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53. A Target Population Derived Method for Developing a Competency Standard in Radiograph Interpretation.

Author

Lee, Michelle S., Pusic, Martin V., Camp, Mark, Stimec, Jennifer, Dixon, Andrew, Carrière, Benoit, Herman, Joshua E., and Boutis, Kathy

Subjects
MUSCULOSKELETAL system injuries, COMPUTERS in medicine, COURSE evaluation (Education), EVIDENCE-based medicine, LEARNING, DIAGNOSTIC imaging, CLINICAL competence, DECISION making, DESCRIPTIVE statistics, DIAGNOSTIC errors, DATA analysis, MEDICAL education, CHILDREN
Abstract

For assessing the skill of visual diagnosis such as radiograph interpretation, competency standards are often developed in an ad hoc method, with a poorly delineated connection to the target clinical population. Commonly used methods to assess for competency in radiograph interpretation are subjective and potentially biased due to a small sample size of cases, subjective evaluations, or include an expert-generated case-mix versus a representative sample from the clinical field. Further, while digital platforms are available to assess radiograph interpretation skill against an objective standard, they have not adopted a data-driven competency standard which informs educators and the public that a physician has achieved adequate mastery to enter practice where they will be making high-stakes clinical decisions. Operating on a purposeful sample of radiographs drawn from the clinical domain, we adapted the Ebel Method, an established standard setting method, to ascertain a defensible, clinically relevant mastery learning competency standard for the skill of radiograph interpretation as a model for deriving competency thresholds in visual diagnosis. Using a previously established digital platform, emergency physicians interpreted pediatric musculoskeletal extremity radiographs. Using one-parameter item response theory, these data were used to categorize radiographs by interpretation difficulty terciles (i.e. easy, intermediate, hard). A panel of emergency physicians, orthopedic surgeons, and plastic surgeons rated each radiograph with respect to clinical significance (low, medium, high). These data were then used to create a three-by-three matrix where radiographic diagnoses were categorized by interpretation difficulty and significance. Subsequently, a multidisciplinary panel that included medical and parent stakeholders determined acceptable accuracy for each of the nine cells. An overall competency standard was derived from the weighted sum. Finally, to examine consequences of implementing this standard, we reported on the types of diagnostic errors that may occur by adhering to the derived competency standard. To determine radiograph interpretation difficulty scores, 244 emergency physicians interpreted 1,835 pediatric musculoskeletal extremity radiographs. Analyses of these data demonstrated that the median interpretation difficulty rating of the radiographs was −1.8 logits (IQR −4.1, 3.2), with a significant difference of difficulty across body regions (p < 0.0001). Physician review classified the radiographs as 1,055 (57.8%) as low, 424 (23.1%) medium or 356 (19.1%) high clinical significance. The multidisciplinary panel suggested a range of acceptable scores between cells in the three-by-three table of 76% to 95% and the sum of equal-weighted scores resulted in an overall performance-based competency score of 85.5% accuracy. Of the 14.5% diagnostic interpretation errors that may occur at the bedside if this competency standard were implemented, 9.8% would be in radiographs of low-clinical significance, while 2.5% and 2.3% would be in radiographs of medium or high clinical significance, respectively. This study's novel integration of radiograph selection and a standard setting method could be used to empirically drive evidence-based competency standard for radiograph interpretation and can serve as a model for deriving competency thresholds for clinical tasks emphasizing visual diagnosis. [ABSTRACT FROM AUTHOR]

Published
2022
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59. Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice

Author

Adelgais, Kathleen, primary, Pusic, Martin, additional, Abdoo, Denise, additional, Caffrey, Sean, additional, Snyder, Katherine, additional, Alletag, Michelle, additional, Balakas, Ashley, additional, Givens, Timothy, additional, Kane, Ian, additional, Mandt, Maria, additional, Roswell, Kelley, additional, Saunders, Mary, additional, and Boutis, Kathy, additional

Published
2020
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62. Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing

Author

Kowalik, Krzysztof, primary, Dai, Ruixue, additional, Safavi, Shahideh, additional, Reyna, Myrtha E., additional, Lou, Wendy, additional, Lepine, Claire, additional, McDonald, Erica, additional, Schaap, Mirjam J., additional, Brydges, May G., additional, Dubeau, Aimee, additional, Boutis, Kathy, additional, Narang, Indra, additional, Eiwegger, Thomas, additional, Moraes, Theo J., additional, Ratjen, Felix, additional, and Subbarao, Padmaja, additional

