Article
Emergency Medicine
Ishan Lamba, Avinav Luthra, Varsha Shinde, S. S. Daniel
Summary: The study tested the validity of the Canadian CT Head rule (CCHR) for minor traumatic brain injury (TBI) cases in an Indian emergency department, showing a high sensitivity but low specificity. Emergency physicians showed a greater awareness and inclination to use CDRs compared to neurosurgeons in cases of minor TBI to guide decisions for neuro-radiology.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Multidisciplinary Sciences
Ryan Tiller, Kevin Chan, John C. Knight, Roger Chafe
Summary: Pediatric high users of hospital and ED services have distinct characteristics, such as more likely to reside in rural communities and lower income quintiles. The most frequent diagnoses for high-use patients include conditions related to growth and development, respiratory and cardiovascular issues. Understanding these characteristics can help in planning children's health services effectively.
Article
Emergency Medicine
Andrew J. Knighton, Doug Wolfe, Angelene Hunt, Allison Neeley, Neer Shrestha, Steven Hess, James Hellewell, Gregory Snow, Rajendu Srivastava, Douglas Nelson, Jeff E. Schunk
Summary: This study aimed to evaluate the effectiveness of a multimodal strategy, including the simultaneous implementation of a clinical decision support system, in sustaining adherence to a clinical pathway for children with minor head trauma in general emergency departments. The results showed that the implementation of the clinical pathway led to improved adherence to guidelines and a modest but safe reduction in CT scans.
ANNALS OF EMERGENCY MEDICINE
(2022)
Article
Public, Environmental & Occupational Health
Aimee Campeau, Andre S. Champagne, Steven R. McFaull
Summary: This study presents an overview of emergency department visits for substance-related self-harm cases. The findings reveal that hospital admissions for substance-related self-harm were highest among females aged 15-19 years, who were more likely to use medications. A significant increasing trend in cases was observed from 2011 to 2019.
Article
Geriatrics & Gerontology
Nicola Romano, Aldo Fischetti, Giacomo Siri, Antonio Castaldi
Summary: The retrospective study evaluates head CTs of centenarian patients in the last 11 years in the Hospital. The study found that CT plays a crucial role in emergency situations and the analysis of NENP suggests that the brains of centenarians on CT are similar to those of patients aged 85-90.
AGING CLINICAL AND EXPERIMENTAL RESEARCH
(2022)
Article
Immunology
Sarah Tubiana, Jose Labarere, Jacques Levraut, Pierre Michelet, Fleur Jourda de Vaux, Benoit Doumenc, Pierre Hausfater, Christophe Choquet, Patrick Plaisance, Jeannot Schmidt, Veronique Mattei, Olivier Gacia, Didier Storme, Patrick Ray, Guillaume Der Sahakian, Marie-Clement Kouka, Laure Jainsky, Jocelyn Raude, Xavier Duval, Yann-Erick Claessens
Summary: This study aimed to evaluate the impact of a multifaceted intervention in improving pneumococcal and influenza vaccinations among patients aged 65 years and older after an emergency department visit. The results showed that the intervention increased influenza vaccination rates, but did not affect pneumococcal vaccination rates. At 12 months, there was no difference in mortality between the intervention and control groups.
Article
Pediatrics
Kamal Abulebda, Travis Whitfill, Erin E. Montgomery, Anita Thomas, Robert A. Dudas, James S. Leung, Daniel J. Scherzer, Michelle Aebersold, Wendy L. Van Ittersum, Shruti Kant, Theresa A. Walls, Anna K. Sessa, Stephen Janofsky, Daniel B. Fenster, David O. Kessler, Jenny Chatfield, Pamela Okada, Grace M. Arteaga, Marc D. Berg, Lynda J. Knight, Ashley Keilman, Ana Makharashvili, Grace Good, Ladonna Bingham, Emily J. Mathias, Kristine Nagy, Melinda F. Hamilton, Samreen Vora, Karen Mathias, Marc A. Auerbach
Summary: This study demonstrates that a national interventional collaborative can significantly improve pediatric readiness within general emergency departments by implementing simulation and quality improvement initiatives in partnership with academic medical centers. The mean improvement in weighted pediatric readiness score (WPRS) was 16.3, with significant enhancements in administration/coordination of care, policies, protocol, and procedures, and quality improvement. This collaborative intervention model led to improved pediatric readiness and care processes.
