la pandémie, il y a eu une augmentation significative par rapport à avant la pandémie des présentations pour intoxication à notre salle d’urgence. Nos résultats permettront de mieux orienter la prestation des soins et les interventions de santé publique en matière d’intoxications pédiatriques.
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Affiliation(s)
| | - Adrienne Davis
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Cohen N, Test G, Pasternak Y, Singer-Harel D, Schneeweiss S, Ratnapalan S, Schuh S, Finkelstein Y. Opioids Safety in Pediatric Procedural Sedation with Ketamine. J Pediatr 2022; 243:146-151.e1. [PMID: 34921870 DOI: 10.1016/j.jpeds.2021.11.072] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/04/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effects of pre- and intraprocedural opioids on adverse events in children undergoing procedural sedation with ketamine in the emergency department (ED). STUDY DESIGN We conducted a retrospective cohort study of all children aged 0-18 years who underwent procedural sedation with intravenous ketamine alone, or in combination with an opioid, at a tertiary-care pediatric ED between June 1, 2018, and August 31, 2020. We explored predictors of serious adverse events (SAEs), desaturation or respiratory intervention, and vomiting. RESULTS Of 1164 included children (694 male, 59.6%; median age 5.0 years [IQR 2.0-8.0]), 80 (6.8%) vomited, 63 (5.4%) had a desaturation or required respiratory interventions, and 6 (0.5%) had SAEs. Pre- and intraprocedural opioids were not independent predictors of sedation-related adverse events. A concurrent respiratory illness (aOR 3.73; 95% CI 1.31-10.60, P = .01), dental procedure (aOR 3.05; 95% CI 1.25-7.21, P = .01), and a greater total ketamine dose (aOR 1.75; 95% CI 1.21-2.54, P = .003) were independent predictors of desaturation or respiratory interventions. A greater total ketamine dose (aOR 1.86; 95% CI 1.16-2.98, P = .01) and older age (aOR 1.15; 95% CI 1.07-1.24, P < .001), were independent predictors of vomiting. CONCLUSIONS Pre- and intraprocedural opioids do not increase the likelihood of sedation-related adverse events. SAEs are rare during pediatric procedural sedation with ketamine in the ED.
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Affiliation(s)
- Neta Cohen
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
| | - Gidon Test
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Yehonatan Pasternak
- Division of Clinical Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Dana Singer-Harel
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Suzan Schneeweiss
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada; Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada; Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Cohen N, Mathew M, Davis A, Brent J, Wax P, Schuh S, Freedman SB, Froberg B, Schwarz E, Canning J, Tortora L, Hoyte C, Koons AL, Burns MM, McFalls J, Wiegand TJ, Hendrickson RG, Judge B, Quang LS, Hodgman M, Chenoweth JA, Algren DA, Carey J, Caravati EM, Akpunonu P, Geib AJ, Seifert SA, Kazzi Z, Othong R, Greene SC, Holstege C, Tweet MS, Vearrier D, Pizon AF, Campleman SL, Li S, Aldy K, Finkelstein Y. Predictors of severe outcome following opioid intoxication in children. Clin Toxicol (Phila) 2022; 60:702-707. [PMID: 35333145 DOI: 10.1080/15563650.2022.2038188] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication. We explore predictors of severe outcome (i.e., intensive care unit [ICU] admission or in-hospital death) in children who presented to the Emergency Department with an opioid intoxication. METHODS In this prospective cohort study we collected data on all children (0-18 years) who presented with an opioid intoxication to the 50 medical centers in the US and two international centers affiliated with the Toxicology Investigators Consortium (ToxIC) of the American College of Medical Toxicology, from August 2017 through June 2020, and who received a bedside consultation by a medical toxicologist. We collected relevant demographic, clinical, management, disposition, and outcome data, and we conducted a multivariable logistic regression analysis to explore predictors of severe outcome. The primary outcome was a composite severe outcome endpoint, defined as ICU admission or in-hospital death. Covariates included sociodemographic, exposure and clinical characteristics. RESULTS Of the 165 (87 females, 52.7%) children with an opioid intoxication, 89 (53.9%) were admitted to ICU or died during hospitalization, and 76 did not meet these criteria. Seventy-four (44.8%) children were exposed to opioids prescribed to family members. Fentanyl exposure (adjusted OR [aOR] = 3.6, 95% CI: 1.0-11.6; p = 0.03) and age ≥10 years (aOR = 2.5, 95% CI: 1.2-4.8; p = 0.01) were independent predictors of severe outcome. CONCLUSIONS Children with an opioid toxicity that have been exposed to fentanyl and those aged ≥10 years had 3.6 and 2.5 higher odds of ICU admission or death, respectively, than those without these characteristics. Prevention efforts should target these risk factors to mitigate poor outcomes in children with an opioid intoxication.