Published
2020
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63. Early versus delayed emergency department presentation following mild Traumatic Brain Injury and the presence of symptom at 1, 4 and 12 weeks in children

Author

Gravel, Jocelyn, primary, Ledoux, Andrée-Ann, additional, Tang, Ken, additional, Yeates, Keith Owens, additional, Craig, William, additional, Osmond, Martin, additional, Boutis, Kathy, additional, Burns, Emma, additional, Sangha, Gurinder, additional, Dubrovsky, Alexander Sasha, additional, Beer, Darcy, additional, and Zemek, Roger, additional

Published
2020
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64. Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations

Author

Harel‐Sterling, Maya, primary, Dai, Ruixue, additional, Moraes, Theo J., additional, Boutis, Kathy, additional, Eiwegger, Thomas, additional, Narang, Indra, additional, Lepine, Claire, additional, Brydges, May Grace, additional, Dubeau, Aimee, additional, Subbarao, Padmaja, additional, and Schuh, Suzanne, additional

Published
2020
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73. Minimally angulated pediatric wrist fractures: is immobilization without manipulation enough?

Author

Ansari, Khalid Al-, Howard, Andrew, Seeto, Brian, Yoo, Solina, Zaki, Salma, and Boutis, Kathy

Subjects
Medical research -- Surveys -- Analysis, Medicine, Experimental -- Surveys -- Analysis, Pediatrics -- Surveys -- Analysis, Aspartame -- Surveys -- Analysis, Graphic design -- Surveys -- Analysis, Graphic arts industry -- Surveys -- Analysis, Drug therapy, Combination -- Surveys -- Analysis, Children -- Health aspects, Health, Health care industry, Science and technology, Analysis, Surveys
Abstract

ABSTRACT Background: Emergency department (ED) manipulation of complete minimally angulated distal radius fractures in children may not be necessary, due to the excellent remodeling potential of these fractures. Objectives: The [...]

Published
2007

76. Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice.

Author

Adelgais, Kathleen, Pusic, Martin, Abdoo, Denise, Caffrey, Sean, Snyder, Katherine, Alletag, Michelle, Balakas, Ashley, Givens, Timothy, Kane, Ian, Mandt, Maria, Roswell, Kelley, Saunders, Mary, and Boutis, Kathy

Subjects
CONFIDENCE intervals, CHILD abuse, CROSS-sectional method, SELF-evaluation, TREATMENT effectiveness, CLINICAL competence, EMERGENCY medical services, CHI-squared test, DESCRIPTIVE statistics, STATISTICAL sampling, LOGISTIC regression analysis, ODDS ratio, EMERGENCY medicine, LONGITUDINAL method, WORLD Wide Web
Abstract

In most states, prehospital professionals (PHPs) are mandated reporters of suspected abuse but cite a lack of training as a challenge to recognizing and reporting physical abuse. We developed a learning platform for the visual diagnosis of pediatric abusive versus non-abusive burn and bruise injuries and examined the amount and rate of skill acquisition. This was a prospective cross-sectional study of PHPs participating in an online educational intervention containing 114 case vignettes. PHPs indicated whether they believed a case was concerning for abuse and would report a case to child protection services. Participants received feedback after submitting a response, permitting deliberate practice of the cases. We describe learning curves, overall accuracy, sensitivity (diagnosis of abusive injuries) and specificity (diagnosis of non-abusive injuries) to determine the amount of learning. We performed multivariable regression analysis to identify specific demographic and case variables associated with a correct case interpretation. After completing the educational intervention, PHPs completed a self-efficacy survey on perceived gains in their ability to recognize cutaneous signs of abuse and report to social services. We enrolled 253 PHPs who completed all the cases; 158 (63.6%) emergency medical technicians (EMT), 95 (36.4%) advanced EMT and paramedics. Learning curves demonstrated that, with one exception, there was an increase in learning for participants throughout the educational intervention. Mean diagnostic accuracy increased by 4.9% (95% CI 3.2, 6.7), and the mean final diagnostic accuracy, sensitivity, and specificity were 82.1%, 75.4%, and 85.2%, respectively. There was an increased odds of getting a case correct for bruise versus burn cases (OR = 1.4; 95% CI 1.3, 1.5); if the PHP was an Advanced EMT/Paramedic (OR = 1.3; 95% CI 1.1, 1.4) ; and, if the learner indicated prior training in child abuse (OR = 1.2; 95% CI 1.0, 1.3). Learners indicated increased comfort in knowing which cases should be reported and interpreting exams in children with cutaneous injuries with a median Likert score of 5 out of 6 (IQR 5, 6). An online module utilizing deliberate practice led to measurable skill improvement among PHPs for differentiating abusive from non-abusive burn and bruise injuries. [ABSTRACT FROM AUTHOR]