JOURNAL OF PEDIATRICS
(2021)
Article
Geriatrics & Gerontology
Charlene Lee, Jonathan Beavers, Jonathan Pham, Liam Hackett, Joseph Miller, Paul Buntine
Summary: The study evaluated the effect of supplementing the Canadian CT head rule with minimum inclusion criteria for determining the need for CT brain scans in elderly patients presenting after a fall. The results indicated that this approach safely reduced the number of CT brain scans performed without adverse outcomes.
Article
Medicine, General & Internal
Fabienne Ropers, Patrick Bossuyt, Ian Maconochie, Frank J. Smit, Claudio Alves, Susanne Greber-Platzer, Henriette A. Moll, Joany Zachariasse
Summary: Distinctive hospital-specific patterns in variability of management in five European pediatric emergency departments were observed, indicating fundamental differences in pediatric healthcare practice influenced by factors such as primary care organization, diagnostic facilities and available beds, professional culture, and patient expectations.
Article
Orthopedics
Brian H. Rowe, Esther H. Yang, Lindsay A. Gaudet, Justin Lowes, Leeor Eliyahu, Cristina Villa-Roel, Jeremy Beach, Martin Mrazik, Garnet Cummings, Donald Voaklander
Summary: This study aimed to document the occurrence and recovery outcomes of sports-related concussions (SRCs) in a community-based sample presenting to the Emergency Department (ED). While most patients returned to normal activities within 30 days, 40% still experienced persistent symptoms at 90 days of follow-up. Physically active individuals recover faster, but patients who return to physical activity before resolution of symptoms are at higher risk of persistent symptoms and further injury.
CLINICAL JOURNAL OF SPORT MEDICINE
(2022)
Article
Health Care Sciences & Services
Amy C. Plint, Amanda S. Newton, Antonia Stang, Zach Cantor, Lamia Hayawi, Nick Barrowman, Kathy Boutis, Serge Gouin, Quynh Doan, Andrew Dixon, Robert Porter, Gary Joubert, Scott Sawyer, Tyrus Crawford, Jocelyn Gravel, Maala Bhatt, Patrick Weldon, Kelly Millar, Sandy Tse, Gina Neto, Simran Grewal, Melissa Chan, Kevin Chan, Grant Yung, Jennifer Kilgar, Tim Lynch, Mary Aglipay, Dale Dalgleish, Ken Farion, Terry P. Klassen, David W. Johnson, Lisa A. Calder
Summary: This study estimates the risk and type of adverse events for children treated in a pediatric emergency department. It found that 3.0% of children experienced at least one adverse event, with majority of the events being preventable and related to management and diagnostic issues. Opportunities for improvement in care were identified.
BMJ QUALITY & SAFETY
(2022)
Article
Medicine, General & Internal
Flavia R. Machado, Alexandre Cavalcanti, Maria Braga, Fernando Tallo, Aline Bossa, Juliana Souza, Josiane Ferreira, Felipe dal Pizzol, Mariana Monteiro, Derek Angus, Thiago Lisboa, Luciano C. P. Azevedo
Summary: The study aimed to evaluate the prevalence, patient allocation adequacy, and mortality of adult sepsis patients in Brazilian emergency departments. The results showed a prevalence rate of 5.4 per 1000 visits and a hospital mortality rate of 32%. Age, SOFA score, healthcare-associated infections, and low-resource institution admission were associated with higher mortality. Only 52.8% of patients were adequately allocated within 24 hours.
INTERNAL AND EMERGENCY MEDICINE
(2023)
Article
Clinical Neurology
Silvia Bressan, Paola Berlese, Marta Arpone, Ivan Steiner, Luigi Titomanlio, Liviana Da Dalt
Summary: This study reviewed the cases of children assessed using PECARN rules at two emergency departments over a 5-year period, finding that unscheduled revisits for mHT were very uncommon and initially missed intracranial injuries were rare, with no need for neurosurgery or intensive care.
CHILDS NERVOUS SYSTEM
(2021)
Article
Emergency Medicine
Ali Ghobadi, Bryan Lin, Visanee V. Musigdilok, Stacy J. Park, Darryl E. Palmer-Toy, Michael K. Gould, David R. Vinson, Dana M. Hutchison, Adam L. Sharp
Summary: The study found that changing the laboratory-reported D-dimer reference intervals to age-adjusted intervals did not decrease the use of advanced chest imaging or increase 30-day adverse events. Noncompliance with the age-adjusted reference intervals postintervention may have blunted the impact of this intervention.