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Affiliation(s)
- Neta Cohen
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Mathew Mathew
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Adrienne Davis
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Jeffrey Brent
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Paul Wax
- Southwestern School of Medicine, University of Texas, Dallas, TX, USA
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Stephen B Freedman
- Department of Paediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Blake Froberg
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Laura Tortora
- Banner - University Medical Centre, Phoenix, AZ, USA
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - Andrew L Koons
- Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | | | - Joshua McFalls
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Bryan Judge
- Spectrum Health - Michigan State University, Grand Rapids, MI, USA
| | - Lawrence S Quang
- Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Douglas A Algren
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jennifer Carey
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Ziad Kazzi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rittirak Othong
- Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | | | | | - David Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anthony F Pizon
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Shao Li
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Kim Aldy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yaron Finkelstein
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Finkelstein Y. Fission product isotope ratios as event characterization tools Part I: Particulate debris, isotopic activity ratios. KERNTECHNIK 2022. [DOI: 10.1515/kern-2001-0080] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The main goal of this work is to develop quantitatively reliable tools that can be used to identify the origin of a nuclear event, e. g. discriminate between a nuclear explosion and an accidental reactor release. A model has been developed, which takes into account the wide range of conditions and parameters, which may exist in connection with nuclear events. Using the model, specific isotope activity ratios are defined, promising to be effective in event characterization, while reducing the influence of various nuclear scenarios to a minimum. Besides, an attempt was made to quantify the concept of “short irradiation reactor” and to set its limits, as related to an event characterization method.
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Kornelsen E, Kuppermann N, Nishijima D, Ren LY, Rumantir M, Gill PJ, Finkelstein Y. Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis. Am J Emerg Med 2022; 55:103-110. [DOI: 10.1016/j.ajem.2022.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/27/2022] Open
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Myran DT, Cantor N, Finkelstein Y, Pugliese M, Guttmann A, Jesseman R, Tanuseputro P. Unintentional Pediatric Cannabis Exposures After Legalization of Recreational Cannabis in Canada. JAMA Netw Open 2022; 5:e2142521. [PMID: 34994796 PMCID: PMC8742190 DOI: 10.1001/jamanetworkopen.2021.42521] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines changes in emergency department visits and hospitalizations due to cannabis exposures among children after legalization of recreational cannabis in Canada.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nathan Cantor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael Pugliese
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
| | - Astrid Guttmann
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
| | - Rebecca Jesseman
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Funk AL, Florin TA, Kuppermann N, Tancredi DJ, Xie J, Kim K, Neuman MI, Ambroggio L, Plint AC, Mintegi S, Klassen TP, Salvadori MI, Malley R, Payne DC, Simon NJ, Yock-Corrales A, Nebhrajani JR, Chaudhari PP, Breslin KA, Finkelstein Y, Campos C, Bergmann KR, Bhatt M, Ahmad FA, Gardiner MA, Avva UR, Shah NP, Sartori LF, Sabhaney VJ, Caperell K, Navanandan N, Borland ML, Morris CR, Gangoiti I, Pavlicich V, Kannikeswaran N, Lunoe MM, Rino PB, Kam AJ, Cherry JC, Rogers AJ, Chong SL, Palumbo L, Angelats CM, Morrison AK, Kwok MY, Becker SM, Dixon AC, Poonai N, Eckerle M, Wassem M, Dalziel SR, Freedman SB. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open 2022; 5:e2142322. [PMID: 35015063 PMCID: PMC8753506 DOI: 10.1001/jamanetworkopen.2021.42322] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. EXPOSURES Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. MAIN OUTCOMES AND MEASURES Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. RESULTS Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). CONCLUSIONS AND RELEVANCE In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
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Affiliation(s)
- Anna L. Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A. Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark I. Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Amy C. Plint
- Children’s Hospital of Eastern Ontario, Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Richard Malley
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C. Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma-Jean Simon
- Data Analytics and Reporting, Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carmen Campos
- Hospital Universitario Miguel Servet, Pediatric Emergency Department, Zaragoza, Spain
| | - Kelly R. Bergmann
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Maala Bhatt
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fahd A. Ahmad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael A. Gardiner
- Rady Children’s Hospital, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Usha R. Avva
- School of Medicine Hackensack Meridian Health, Hackensack, New Jersey
| | - Nipam P. Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Laura F. Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vikram J. Sabhaney
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Caperell
- Norton Children’s Hospital, University of Louisville, Louisville, Kentucky
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Meredith L. Borland
- Perth Children’s Hospital, Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | | | - Maren M. Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro B. Rino
- Hospital de Pediatría “Prof Dr Juan P. Garrahan”, RIDEPLA, Buenos Aires, Argentina
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jonathan C. Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | | | - Andrea K. Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maria Y. Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York
| | - Sarah M. Becker
- University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah
| | - Andrew C. Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Naveen Poonai
- Child Health Research Institute, Division of Paediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Freedman SB, Kuppermann N, Funk AL, Kim K, Xie J, Tancredi D, Dalziel SR, Neuman MI, Mintegi S, Plint AC, Gómez-Vargas J, Finkelstein Y, Ambroggio L, Klassen TP, Salvadori M, Malley R, Payne DC, Florin TA. Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments. Acad Pediatr 2022; 22:1200-1211. [PMID: 35462066 PMCID: PMC9023083 DOI: 10.1016/j.acap.2022.04.006] [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: 02/03/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We sought to determine if corticosteroid administration is associated with a SARS-CoV-2 nucleic acid test-positive result and to describe therapies administered to SARS-CoV-2 infected children. METHODS We collected cross-sectional data from participants recruited in 41 pediatric emergency departments (ED) in 10 countries between March 2020 and June 2021. Participants were <18 years old, had signs or symptoms of, or risk factors for acute SARS-CoV-2 infection, and had nucleic acid testing performed. To determine if SARS-CoV-2 test status was independently associated with corticosteroid administration, we used a multivariable conditional logistic regression model matched by study site to compare treatments administered based on SARS-CoV-2 test and disposition status. This analysis was repeated for the subgroup of study participants who were hospitalized. RESULTS 30.3% (3,121/10,315) of participants were SARS-CoV-2-positive. Although remdesivir was more commonly administered to SARS-CoV-2-positive children, use was infrequent (25/3120 [0.8%] vs 1/7188 [0.01%]; P = .001). Corticosteroid use was less common among SARS-CoV-2-positive children (219/3120 [7.0%] vs 759/7190 [10.6%]; P < .001). Among hospitalized children, there were no differences in provision of inotropes, respiratory support, chest drainage or extracorporeal membrane oxygenation between groups. Corticosteroid administration was associated with age, history of asthma, wheezing, study month, hospitalization and intensive care unit admission; it was not associated with a positive SARS-CoV-2 test result overall (aOR: 0.91; 95%CI: 0.74, 1.12) or among the subgroup of those hospitalized (aOR: 1.04; 95%CI: 0.75, 1.44). CONCLUSIONS Few disease-specific treatments are provided to SARS-CoV-2-positive children; clinical trials evaluating therapies in children are urgently needed.