Published
2021
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78. Characterisation of serum total tau following paediatric traumatic brain injury: a case-control study

Author

Stukas, Sophie, primary, Higgins, Victoria, additional, Frndova, Helena, additional, Gill, Jasmine, additional, Hubara, Evyatar, additional, Guerguerian, Anne-Marie, additional, Boutis, Kathy, additional, Beauchamp, Miriam, additional, Farrell, Catherine, additional, Babl, Franz E, additional, Delzoppo, Carmel, additional, Greenham, Mardee, additional, Wilkinson, Amy A, additional, Crichton, Alison, additional, Anderson, Vicki, additional, Adeli, Khosrow, additional, Hutchison, Jamie, additional, and Wellington, Cheryl, additional

Published
2019
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82. Characterization Of Allergen Sensitization Patterns In Canadian Preschool Children With Severe Wheezing

Author

Hoang, Jennifer A., primary, Mashouri, Pouria, additional, Dai, Vera, additional, Brydges, May, additional, Dubeau, Aimée, additional, Lépine, Claire, additional, Yin, Xiaojun, additional, Kowalik, Krzysztof, additional, DeLorenzo, Stephanie, additional, Moraes, Theo, additional, Amin, Reshma, additional, Narang, Indra, additional, Boutis, Kathy, additional, Schuh, Suzanne, additional, Maksym, Geoffrey N., additional, Ramani, Arun, additional, Subbarao, Padmaja, additional, and Eiwegger, Thomas, additional

Published
2019
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86. Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study.

Author

Al‐Sani, Faisal, Prasad, Soni, Panwar, Jyoti, Stimec, Jennifer, Khosroawshahi, Arash, Mizzi, Trent, Camp, Mark, Colaco, Keith, Kramer, Adam, Boutis, Kathy, and Alpern, Elizabeth

Subjects
INJURIES of the anatomical extremities, CONFIDENCE intervals, DIAGNOSIS, EXTREMITIES (Anatomy), BONE fractures, PATIENT aftercare, HOSPITAL emergency services, INFORMATION storage & retrieval systems, MEDICAL databases, LONGITUDINAL method, MEDICAL errors, MEDICAL records, PAIN, PEDIATRICS, MEDICAL radiology, TELEMEDICINE, ADVERSE health care events, ACQUISITION of data methodology, TERTIARY care, ODDS ratio
Abstract

Objectives: We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. Methods: This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs. ED physicians documented their radiograph interpretation, which was compared to a radiology reference standard. Patients received telephone follow‐up and had institutional medical records reviewed in 3 weeks. An AE occurred if there were clinical sequelae and/or repeat health care visits due to a delay in correct radiograph interpretation. Results: We enrolled 2,302 children (mean [±SD] age = 9.0 [4.4] years; 1,288 (56.0%) male]. Of these, 180 (7.8%; 95% confidence interval = 6.8 to 9.0) ED physician discordant interpretations resulted in an AE. Specifically, there were no negative clinical outcomes; however, relative to cases diagnosed correctly at the index ED, patients whose fracture was not initially identified encountered 77.2% more subsequent ED visits, while those falsely diagnosed with a fracture experienced 41.5% additional orthopedic clinic visits. Odds of an ED discrepant interpretation was significantly higher if a physician's pretest probability of a fracture was ≤ 20% versus> 20% (adjusted odds ratio [aOR] = 1.6), patient's pain score was ≤ 2 versus> 2 (aOR = 1.6), and injury was located in a joint versus other location (aOR = 1.7). Conclusions: Emergency physician discordant pediatric MSK radiograph interpretations that resulted in an AE occurred with regular frequency in a pediatric ED setting. AEs were primarily an increase in subsequent health care visits. Importantly, a low clinical suspicion for a fracture or injury located in the joint were risk factors for ED physician discordant interpretations. [ABSTRACT FROM AUTHOR]

Published
2020
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87. Natural Progression of Recovery from Concussion in a Pediatric Population

Author

Ledoux, Andrée-Anne, primary, Gioia, Gerard, additional, Gagnon, Isabelle, additional, Gravel, Jocelyn, additional, Boutis, Kathy, additional, Yeates, Keith, additional, Tang, Ken, additional, Pusic, Martin, additional, Osmond, Martin H., additional, Zemek, Roger, additional, Freedman, Stephen B., additional, and Craig, William, additional

Published
2018
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89. Predictors of neuropsychological outcome after pediatric concussion.