ACADEMIC EMERGENCY MEDICINE
(2021)
Article
Allergy
Laurence Ducharme, Sofianne Gabrielli, Ann E. Clarke, Judy Morris, Jocelyn Gravel, Rodrick Lim, Edmond S. Chan, Ran D. Goldman, Andrew O'Keefe, Jennifer Gerdts, Derek K. Chu, Julia Upton, Elana Hochstadter, Adam Bretholz, Christine McCusker, Xun Zhang, Moshe Ben-Shoshan
Summary: This study aimed to characterize the rate, clinical characteristics, and management of tree nut-induced anaphylaxis (TNA) in children across Canada. The study found that tree nut-induced reactions accounted for 17% of anaphylaxis cases, with 7.0% being severe reactions. Male sex, older age, and macadamia-triggered reactions were more likely to be associated with severe reactions.
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY
(2022)
Article
Geriatrics & Gerontology
Jacques S. Lee, Tiffany Tong, Mark Chignell, Mary C. Tierney, Judah Goldstein, Debra Eagles, Jeffrey J. Perry, Andrew McRae, Eddy Lang, Darren Hefferon, Louise Rose, Alex Kiss, Bjug Borgundvaag, Shelley McLeod, Don Melady, Valerie Boucher, Marie-Josee Sirois, Marcel Emond
Summary: Recognition of delirium by nurses and physicians in the emergency department is sub-optimal, at around 50%, and may be associated with increased mortality. Further research should investigate the underlying causes of unrecognized delirium and propose novel strategies to enhance delirium recognition and improve patient outcomes.
Editorial Material
Geriatrics & Gerontology
Jacques S. Lee
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Review
Geriatrics & Gerontology
Sangil Lee, Hao Chen, Seikei Hibino, Daniel Miller, Heather Healy, Jacques S. Lee, Glenn Arendts, Jin Ho Han, Maura Kennedy, Christopher R. Carpenter
Summary: This systematic review evaluated interventions to prevent incident delirium or shorten the duration of prevalent delirium in older adults presenting to the emergency department. The findings suggest that few interventions initiated in the ED consistently reduce the incidence or duration of delirium.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Public, Environmental & Occupational Health
Andrea M. Patey, Guillaume Fontaine, Jillian J. Francis, Nicola McCleary, Justin Presseau, Jeremy M. Grimshaw
Summary: Understanding and changing healthcare professional behaviors is the focus of implementation science, which aims to develop principles and approaches to address care gaps. Behavioral sciences can be applied to develop implementation strategies that support behavior change and evaluate their effectiveness.
PSYCHOLOGY & HEALTH
(2023)
Article
Health Care Sciences & Services
Sylvain Boet, Joseph K. K. Burns, Jamie Brehaut, Meghan Britton, Teodor Grantcharov, Jeremy Grimshaw, Meghan McConnell, Glenn Posner, Isabelle Raiche, Sukhbir Singh, Patricia Trbovich, Cole Etherington
Summary: Effective intraoperative teamwork is crucial for patient safety. This study examined the use of different assessment tools (NOTECHS, TEAM, and modified-SEIPS) to characterize teamwork and provide feedback for improvement. Both NOTECHS and TEAM provided overall assessments, while SEIPS offered deeper insights into teamwork processes.
JOURNAL OF INTERPROFESSIONAL CARE
(2023)
Article
Emergency Medicine
James-Jules Linton, Caroline Eagles, Martin S. Green, Marie-Joe Nemnom, Ian G. Stiell
Summary: This study aimed to compare the accuracy of diagnosis and treatment for narrow complex tachycardia (NCT) caused by primary arrhythmias and those caused by medical issues in the emergency department (ED), as well as to assess the expertise of ED physicians in managing NCT. The study found that NCT accounted for 0.8% of all ED visits, with primary arrhythmias being the majority at 54.8%. ED physicians had an 86.6% accuracy rate in interpreting electrocardiograms (ECGs), but had difficulty differentiating atrial flutter and supraventricular tachycardia (SVT). Overall, ED physicians had a high accuracy rate in diagnosing and treating NCT, but missed opportunities to adequately control heart rate or address underlying causes, suggesting room for improvement in NCT management in the ED.
CANADIAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Review
Health Care Sciences & Services
Sarah Filiatreault, Jeremy M. Grimshaw, Sara A. Kreindler, Alecs Chochinov, Janice Linton, Rashmita Chatterjee, Rilwan Azeez, Malcolm B. Doupe
Summary: Older adults are at high risk of developing delirium in the emergency department, but it is often missed or undertreated. Improving delirium care in the emergency department is challenging due to a lack of standards. This study critically appraised and synthesized clinical practice guidelines for delirium care relevant to older emergency department patients.