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Affiliation(s)
- Stephen B. Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine (SB Freedman), University of Calgary, Calgary, Canada,Address correspondence to Stephen Freedman MDCM, MSc, Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics (N Kuppermann), University of California (UC), Davis School of Medicine, and UC Davis Health, Sacramento, Calif
| | - Anna L. Funk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Kelly Kim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Jianling Xie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada
| | - Daniel Tancredi
- Department of Pediatrics (D Tancredi), UC Davis School of Medicine, Sacramento, Calif
| | - Stuart R. Dalziel
- Departments of Surgery and Paediatrics, Child and Youth Health, The University of Auckland and Children's Emergency Department (SR Dalziel), Starship Children's Hospital, Auckland, New Zealand
| | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics (MI Neuman), Harvard Medical School, Boston, Mass
| | - Santiago Mintegi
- Pediatric Emergency Department (S Mintegi), Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine (AC Plint), University of Ottawa and Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jessica Gómez-Vargas
- Emergency Department (J Gómez-Vargas), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, CCSS, San José, Costa Rica
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics (Y Finkelstein), Hospital for Sick Children, Toronto, Canada
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics (L Ambroggio), University of Colorado, Denver, Colo
| | - Terry P. Klassen
- Children's Hospital Research Institute of Manitoba and Department of Pediatrics and Child Health (TP Klassen), University of Manitoba, Winnipeg, Canada
| | - Marina Salvadori
- Public Health Agency of Canada, Division of Infectious Diseases, Department of Pediatrics McGill University (M Salvadori), Montreal, Canada
| | - Richard Malley
- Division of Infectious Diseases (R Malley), Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Daniel C. Payne
- Centers for Disease Control and Prevention (DC Payne), Atlanta, United States
| | - Todd A. Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics (TA Florin), Northwestern University Feinberg School of Medicine, Chicago, Ill,Address correspondence to Todd Florin MD, MSCE, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, Il 60611
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Huntsman RJ, Kelly LE, Alcorn J, Appendino JP, Bélanger RE, Crooks B, Finkelstein Y, Gilpin A, Lewis E, Litalien C, Jacobs J, Moore-Hepburn C, Oberlander T, Rassekh SR, Repetski AE, Rieder MJ, Shackelford A, Siden H, Szafron M, 't Jong GW, Vaillancourt R. Améliorer la réglementation du cannabis médical au Canada pour mieux servir les patients pédiatriques. CMAJ 2021; 193:E1864-E1867. [PMID: 34872964 PMCID: PMC8648360 DOI: 10.1503/cmaj.202169-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Richard J Huntsman
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Lauren E Kelly
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Jane Alcorn
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Juan Pablo Appendino
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Richard E Bélanger
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont.