Author

Beauchamp, Miriam H., primary, Aglipay, Mary, additional, Yeates, Keith Owen, additional, Désiré, Naddley, additional, Keightley, Michelle, additional, Anderson, Peter, additional, Brooks, Brian L., additional, Barrowman, Nick, additional, Gravel, Jocelyn, additional, Boutis, Kathy, additional, Gagnon, Isabelle, additional, Dubrovsky, Alexander Sasha, additional, and Zemek, Roger, additional

Published
2018
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91. Fatigue Following Traumatic Brain Injury in Children and Adolescents: A Longitudinal Follow-Up 6 to 12 Months After Injury

Author

Crichton, Alison, primary, Anderson, Vicki, additional, Oakley, Ed, additional, Greenham, Mardee, additional, Hearps, Stephen, additional, Delzoppo, Carmel, additional, Beauchamp, Miriam H., additional, Hutchison, James S., additional, Guerguerian, Anne-Marie, additional, Boutis, Kathy, additional, and Babl, Franz E., additional

Published
2018
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94. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Author

Maas, Andrew I R, primary, Menon, David K, additional, Adelson, P David, additional, Andelic, Nada, additional, Bell, Michael J, additional, Belli, Antonio, additional, Bragge, Peter, additional, Brazinova, Alexandra, additional, Büki, András, additional, Chesnut, Randall M, additional, Citerio, Giuseppe, additional, Coburn, Mark, additional, Cooper, D Jamie, additional, Crowder, A Tamara, additional, Czeiter, Endre, additional, Czosnyka, Marek, additional, Diaz-Arrastia, Ramon, additional, Dreier, Jens P, additional, Duhaime, Ann-Christine, additional, Ercole, Ari, additional, van Essen, Thomas A, additional, Feigin, Valery L, additional, Gao, Guoyi, additional, Giacino, Joseph, additional, Gonzalez-Lara, Laura E, additional, Gruen, Russell L, additional, Gupta, Deepak, additional, Hartings, Jed A, additional, Hill, Sean, additional, Jiang, Ji-yao, additional, Ketharanathan, Naomi, additional, Kompanje, Erwin J O, additional, Lanyon, Linda, additional, Laureys, Steven, additional, Lecky, Fiona, additional, Levin, Harvey, additional, Lingsma, Hester F, additional, Maegele, Marc, additional, Majdan, Marek, additional, Manley, Geoffrey, additional, Marsteller, Jill, additional, Mascia, Luciana, additional, McFadyen, Charles, additional, Mondello, Stefania, additional, Newcombe, Virginia, additional, Palotie, Aarno, additional, Parizel, Paul M, additional, Peul, Wilco, additional, Piercy, James, additional, Polinder, Suzanne, additional, Puybasset, Louis, additional, Rasmussen, Todd E, additional, Rossaint, Rolf, additional, Smielewski, Peter, additional, Söderberg, Jeannette, additional, Stanworth, Simon J, additional, Stein, Murray B, additional, von Steinbüchel, Nicole, additional, Stewart, William, additional, Steyerberg, Ewout W, additional, Stocchetti, Nino, additional, Synnot, Anneliese, additional, Te Ao, Braden, additional, Tenovuo, Olli, additional, Theadom, Alice, additional, Tibboel, Dick, additional, Videtta, Walter, additional, Wang, Kevin K W, additional, Williams, W Huw, additional, Wilson, Lindsay, additional, Yaffe, Kristine, additional, Adams, Hadie, additional, Agnoletti, Vanni, additional, Allanson, Judith, additional, Amrein, Krisztina, additional, Andaluz, Norberto, additional, Anke, Audny, additional, Antoni, Anna, additional, van As, Arjan Bastiaan, additional, Audibert, Gérard, additional, Azaševac, Antun, additional, Azouvi, Philippe, additional, Azzolini, Maria Luisa, additional, Baciu, Camelia, additional, Badenes, Rafael, additional, Barlow, Karen