JOURNAL OF EVALUATION IN CLINICAL PRACTICE
(2023)
Article
Clinical Neurology
Emma Ferguson, Krishan Yadav, Mukul Sharma, Marco L. A. Sivilotti, Marcel Emond, Ian G. Stiell, Grant Stotts, Jacques S. Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y. Jin, Wieslaw J. Oczkowski, Demetrios J. Sahlas, Heather E. Murray, Ariane Mackey, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J. Gladstone, Mark I. Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitelbaum, Marie-Joe Nemnom, George A. Wells, Avik Nath, Jeffrey J. Perry
Summary: In a large prospective cohort study, CT findings of acute and chronic ischemia were found to be associated with subsequent stroke risk in patients with transient ischemic attack or minor stroke. The combination of acute ischemia with chronic ischemia and microangiopathy was the strongest predictor for early stroke occurrence.
Article
Cardiac & Cardiovascular Systems
Graham Wilson, Mukul Sharma, Debra Eagles, Marie-Joe Nemnom, Marco L. A. Sivilotti, Marcel Emond, Ian G. Stiell, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y. Jin, Wieslaw J. Oczkowski, Demetrios J. Sahlas, Heather E. Murray, Ariane Mackey, Steve Verreault, Marie Christine Camden, Samuel Yip, Philip Teal, David J. Gladstone, Mark I. Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitlebaum, George A. Wells, Avik Nath, Jeffrey J. Perry
Summary: It is unclear whether initiating oral anticoagulation immediately in the emergency department (ED) for patients with atrial fibrillation after a transient ischemic attack (TIA) or minor stroke is more effective than deferring the decision to outpatient follow-up.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Article
Psychology, Clinical
Mackenzie Wilson, Zachary M. van Allen, Jeremy M. Grimshaw, Jamie C. Brehaut, Audrey Durand, Jean-Francois Lalonde, Douglas G. Manuel, Susan Michie, Robert West, Justin Presseau
Summary: Through a study on Canadians, it was found that outcome expectancy was the strongest predictor of intention to reduce facial 'T-zone' touching, while self-efficacy only played a significant predictive role for the eyes and mouth touching. Automaticity was the strongest predictor of behavior at the 2-week follow-up. These findings suggest that focusing on reflective processes may increase intention to reduce 'T-zone' touching, while reducing actual touching may require strategies that address the automatic nature of this behavior.
BRITISH JOURNAL OF HEALTH PSYCHOLOGY
(2023)
Article
Emergency Medicine
Jessica Poliwoda, Debra Eagles, Krishan Yadav, Marie-Joe Nemnom, Charlotte Grace Walmsley, Lisa Mielniczuk, Ian G. G. Stiell
Summary: This study retrospectively reviewed the management and outcomes of acute heart failure patients in the emergency department (ED), finding that both admitted and discharged patients experienced a high proportion of poor outcomes. The HEARTRISK6 Scale showed a high sensitivity for short-term serious outcomes but with the potential to increase hospital admissions. Further validation of the HEARTRISK6 Scale is required.
CANADIAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Letter
Emergency Medicine
Ian G. Stiell
EMERGENCY MEDICINE AUSTRALASIA
(2023)
Article
Medicine, General & Internal
Sathya Karunananthan, Jeremy M. Grimshaw, Lara Maxwell, Phi-Yen Nguyen, Matthew J. Page, Jordi Pardo Pardo, Jennifer Petkovic, Brigitte Vachon, Vivian Andrea Welch, Peter Tugwell
BMJ EVIDENCE-BASED MEDICINE
(2023)
Article
Medicine, General & Internal
Jeremy M. Grimshaw, Wendy Levinson
BMJ EVIDENCE-BASED MEDICINE
(2023)
Review
Primary Health Care
Mary Carter, Nouf Abutheraa, Noah Ivers, Jeremy Grimshaw, Sarah Chapman, Philip Rogers, Michelle Simeoni, Jesmin Antony, Margaret C. Watson
Summary: Pharmacists' involvement in audit and feedback interventions can lead to improvements in prescribing in general practice settings. The effectiveness of these interventions may be enhanced by providing both verbal and written feedback or computerized decision support for prescribers, as well as by incorporating study-specific training and ongoing support for pharmacists.