| | - Bruce Crooks
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Yaron Finkelstein
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Andrea Gilpin
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Evan Lewis
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Catherine Litalien
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Julia Jacobs
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Charlotte Moore-Hepburn
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Timothy Oberlander
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - S Rod Rassekh
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Alexander E Repetski
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Michael J Rieder
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Alan Shackelford
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Hal Siden
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Michael Szafron
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Geert W 't Jong
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
| | - Régis Vaillancourt
- Division de neurologie pédiatrique (Huntsman), Département de pédiatrie et Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), Université de la Saskatchewan, Saskatoon, Sask.; Consortium C4T (Canadian Childhood Cannabinoid Clinical Trial) (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); Centre George et Fay Yee pour l'innovation en soins de santé (Kelly), Institut de recherche de l'Hôpital pour enfants du Manitoba, Département de pédiatrie et de santé infantile, Université du Manitoba, Winnipeg, Man.; École de pharmacie et de nutrition (Alcorn) de l'Université de la Saskatchewan, Saskatoon, Sask.; Division de neurologie pédiatrique (Appendino, Jacobs), Département de pédiatrie et Institut de recherche de l'Hôpital pour enfants de l'Alberta (Appendino, Jacobs), Université de Calgary, Calgary, Alb.; Département de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Qc; Société canadienne de pédiatrie (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division d'hémato-oncologie pédiatrique (Crooks), Département de pédiatrie, Université Dalhousie, Halifax, N.-E.; Divisions de médecine d'urgence et de pharmacologie et toxicologie cliniques (Finkelstein), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Centre de formulations pédiatriques Goodman du Centre hospitalier universitaire Sainte-Justine (Gilpin, Litalien), Montréal, Qc; Centre de neurologie de Toronto (Lewis); Division de neurologie pédiatrique (Lewis), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore-Hepburn), Département de pédiatrie, Université de Toronto, Toronto, Ont.; Département de pédiatrie et École de santé des populations et de santé publique (Oberlander) et Division d'hémato-oncologie et de greffes de moelle osseuse pédiatriques (Rassekh), Département de pédiatrie, Université de la Colombie-Britannique, Vancouver, C.-B.; Division de pharmacologie pédiatrique (Rieder), Département de pédiatrie, Université Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver (Colorado); Division des soins palliatifs (Siden), Département de pédiatrie, Université de la Colombie-Britannique; Canuck Place (Siden), Children's Hospice, Vancouver, C.-B.; École de santé publique (Szafron), Université de la Saskatchewan, Saskatoon, Sask.; Départements de pédiatrie et de pharmacologie ('t Jong), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Hôpital pédiatrique de l'Est de l'Ontario (Vaillancourt), Ottawa, Ont
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Sander B, Finkelstein Y, Lu H, Nagamuthu C, Graves E, Ramsay LC, Kwong JC, Schuh S. Healthcare cost attributable to bronchiolitis: A population-based cohort study. PLoS One 2021; 16:e0260809. [PMID: 34855892 PMCID: PMC8639079 DOI: 10.1371/journal.pone.0260809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine 1-year attributable healthcare costs of bronchiolitis. METHODS Using a population-based matched cohort and incidence-based cost analysis approach, we identified infants <12 months old diagnosed in an emergency department (ED) or hospitalized with bronchiolitis between April 1, 2003 and March 31, 2014. We propensity-score matched infants with and without bronchiolitis on sex, age, income quintile, rurality, co-morbidities, gestational weeks, small-for-gestational-age status and pre-index healthcare cost deciles. We calculated mean attributable 1-year costs using a generalized estimating equation model and stratified costs by age, sex, income quintile, rurality, co-morbidities and prematurity. RESULTS We identified 58,375 infants with bronchiolitis (mean age 154±95 days, 61.3% males, 4.2% with comorbidities). Total 1-year mean bronchiolitis-attributable costs were $4,313 per patient (95%CI: $4,148-4,477), with $2,847 (95%CI: $2,712-2,982) spent on hospitalizations, $610 (95%CI: $594-627) on physician services, $562 (95%CI: $556-567)] on ED visits, $259 (95%CI: $222-297) on other healthcare costs and $35 ($27-42) on drugs. Attributable bronchiolitis costs were $2,765 (95%CI: $2735-2,794) vs $111 (95%CI: $102-121) in the initial 10 days post index date, $4,695 (95%CI: $4,589-4,800) vs $910 (95%CI: $847-973) in the initial 180 days and $1,158 (95%CI: $1,104-1213) vs $639 (95%CI: $599-679) during days 181-360. Mean 1-year bronchiolitis costs were higher in infants <3 months old [$5,536 (95%CI: $5,216-5,856)], those with co-morbidities [$17,530 (95%CI: $14,683-20,377)] and with low birthweight [$5,509 (95%CI: $4,927-6,091)]. CONCLUSIONS Compared to no bronchiolitis, bronchiolitis incurs five-time and two-time higher healthcare costs within the initial and subsequent six-months, respectively. Most expenses occur in the initial 10 days and relate to hospitalization.
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Affiliation(s)
- Beate Sander
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Yaron Finkelstein
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Institute, Division of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, Toronto, Ontario, Canada
| | | | | | - Lauren C. Ramsay
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C. Kwong
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Suzanne Schuh
- University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Institute, Division of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Cohen N, Schuh S, Finkelstein Y. Response to the comment on "pediatric cannabis intoxication trends in the pre and post-legalization era". Clin Toxicol (Phila) 2021; 60:545-546. [PMID: 34726131 DOI: 10.1080/15563650.2021.1996593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Neta Cohen
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Suzanne Schuh
- The Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,The Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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43
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Huntsman RJ, Kelly LE, Alcorn J, Appendino JP, Bélanger RE, Crooks B, Finkelstein Y, Gilpin A, Lewis E, Litalien C, Jacobs J, Moore-Hepburn C, Oberlander T, Rassekh SR, Repetski AE, Rieder MJ, Shackelford A, Siden H, Szafron M, 't Jong GW, Vaillancourt R. Improving the regulation of medical cannabis in Canada to better serve pediatric patients. CMAJ 2021; 193:E1596-E1599. [PMID: 34663604 PMCID: PMC8547246 DOI: 10.1503/cmaj.202169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont.