M, additional, Bartels, Ronald, additional, Bauerfeind, Ursula, additional, Beauchamp, Miriam, additional, Beer, Darcy, additional, Beer, Ronny, additional, Belda, Francisco Javier, additional, Bellander, Bo-Michael, additional, Bellier, Rémy, additional, Benali, Habib, additional, Benard, Thierry, additional, Beqiri, Valzerda, additional, Beretta, Luigi, additional, Bernard, Francis, additional, Bertolini, Guido, additional, Bilotta, Federico, additional, Blaabjerg, Morten, additional, den Boogert, Hugo, additional, Boutis, Kathy, additional, Bouzat, Pierre, additional, Brooks, Brian, additional, Brorsson, Camilla, additional, Bullinger, Monika, additional, Burns, Emma, additional, Calappi, Emiliana, additional, Cameron, Peter, additional, Carise, Elsa, additional, Castaño-León, Ana M, additional, Causin, Francesco, additional, Chevallard, Giorgio, additional, Chieregato, Arturo, additional, Christie, Brian, additional, Cnossen, Maryse, additional, Coles, Jonathan, additional, Collett, Johnny, additional, Della Corte, Francesco, additional, Craig, William, additional, Csato, Gabor, additional, Csomos, Akos, additional, Curry, Nicola, additional, Dahyot-Fizelier, Claire, additional, Dawes, Helen, additional, DeMatteo, Carol, additional, Depreitere, Bart, additional, Dewey, Deborah, additional, van Dijck, Jeroen, additional, Đilvesi, Đula, additional, Dippel, Diederik, additional, Dizdarevic, Kemal, additional, Donoghue, Emma, additional, Duek, Or, additional, Dulière, Guy-Loup, additional, Dzeko, Adelaida, additional, Eapen, George, additional, Emery, Carolyn A, additional, English, Shane, additional, Esser, Patrick, additional, Ezer, Erzsébet, additional, Fabricius, Martin, additional, Feng, Junfeng, additional, Fergusson, Dean, additional, Figaji, Anthony, additional, Fleming, Joanne, additional, Foks, Kelly, additional, Francony, Gilles, additional, Freedman, Stephen, additional, Freo, Ulderico, additional, Frisvold, Shirin K, additional, Gagnon, Isabelle, additional, Galanaud, Damien, additional, Gantner, Dashiell, additional, Giraud, Benoit, additional, Glocker, Ben, additional, Golubovic, Jagoš, additional, Gómez López, Pedro A, additional, Gordon, Wayne A, additional, Gradisek, Primoz, additional, Gravel, Jocelyn, additional, Griesdale, Donald, additional, Grossi, Francesca, additional, Haagsma, Juanita A, additional, Håberg, Asta Kristine, additional, Haitsma, Iain, additional, Van Hecke, Wim, additional, Helbok, Raimund, additional, Helseth, Eirik, additional, van Heugten, Caroline, additional, Hoedemaekers, Cornelia, additional, Höfer, Stefan, additional, Horton, Lindsay, additional, Hui, Jiyuan, additional, Huijben, Jilske Antonia, additional, Hutchinson, Peter J, additional, Jacobs, Bram, additional, van der Jagt, Mathieu, additional, Jankowski, Stefan, additional, Janssens, Koen, additional, Jelaca, Bojan, additional, Jones, Kelly M, additional, Kamnitsas, Konstantinos, additional, Kaps, Rafael, additional, Karan, Mladen, additional, Katila, Ari, additional, Kaukonen, Kirsi-Maija, additional, De Keyser, Véronique, additional, Kivisaari, Riku, additional, Kolias, Angelos G, additional, Kolumbán, Bálint, additional, Kolundžija, Ksenija, additional, Kondziella, Daniel, additional, Koskinen, Lars-Owe, additional, Kovács, Noémi, additional, Kramer, Andreas, additional, Kutsogiannis, Demitri, additional, Kyprianou, Theodoros, additional, Lagares, Alfonso, additional, Lamontagne, François, additional, Latini, Roberto, additional, Lauzier, François, additional, Lazar, Isaac, additional, Ledig, Christian, additional, Lefering, Rolf, additional, Legrand, Valerie, additional, Levi, Leon, additional, Lightfoot, Roger, additional, Lozano, Angels, additional, MacDonald, Stephen, additional, Major, Sebastian, additional, Manara, Alex, additional, Manhes, Pauline, additional, Maréchal, Hugues, additional, Martino, Costanza, additional, Masala, Alessandro, additional, Masson, Serge, additional, Mattern, Julia, additional, McFadyen, Bradford, additional, McMahon, Catherine, additional, Meade, Maureen, additional, Melegh, Béla, additional, Menovsky, Tomas, additional, Moore, Lynne, additional, Morgado