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BackgroundTrauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting. ObjectiveOur main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec. MethodsFirst, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected—one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry. ResultsThis project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months. ConclusionsWe expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions.

Introduction. Des recherches ont mis en évidence une diminution du nombre de visites à l'urgence par des enfants pendant la pandémie de SRAS en 2003. Nous avons fait enquête afin de déterminer s'il en avait été de même pour les visites à l'urgence en raison de blessures pendant la pandémie de COVID-19. Méthodologie. Nous avons examiné les données du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT) afin d'obtenir de l'information sur les visites liées à des blessures au service des urgences de l'Hôpital de Montréal pour enfants, l'un des centres de traumatologie pédiatrique de la province faisant partie du système, pour les 28 dernières années. Nous avons comparé les données correspondant à une période de deux mois pendant le confinement en raison de la COVID-19 (du 16 mars au 15 mai) avec celles de la même période pour les années précédentes (de 1993 à 2019), afin de déterminer si la diminution du nombre de visites à l'urgence en 2020 était sans précédent (c.-à-d. qu'aucune diminution semblable ne s'était jamais produite). Différents facteurs ont été inclus dans cette comparaison, à savoir les groupes d'âge, la nature des blessures, les mécanismes de blessure et la gravité. Résultats. La diminution observée en 2020 était sans précédent pour tous les groupes d'âge examinés selon les données compilées entre 1993 et 2019. Comparativement à la moyenne obtenue pour 2015-2019, la diminution la plus faible s'est produite chez les enfants de 2 à 5 ans (baisse de 35 %) alors que la plus forte a eu lieu chez les jeunes de 12 à 17 ans (83 %). Les blessures liées aux collisions de véhicules automobiles et aux sports ont pratiquement disparu pendant le confinement lié à la COVID-19. Fait étonnant, pendant le confinement, plus d'enfants entre 6 et 17 ans se sont présentés à l'urgence avec des blessures moins urgentes que les années précédentes. Conclusion. Comme dans le cas du SRAS en 2003, la COVID-19 a eu un effet dissuasif sur les visites aux urgences pédiatriques. Le confinement, en particulier, a eu une incidence profonde sur les visites associées aux blessures. La période de déconfinement fera l'objet d'une surveillance afin d'en déterminer les répercussions, tant à court qu'à long terme. [ABSTRACT FROM AUTHOR]

Introduction: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. Methods: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. Results: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. Conclusion: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term. [ABSTRACT FROM AUTHOR]

Introduction: The recent rise in mild traumatic brain injuries (mTBI) in the pediatric population has been documented by many studies in Canada and the United States. The objective of our study was to compare mTBI rates from the Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) in Montréal with population-based rates (Quebec mTBI rates). Methods: We calculated CHIRPP's mTBI rates via two methods: (1) using all CHIRPP injuries as the denominator; and (2) using the number of children aged 0 to 17 years living within 5 km of either of two CHIRPP centres in Montréal as the denominator. We plotted CHIRPP's mTBI rates against the provincial rates and compared them according to sex and age. Results: Whether using all CHIRPP injuries or the number of children aged 0 to 17 years living within 5 km of either CHIRPP centre in Montreal as the denominator, CHIRPP paralleled the fluctuations seen in Quebec's rates between 2003 and 2016. When stratifying by sex and age, CHIRPP was better at estimating the population-based rates for the youngest (0 to 4 years) and the oldest (13 to 17 years) age groups. Conclusion: CHIRPP in Montréal proved a valid tool for estimating the variations in rates of mTBI in the population. This suggests that CHIRPP could also be used to estimate population-based rates of other types of injuries. [ABSTRACT FROM AUTHOR]

Aim: The 'trickle-down effect', or how major sports events have a positive impact on sports participation, has been the subject of many studies, but none produced conclusive results. We took a different approach and rather than look at sports participation, we used injuries as a proxy and see if injuries increased, or remained the same, after the International Federation of Association Football World Cup.Methods: Using a retrospective cohort design, we looked at the injuries suffered by males and females (13-16 years old) while playing team sports in Montreal, that occurred in May to July, from 1999 to 2014. Information reported by the Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) was limited to the two CHIRPP centres in Montreal: the Montreal Children's Hospital and Hopital Sainte-Justine.Results: In females, no significant trends were noticed. In males who played non-organised soccer, the percent changes between FIFA World Cup (WC) (June) and pre-FIFA WC (May) was always highest during FIFA WC years: 17.2% more injuries in years when FIFA WC was held compared to 1.3% less injuries during non-FIFA WC years. In non-organised soccer, male players suffered less strains/sprains (11.9% vs. 30.1%; P = 0.015), suffered more severe injuries (59.7% vs. 43.1%; P = 0.049) and more of their injuries were the results of direct contact with another player (26.8% vs. 13.3%; P = 0.028) during FIFA WC.Conclusion: FIFA WC seems to have an impact on the injuries of teenage boys when playing non-organised soccer. The impact was short-lived, only lasting during the FIFA WC event. [ABSTRACT FROM AUTHOR]

Objective: To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children., Setting: Participants were recruited from a concussion clinic or the community., Participants: A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities., Study Design: A prospective cross-sectional study., Main Measures: All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex ® , Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory., Results: There was a significant group effect for vergence during smooth pursuit ( F2,176 = 10.90; P < .05), mean latency during saccades ( F2,171 = 5.99; P = .003), and mean response delay during antisaccades ( F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward ( F2,168 = 7; P = .001) and rightward directions ( F2,163 = 13.08; P < .05) and vertical upward ( F2,147 = 7.60; P = .001) and downward directions ( F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children., Conclusion: VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic., Methods: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity., Results: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years., Conclusion: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term., Competing Interests: We have no conflict of interest to report.

A critical component for accelerating the clinical uptake of research data in the area of pediatric concussion or mild traumatic brain injury (MTBI) pertains to the establishment and utilization of common databases. The objective of the first phase of our CanPedCDE initiative was to agree upon pediatric common data elements (CDEs) that could best characterize children with MTBI over their recovery period. The selection of CDEs for our framework aimed to balance factors such as the comprehensiveness of outcomes collected, their applicability to diverse settings, as well as the costs associated with their use. Selection began by identifying relevant domains of functioning (e.g., post-concussion symptoms, attention, and balance). Two sources were used to make this process more efficient: 1) the World Health Organization International Classification of Functioning (ICF) Traumatic Brain Injury Core Set, and the U.S. National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Common Data Elements, both of which had already suggested relevant domains to include in TBI research. The process was completed in two phases: 1) using an online survey of experts and 2) through an in-person consensus meeting. Measurement tools were also proposed that were best felt to capture these domains. Forty experts in MTBI in children from multiple health-related perspectives (e.g., emergency medicine, pediatrics, neurosurgery, nursing, physiotherapy, and neuroscience), as well as knowledge users, participated in the selection process. The final list of CDEs included 77 distinct areas of functioning, covering all categories of the ICF model. Outcome measures were attached to each element, when applicable. The CanPedCDE initiative addresses a significant limitation in MTBI research to date and may help both researchers and clinicians to organize and standardize their assessment of children and youth post-MTBI in order to move the field in promising directions.