| | - Lauren E Kelly
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Jane Alcorn
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Juan Pablo Appendino
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Richard E Bélanger
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Bruce Crooks
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Yaron Finkelstein
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Andrea Gilpin
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Evan Lewis
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Catherine Litalien
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Julia Jacobs
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Charlotte Moore-Hepburn
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Timothy Oberlander
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - S Rod Rassekh
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Alexander E Repetski
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Michael J Rieder
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Alan Shackelford
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Hal Siden
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Michael Szafron
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Geert W 't Jong
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
| | - Régis Vaillancourt
- Division of Pediatric Neurology (Huntsman), Department of Pediatrics, and Cannabinoid Research Initiative of Saskatchewan (Huntsman, Alcorn, Szafron, Shackelford), University of Saskatchewan, Saskatoon, Sask.; Canadian Childhood Cannabinoid Clinical Trial (C4T) Consortium (Kelly, Crooks, Finkelstein, Gilpin, Oberlander, Rassekh, Repetski, Rieder, Vaillancourt); George and Fay Yee Centre for Health Care Innovation (Kelly), Children's Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Man.; College of Pharmacy and Nutrition (Alcorn), University of Saskatchewan, Saskatoon, Sask.; Division of Pediatric Neurology (Appendino, Jacobs), Department of Pediatrics, and Alberta Children's Hospital Research Institute (Appendino, Jacobs), University of Calgary, Calgary, Alta.; Départment de pédiatrie (Bélanger), Faculté de médecine, Université Laval, Québec, Que.; Canadian Paediatric Society (Bélanger, Moore-Hepburn, 't Jong), Ottawa, Ont.; Division of Paediatric Haematology/Oncology (Crooks), Department of Pediatrics, Dalhousie University, Halifax, NS; Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology (Finkelstein), Department of Pediatrics, University of Toronto, Toronto, Ont.; The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Sainte-Justine University Hospital Centre (Gilpin, Litalien), Montréal, Que.; Neurology Centre of Toronto (Lewis); Division of Pediatric Neurology (Lewis), Department of Pediatrics, University of Toronto, Toronto, Ont.; Départment de pédiatrie (Litalien), Faculté de médecine, Université de Montréal, Montréal, Que.; Division of Paediatric Medicine (Moore-Hepburn), Department of Paediatrics, University of Toronto, Toronto, Ont.; Department of Pediatrics and School of Population and Public Health (Oberlander), and Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC; Division of Pediatric Pharmacology (Rieder), Department of Pediatrics, University of Western Ontario, London, Ont.; Amarimed of Colorado (Shackelford), Denver, Colorado; Division of Palliative Care (Siden), Department of Pediatrics, University of British Columbia; Canuck Place (Siden), Children's Hospice, Vancouver, BC; School of Public Health (Szafron), University of Saskatchewan, Saskatoon, Sask.; Departments of Pediatrics and Pharmacology ('t Jong), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Children's Hospital of Eastern Ontario (Vaillancourt), Ottawa, Ont
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Finkelstein Y, Maguire B, Zemek R, Osmanlliu E, Kam AJ, Dixon A, Desai N, Sawyer S, Emsley J, Lynch T, Mater A, Schuh S, Rumantir M, Freedman SB. Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study. Pediatr Emerg Care 2021; 37:427-434. [PMID: 34074990 PMCID: PMC8327936 DOI: 10.1097/pec.0000000000002484] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes. METHODS This study is an interrupted-time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018-January 27, 2020), peripandemic (January 28, 2020-March 10, 2020), and early pandemic (March 11, 2020-April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns. RESULTS There were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [-58%; 95% confidence interval (CI), -63% to -51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32-1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01-1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45-1.56). Mental health-related visits in children declined in the early-pandemic period (in <10 years, -60%; 95% CI, -67% to -51%; in children ≥10 years: -56%; 95% CI, -63% to -47%) relative to the pre-COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change: -55%; 95% CI, -61% to -49%; P < 0.001). CONCLUSIONS After the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children's health and acute care needs.
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Affiliation(s)
- Yaron Finkelstein
- From the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology
| | - Bryan Maguire
- Biostatistical Design and Analysis team, The Hospital for Sick Children, University of Toronto, Toronto
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Montreal Children’s Hospital, McGill University, Montreal, Quebec
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario
| | - Andrew Dixon
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Neil Desai
- Division of Pediatric Emergency Medicine, British Columbia Children’s Hospital, Vancouver, British Columbia
| | - Scott Sawyer
- Department of Pediatrics and Emergency Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Jason Emsley
- Department of Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
| | - Tim Lynch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Schulich School of Medicine, Western University, London, Ontario
| | - Ahmed Mater
- Division Pediatric Emergency Medicine, Jim Pattison Children’s Hospital, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Maggie Rumantir
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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45
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Schuh S, Freedman SB, Zemek R, Plint AC, Johnson DW, Ducharme F, Gravel J, Thompson G, Curtis S, Stephens D, Coates AL, Black KJ, Beer D, Sweeney J, Rumantir M, Finkelstein Y. Association Between Intravenous Magnesium Therapy in the Emergency Department and Subsequent Hospitalization Among Pediatric Patients With Refractory Acute Asthma: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2117542. [PMID: 34279646 PMCID: PMC8290299 DOI: 10.1001/jamanetworkopen.2021.17542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/20/2022] Open
Abstract