Correia, Marta, additional, Morganti-Kossmann, Maria Cristina, additional, Muehlan, Holger, additional, Mukherjee, Pratik, additional, Murray, Lynnette, additional, van der Naalt, Joukje, additional, Negru, Ancuta, additional, Nelson, David, additional, Nieboer, Daan, additional, Noirhomme, Quentin, additional, Nyirádi, József, additional, Oddo, Mauro, additional, Okonkwo, David O, additional, Oldenbeuving, Annemarie W, additional, Ortolano, Fabrizio, additional, Osmond, Martin, additional, Payen, Jean-François, additional, Perlbarg, Vincent, additional, Persona, Paolo, additional, Pichon, Nicolas, additional, Piippo-Karjalainen, Anna, additional, Pili-Floury, Sébastien, additional, Pirinen, Matti, additional, Ple, Horia, additional, Poca, Maria Antonia, additional, Posti, Jussi, additional, Van Praag, Dominique, additional, Ptito, Alain, additional, Radoi, Andreea, additional, Ragauskas, Arminas, additional, Raj, Rahul, additional, Real, Ruben G L, additional, Reed, Nick, additional, Rhodes, Jonathan, additional, Robertson, Claudia, additional, Rocka, Saulius, additional, Røe, Cecilie, additional, Røise, Olav, additional, Roks, Gerwin, additional, Rosand, Jonathan, additional, Rosenfeld, Jeffrey V, additional, Rosenlund, Christina, additional, Rosenthal, Guy, additional, Rossi, Sandra, additional, Rueckert, Daniel, additional, de Ruiter, Godard C W, additional, Sacchi, Marco, additional, Sahakian, Barbara J, additional, Sahuquillo, Juan, additional, Sakowitz, Oliver, additional, Salvato, Gerardo, additional, Sánchez-Porras, Renán, additional, Sándor, János, additional, Sangha, Grinder, additional, Schäfer, Nadine, additional, Schmidt, Silke, additional, Schneider, Kathryn J, additional, Schnyer, David, additional, Schöhl, Herbert, additional, Schoonman, Guus G, additional, Schou, Rico Frederik, additional, Sir, Özcan, additional, Skandsen, Toril, additional, Smeets, Dirk, additional, Sorinola, Abayomi, additional, Stamatakis, Emmanuel, additional, Stevanovic, Ana, additional, Stevens, Robert D, additional, Sundström, Nina, additional, Taccone, Fabio Silvio, additional, Takala, Riikka, additional, Tanskanen, Päivi, additional, Taylor, Mark Steven, additional, Telgmann, Ralph, additional, Temkin, Nancy, additional, Teodorani, Guido, additional, Thomas, Matt, additional, Tolias, Christos M, additional, Trapani, Tony, additional, Turgeon, Alexis, additional, Vajkoczy, Peter, additional, Valadka, Alex B, additional, Valeinis, Egils, additional, Vallance, Shirley, additional, Vámos, Zoltán, additional, Vargiolu, Alessia, additional, Vega, Emmanuel, additional, Verheyden, Jan, additional, Vik, Anne, additional, Vilcinis, Rimantas, additional, Vleggeert-Lankamp, Carmen, additional, Vogt, Lidia, additional, Volovici, Victor, additional, Voormolen, Daphne C, additional, Vulekovic, Peter, additional, Vande Vyvere, Thijs, additional, Van Waesberghe, Julia, additional, Wessels, Lars, additional, Wildschut, Eno, additional, Williams, Guy, additional, Winkler, Maren K L, additional, Wolf, Stefan, additional, Wood, Gordon, additional, Xirouchaki, Nektaria, additional, Younsi, Alexander, additional, Zaaroor, Menashe, additional, Zelinkova, Veronika, additional, Zemek, Roger, additional, and Zumbo, Fabrizio, additional