IMPORTANCE Despite guidelines recommending administration of intravenous (IV) magnesium sulfate for refractory pediatric asthma, the number of asthma-related hospitalizations has remained stable, and IV magnesium therapy is independently associated with hospitalization. OBJECTIVE To examine the association between IV magnesium therapy administered in the emergency department (ED) and subsequent hospitalization among pediatric patients with refractory acute asthma after adjustment for patient-level variables. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of a double-blind randomized clinical trial of children with acute asthma treated from September 26, 2011, to November 19, 2019, at 7 Canadian tertiary care pediatric EDs was conducted between September and November 2020. In the randomized clinical trial, 816 otherwise healthy children aged 2 to 17 years with Pediatric Respiratory Assessment Measure (PRAM) scores of 5 points or higher after initial therapy with systemic corticosteroids and inhaled albuterol with ipratropium bromide were randomly assigned to 3 nebulized treatments of albuterol plus either magnesium sulfate or 5.5% saline placebo. EXPOSURES Intravenous magnesium sulfate therapy (40-75 mg/kg). MAIN OUTCOMES AND MEASURES The association between IV magnesium therapy in the ED and subsequent hospitalization for asthma was assessed using multivariable logistic regression analysis. Analyses were adjusted for year epoch at enrollment, receipt of IV magnesium, PRAM score after initial therapy and at ED disposition, age, sex, duration of respiratory distress, previous intensive care unit admission for asthma, hospitalizations for asthma within the past year, atopy, and receipt of oral corticosteroids within 48 hours before arrival in the ED, nebulized magnesium, and additional albuterol after inhaled magnesium or placebo, with site as a random effect. RESULTS Among the 816 participants, the median age was 5 years (interquartile range, 3-7 years), 517 (63.4%) were boys, and 364 (44.6%) were hospitalized. A total of 215 children (26.3%) received IV magnesium, and 190 (88.4%) of these children were hospitalized compared with 174 of 601 children (29.0%) who did not receive IV magnesium. Multivariable factors associated with hospitalization were IV magnesium receipt from 2011 to 2016 (odds ratio [OR], 22.67; 95% CI, 6.26-82.06; P < .001) and from 2017 to 2019 (OR, 4.19; 95% CI, 1.99-8.86; P < .001), use of additional albuterol (OR, 5.94; 95% CI, 3.52-10.01; P < .001), and increase in PRAM score at disposition (per 1-U increase: OR, 2.24; 95% CI, 1.89-2.65; P < .001). In children with a disposition PRAM score of 3 or lower, receipt of IV magnesium therapy was associated with hospitalization (OR, 8.52; 95% CI, 2.96-24.41; P < .001). CONCLUSIONS AND RELEVANCE After adjustment for patient-level characteristics, receipt of IV magnesium therapy after initial asthma treatment in the ED was associated with subsequent hospitalization. This association also existed among children with mild asthma at ED disposition. Evidence of a benefit of IV magnesium regarding hospitalization may clarify its use in the treatment of refractory pediatric asthma. TRIAL REGISTRATION ClinicalTrials.gov: NCT01429415.
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Affiliation(s)
- Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sick Kids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephen B. Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Emergency Medicine, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Amy C. Plint
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - David W. Johnson
- Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Emergency Medicine, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Physiology & Pharmacology, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Francine Ducharme
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Graham Thompson
- Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Curtis
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
- Department of Emergency Medicine, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Derek Stephens
- Department of Pediatrics, Clinical Research Services, Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allan L. Coates
- Division of Respiratory Medicine, Sick Kids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen J. Black
- Division of Pediatric Emergency Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darcy Beer
- Department of Pediatrics and Child Health, Division of Pediatric Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Judy Sweeney
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maggie Rumantir
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yaron Finkelstein
- Sick Kids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Cohen N, Galvis Blanco L, Davis A, Kahane A, Mathew M, Schuh S, Kestenbom I, Test G, Pasternak Y, Verstegen RHJ, Jung B, Maguire B, Rached d'Astous S, Rumantir M, Finkelstein Y. Pediatric cannabis intoxication trends in the pre and post-legalization era. Clin Toxicol (Phila) 2021; 60:53-58. [PMID: 34137352 DOI: 10.1080/15563650.2021.1939881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION On April 13, 2017, a bill to legalize cannabis was introduced to the Canadian Parliament and presented to the public. On October 17, 2018, Canada legalized recreational cannabis use. We assessed intoxication severity, reflected by ICU admission rates, risk factors and other characteristics in children who presented to the emergency department (ED) with cannabis intoxication, before and after legalization. METHODS A retrospective cohort study of children 0-18 years who presented to a pediatric ED between January 1, 2008 and December 31, 2019 with cannabis intoxication. The pre-legalization period was defined from January 1, 2008 to April 12, 2017 and the peri-post legalization period from April 13, 2017 to December 31, 2019. RESULTS We identified 298 patients; 232 (77.8%) presented in the pre legalization period and 66 (22.1%) in the peri-post legalization period; median age: 15.9 years (range: 11 months-17.99 years). A higher proportion of children were admitted to the ICU in the peri-post legalization period (13.6% vs. 4.7%, respectively; p = .02). While the median monthly number of cannabis-related presentations did not differ between the time periods (2.1 [IQR:1.9-2.5] in the pre legalization period vs. 1.7 [IQR:1.0-3.0] in the peri-post legalization period; p = .69), the clinical severity did. The proportions of children with respiratory involvement (65.9% vs. 50.9%; p = .05) and altered mental status (28.8% vs. 14.2%; p < .01) were higher in the peri-post legalization period. The peri-post legalization period was characterized by more children younger than 12 years (12.1% vs. 3.0%; p = .04), unintentional exposures (14.4% vs, 2.8%; p = .002) and edibles ingestion (19.7% vs. 7.8%; p = .01). Edible ingestion was an independent predictor of ICU admission (adjusted OR: 4.1, 95%CI: 1.2-13.7, p = .02). CONCLUSIONS The recreational cannabis legalization in Canada is associated with increased rates of severe intoxications in children. Edible ingestion is a strong predictor of ICU admission in the pediatric population.
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Affiliation(s)
- Neta Cohen
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Laura Galvis Blanco
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Adrienne Davis
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alyssa Kahane
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mathew Mathew
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Inbal Kestenbom
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Gidon Test
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Yehonatan Pasternak
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Division of Clinical Immunology and Allergy, The Hospital for Sick Children, Toronto, Canada
| | - Ruud H J Verstegen
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Benjamin Jung
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Soha Rached d'Astous
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Maggie Rumantir
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,The Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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47
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Lin CY, Xie J, Freedman SB, McKee R, Schnadower D, Tarr PI, Finkelstein Y, Desai NM, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Powell EC, Kilgar J, Michelson KA, Bitzan M, Yen K, Meckler GD, Plint AC, Balamuth F, Bradin S, Gouin S, Kam AJ, Meltzer J, Hunley TE, Avva U, Porter R, Fein DM, Louie JP, Tarr GA. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. J Pediatr 2021; 232:200-206.e4. [PMID: 33417918 PMCID: PMC8084908 DOI: 10.1016/j.jpeds.2020.12.077] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. STUDY DESIGN We reviewed medical records of children <18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores >13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. RESULTS A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children <5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children <5 years, greatest net benefit was achieved for a threshold probability >26%. CONCLUSIONS The HUS severity score was able to discriminate between high- and low-risk children <5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
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Affiliation(s)
- Chu Yang Lin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital and Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Ryan McKee
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip I. Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Neil M. Desai
- British Columbia Children’s Hospital Division of Pediatric Emergency Medicine
| | - Roni D. Lane
- Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Ron L. Kaplan
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA
| | - Selena Hariharan
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrea T. Cruz
- Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine
| | - Daniel M. Cohen
- Professor of Clinical Pediatrics, Nationwide Children’s, Professor of Clinical Pediatrics, Nationwide Children’s Hospital & The Ohio State University, Columbus, OH
| | - Andrew Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth C. Powell
- Professor of Pediatrics, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children’s Hospital of Chicago; Division of Emergency Medicine
| | - Jennifer Kilgar
- Department or Pediatrics & Division of Emergency Medicine, Children’s Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | | | - Martin Bitzan
- Division of Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Canada; A1 Jalila Children’s Hospital, Kidney Centre of Excellence, Dubai, UAE
| | - Kenneth Yen
- Pediatric Emergency Medicine, Children’s Medical Center, UT Southwestern
| | - Garth D. Meckler
- Pediatrics and Emergency Medicine; University of British Columbia, Vancouver, BC
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine, University of Ottawa and the Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fran Balamuth
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine; Division of Emergency Medicine, Children’s Hospital of Philadelphia
| | - Stuart Bradin
- Children’s Emergency Services, Department of Emergency Medicine, University of Michigan Medical School
| | - Serge Gouin
- Professor, Departments of Pediatric Emergency Medicine & Pediatrics, CHU Sainte-Justine, Universite de Montreal, QC, Canada
| | - April J. Kam
- Department of Pediatrics, McMaster Children’s Hospital, McMaster University
| | - James Meltzer
- Division of Emergency Medicine; Department of Pediatrics; Jacobi Medical Center
| | - Tracy E. Hunley
- Division of Pediatric Nephrology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Usha Avva
- Department of Pediatrics, Joseph M Sanzari Women and Children’s Hospital, Hackensack University Medical Center
| | - Robert Porter
- Discipline of Pediatrics, Memorial University of Newfoundland
| | - Daniel M. Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey P. Louie
- Division of Emergency Medicine, University of Minnesota, Masonic Children’s Hospital
| | - Gillian A.M. Tarr
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
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48
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Freedman SB, Horne R, Johnson-Henry K, Xie J, Williamson-Urquhart S, Chui L, Pang XL, Lee B, Schuh S, Finkelstein Y, Gouin S, Farion KJ, Poonai N, Hurley K, Schnadower D, Sherman PM. Probiotic stool secretory immunoglobulin A modulation in children with gastroenteritis: a randomized clinical trial. Am J Clin Nutr 2021; 113:905-914. [PMID: 34269370 PMCID: PMC8023833 DOI: 10.1093/ajcn/nqaa369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We previously conducted the Probiotic Regimen for Outpatient Gastroenteritis Utility of Treatment (PROGUT) study, which identified no improvements in children with acute gastroenteritis (AGE) administered a probiotic. However, the aforementioned study did not evaluate immunomodulatory benefits. OBJECTIVES The object of this study was to determine if stool secretory immunoglobulin A (sIgA) concentrations in children with AGE increase more among participants administered a Lactobacillus rhamnosus/helveticus probiotic compared with those administered placebo. METHODS This a priori planned multicenter, randomized, double-blinded, placebo-controlled ancillary study enrolled children presenting for emergency care who received a 5-d probiotic or placebo course. Participants submitted stool specimens on days 0, 5, and 28. The primary endpoint was the change in stool sIgA concentrations on day 5 compared with baseline. RESULTS A total of 133 (n = 66 probiotic, 67 placebo) of 886 PROGUT participants (15.0%) provided all 3 specimens. Median stool sIgA concentrations did not differ between the probiotic and placebo groups at any of the study time points: day 0 median (IQR): 1999 (768, 4071) compared with 2198 (702, 5278) (P = 0.27, Cohen's d = 0.17); day 5: 2505 (1111, 5310) compared with 3207 (982, 7080) (P = 0.19, Cohen's d = 0.16); and day 28: 1377 (697, 2248) compared with 1779 (660, 3977) (P = 0.27, Cohen's d = 0.19), respectively. When comparing measured sIgA concentrations between days 0 and 5, we found no treatment allocation effects [β: -0.24 (-0.65, 0.18); P = 0.26] or interaction between treatment and specimen collection day [β: -0.003 (-0.09, 0.09); P = 0.95]. Although stool sIgA decreased between day 5 and day 28 within both groups (P < 0.001), there were no differences between the probiotic and placebo groups in the median changes in sIgA concentrations when comparing day 0 to day 5 median (IQR) [500 (-1135, 2362) compared with 362 (-1122, 4256); P = 0.77, Cohen's d = 0.075] and day 5 to day 28 [-1035 (-3130, 499) compared with -1260 (-4437, 843); P = 0.70, Cohen's d = 0.067], respectively. CONCLUSIONS We found no effect of an L. rhamnosus/helveticus probiotic, relative to placebo, on stool IgA concentrations. This trial was registered at clinicaltrials.gov as NCT01853124.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rachael Horne