Published
2017
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96. Multicentre, randomised clinical trial of paediatric concussion assessment of rest and exertion (PedCARE): a study to determine when to resume physical activities following concussion in children

Author

Ledoux, Andrée-Anne, primary, Barrowman, Nicholas J, additional, Boutis, Kathy, additional, Davis, Adrienne, additional, Reid, Sarah, additional, Sangha, Gurinder, additional, Farion, Ken J, additional, Belanger, Kevin, additional, Tremblay, Mark S, additional, Yeates, Keith Owen, additional, DeMatteo, Carol, additional, Reed, Nick, additional, and Zemek, Roger, additional

Published
2017
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98. The Stability of Retrospective Pre-injury Symptom Ratings Following Pediatric Concussion.

Author

Teel, Elizabeth F., Zemek, Roger L., Tang, Kenneth, Gioia, Gerard, Vaughan, Christopher, Sady, Maegan, Gagnon, Isabelle J., Osmond, Martin H., Barrowman, Nick, Freedman, Stephen B., Gravel, Jocelyn, Sangha, Gurinder, Boutis, Kathy, Beer, Darcy, Craig, William, Burns, Emma, and Farion, Ken J.

Subjects
BRAIN concussion, CLINICAL trial registries, HOSPITAL emergency services, ADOLESCENCE, PEDIATRIC emergencies
Abstract

Objective: To determine the stability of children's retrospective ratings of pre-injury levels of symptoms over time following concussion. Methods: Children and adolescents (n = 3,063) between the ages of 5–17 diagnosed with a concussion by their treating pediatric emergency department (PED) physician within 48 h of injury completed the Post-Concussion Symptom Inventory (PCSI) at the PED and at 1, 2, 4, 8, and 12-weeks post-injury. At each time point, participants retrospectively recalled their pre-injury levels of post-injury symptoms. The PCSI has three age-appropriate versions for children aged 5–7 (PCSI-SR5), 8–12 (PCSI-SR8), and 13–18 (PCSI-SR13). Total scale, subscales (physical, cognitive, emotional, and sleep), and individual items from the PCSI were analyzed for stability using Gini's mean difference (GMD). Results: The mean GMD for total score was 0.31 (95% CI = 0.28, 0.34) for the PCSI-SR5, 0.19 (95% CI = 0.18, 0.20) for the PCSI-SR8, and 0.17 (95% CI = 0.16, 0.18) for the PCSI-SR13. Subscales ranged from mean GMD 0.18 (physical) to 0.31 (emotional) for the PCSI-SR8 and 0.16 (physical) to 0.31 (fatigue) for the PCSI-SR13. At the item-level, mean GMD ranged from 0.13 to 0.60 on the PCSI-SR5, 0.08 to 0.59 on the PCSI-SR8, and 0.11 to 0.41 on the PCSI-SR13. Conclusions: Children and adolescents recall their retrospective pre-injury symptom ratings with good-to-perfect stability over the first 3-months following their concussion. Although some individual items underperformed, variability was reduced as items were combined at the subscale and full-scale level. There is limited benefit gained from collecting multiple pre-injury symptom queries. Clinical Trial Registration: Clinicaltrials.gov through the US National Institute of Health/National Library of Medicine. (NCT01873287; http://clinicaltrials.gov/ct2/show/NCT01873287). [ABSTRACT FROM AUTHOR]

Published
2019
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99. Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study.

Author

Yeates, Keith Owen, Tang, Kenneth, Barrowman, Nick, Freedman, Stephen B., Gravel, Jocelyn, Gagnon, Isabelle, Sangha, Gurinder, Boutis, Kathy, Beer, Darcy, Craig, William, Burns, Emma, Farion, Ken J., Mikrogianakis, Angelo, Barlow, Karen, Dubrovsky, Alexander S., Meeuwisse, Willem, Gioia, Gerard, Meehan, William P., Beauchamp, Miriam H., and Kamil, Yael

Published
2019
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100. Predicting Wellness After Pediatric Concussion.

Author

Beauchamp, Miriam H., Tang, Ken, Yeates, Keith Owen, Anderson, Peter, Brooks, Brian L., Keightley, Michelle, Désiré, Naddley, Boutis, Kathy, Gagnon, Isabelle, Gravel, Jocelyn, Dubrovsky, Alexander Sasha, and Zemek, Roger

Subjects
HOSPITAL emergency services, NEUROPSYCHOLOGICAL tests, ADOLESCENCE, QUALITY of life, SHORT-term memory
Abstract

Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome ("wellness") after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS , 2019, 25 , 375–389) [ABSTRACT FROM AUTHOR]

Published
2019
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