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Kathene Johnson-Henry
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sarah Williamson-Urquhart
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Linda Chui
- Alberta Precision Laboratories - ProvLab, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Xiao-Li Pang
- Alberta Precision Laboratories - ProvLab, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Bonita Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Canada
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, and Pediatric Emergency Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, London, Canada
| | - Katrina Hurley
- Division of Paediatric Emergency Medicine, Dalhousie University, Halifax, Canada
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Philip M Sherman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, and the Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
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49
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McKee RS, Schnadower D, Tarr PI, Xie J, Finkelstein Y, Desai N, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Rominger A, Powell EC, Kilgar J, Michelson KA, Beer D, Bitzan M, Pruitt CM, Yen K, Meckler GD, Plint AC, Bradin S, Abramo TJ, Gouin S, Kam AJ, Schuh A, Balamuth F, Hunley TE, Kanegaye JT, Jones NE, Avva U, Porter R, Fein DM, Louie JP, Freedman SB. Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children. Clin Infect Dis 2021; 70:1643-1651. [PMID: 31125419 DOI: 10.1093/cid/ciz432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/23/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. METHODS We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. RESULTS Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14-5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18-6.21]). CONCLUSIONS The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
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Affiliation(s)
- Ryan S McKee
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Ontario
| | - Neil Desai
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Roni D Lane
- Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Ron L Kaplan
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital
| | - Selena Hariharan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital and Ohio State University, Columbus
| | - Andrew Dixon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Stollery Children's Hospital, Women and Children's Research Institute, University of Alberta, Edmonton, Canada
| | - Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital, Pennsylvania
| | - Annie Rominger
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Kentucky
| | - Elizabeth C Powell
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Kilgar
- Department of Pediatrics and Division of Emergency Medicine, Children's Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Darcy Beer
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Martin Bitzan
- Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Christopher M Pruitt
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health, Dallas
| | - Garth D Meckler
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Stuart Bradin
- Departments of Pediatrics and Emergency Medicine, University of Michigan Health System, Ann Arbor
| | - Thomas J Abramo
- Departments of Pediatrics and Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital Research Institute, Little Rock
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine and Pediatrics, Université de Montréal, Québec
| | - April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Abigail Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Fran Balamuth
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia
| | - Tracy E Hunley
- Division of Pediatric Nephrology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John T Kanegaye
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla.,Rady Children's Hospital San Diego, California
| | - Nicholas E Jones
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Georgia
| | - Usha Avva
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall, Joseph M. Sanzari Children's Hospital, New Jersey
| | - Robert Porter
- Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey P Louie
- Department of Pediatrics, Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Abstract
OBJECTIVE The objective of this study was to characterize the clinical picture and management of synthetic cannabinoid exposure in a cohort of adolescents. METHODS Using the 45 participating sites of the Toxicology Investigators Consortium Registry, a North American database, we conducted an observational study of a prospectively collected cohort. We identified all adolescent (12-19 years) cases of synthetic cannabinoid exposure who have received medical toxicology consultation between January 2012 and December 2016. Clinical and demographic data were collected including age, sex, circumstances surrounding exposure, coingestants, clinical manifestations, treatment, disposition, and outcome. RESULTS We identified 75 adolescents who presented to the emergency department with synthetic cannabinoid exposure. Most were male (91%) and between the ages of 16 and 19 (66%). The most common symptoms were neuropsychiatric with 50 adolescents (67%) exhibiting central nervous system (CNS) manifestations. There was no predominant toxidrome, and 9 patients (12%) were mechanically ventilated. Mainstay of treatment was supportive care. No deaths were reported. CONCLUSIONS Synthetic cannabinoid exposure in adolescents is primarily characterized by CNS manifestations, which are varied and may be life-threatening. Frontline caregivers should maintain a high index of suspicion for synthetic cannabinoids, especially in adolescents who present with unexplained CNS manifestations, as there is no specific toxidrome or confirmatory rapid drug screen to detect them.
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Affiliation(s)
- Meghan Gilley
- From the Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Diane P Calello
- New Jersey Poison Information and Education System, Department of Emergency Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Paul Wax
- Department of Emergency Medicine (Medical Toxicology), UT Southwestern Medical School, Dallas, TX
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