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Incidence of delayed intracranial hemorrhage in children after uncomplicated minor head injuries.

https://arctichealth.org/en/permalink/ahliterature142701
Source
Pediatrics. 2010 Jul;126(1):e33-9
Publication Type
Article
Date
Jul-2010
Author
Mark Hamilton
Martin Mrazik
David W Johnson
Author Affiliation
Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Source
Pediatrics. 2010 Jul;126(1):e33-9
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Alberta - epidemiology
Child
Child, Preschool
Cohort Studies
Confidence Intervals
Craniocerebral Trauma - complications - diagnosis
Delayed Diagnosis - trends
Emergency Service, Hospital
Female
Follow-Up Studies
Glasgow Coma Scale
Humans
Incidence
Injury Severity Score
Intracranial Hemorrhages - diagnosis - epidemiology - etiology
Male
Neurologic Examination - methods
Probability
Retrospective Studies
Risk assessment
Sex Distribution
Tomography, X-Ray Computed
Abstract
This study sought to determine the incidence of delayed diagnosis of intracranial hemorrhage in the general population and the proportion of children who presented to emergency departments (EDs) with uncomplicated minor head injuries who received delayed diagnoses of intracranial hemorrhage.
This was an 8-year, retrospective, cohort study of children or =6 hours after injury) were identified.
An estimated 17,962 children (95% confidence interval [CI]: 17,412-18,511 children) with uncomplicated minor head injuries were evaluated at Calgary Health Region EDs. Two and 8 children were identified as having delayed diagnoses of intracranial hemorrhage with and without delayed deterioration in level of consciousness (Glasgow Coma Scale scores of
PubMed ID
20566618 View in PubMed
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The frequency of complications associated with the use of multiple-dose activated charcoal.

https://arctichealth.org/en/permalink/ahliterature186505
Source
Ann Emerg Med. 2003 Mar;41(3):370-7
Publication Type
Article
Date
Mar-2003
Author
Catherine L Dorrington
David W Johnson
Rollin Brant
Author Affiliation
Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Source
Ann Emerg Med. 2003 Mar;41(3):370-7
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Charcoal - administration & dosage - adverse effects
Child
Child, Preschool
Cohort Studies
Cornea - injuries
Female
Humans
Hypernatremia - epidemiology - etiology
Infant
Intestinal Obstruction - epidemiology - etiology
Magnesium - blood
Male
Middle Aged
Multicenter Studies as Topic
Pneumonia, Aspiration - epidemiology - etiology
Poisoning - therapy
Retrospective Studies
United States - epidemiology
Abstract
The objective of this study was to determine the frequency of complications associated with the use of multiple-dose activated charcoal.
The study population was drawn from 8 tertiary care hospitals in 4 North American cities. Medical records of all inpatients between March 1993 and March 1998 with a discharge diagnosis of poisoning (International Classification of Diseases, 9th edition, Clinical Modification codes 960-989.9) were reviewed to select patients who had received multiple-dose activated charcoal (defined as > or =2 doses administered within 12 hours). Medical records of patients who received multiple-dose activated charcoal were reviewed for patient demographics and clinical information regarding the occurrence of pulmonary aspiration, gastrointestinal obstruction, hypernatremia, hypermagnesemia, corneal abrasion, and other complications associated with the use of multiple-dose activated charcoal.
We reviewed 6,258 medical records, identifying 878 patients who received multiple-dose activated charcoal. We judged 5 (0.6%; 95% confidence interval [CI] 0.1% to 1.1%) patients to have had clinically significant pulmonary aspiration and none (0%; upper 95% CI 0.3%) to have had gastrointestinal obstruction. None of the patients with pulmonary aspiration died or had residual sequelae recorded. Hypernatremia (peak serum sodium >145 mEq/L [145 mmol/L]) was documented in 53 (6.0%; 95% CI 4.4% to 7.6%) patients, of whom 5 (0.6%; 95% CI 0.1% to 1.1%) had a serum sodium concentration of greater than 155 mEq/L (155 mmol/L). Hypermagnesemia (peak serum magnesium >2.5 mg/dL [1.0 mmol/L]) was documented in 27 (3.1%; 95% CI 2.0% to 4.2%) patients, of whom 3 (0.3%; 95% CI 0.1% to 1.0%) had peak values that were greater than 3.75 mg/dL (1.5 mmol/L). One patient had a corneal abrasion (0.1%; 95% CI 0% to 0.6%). No other complications were identified.
Clinically significant complications associated with the use of multiple-dose activated charcoal occur infrequently.
Notes
Comment In: Ann Emerg Med. 2003 Oct;42(4):597-8; author reply 598-914533638
PubMed ID
12605204 View in PubMed
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Current practice and tolerance for risk in performing procedural sedation and analgesia on children who have not met fasting guidelines: a Canadian survey using a stated preference discrete choice experiment.

https://arctichealth.org/en/permalink/ahliterature138455
Source
Acad Emerg Med. 2010 Nov;17(11):1207-15
Publication Type
Article
Date
Nov-2010
Author
Maala Bhatt
Gillian R Currie
M Christopher Auld
David W Johnson
Author Affiliation
Department of Pediatrics, Montreal Children's Hospital McGill University, Quebec, Canada. maala.bhatt@muhc.mcgill.ca
Source
Acad Emerg Med. 2010 Nov;17(11):1207-15
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Analgesia - adverse effects
Canada
Conscious Sedation - adverse effects
Cross-Sectional Studies
Decision Making
Emergency Service, Hospital
Fasting
Female
Guideline Adherence - statistics & numerical data
Humans
Ketamine - adverse effects - therapeutic use
Male
Pediatrics - methods - standards
Practice Guidelines as Topic
Questionnaires
Regression Analysis
Risk assessment
Time Factors
Abstract
The objectives were to explore the tolerance of pediatric emergency medicine (PEM) physicians for risk in choosing when to perform procedural sedation and analgesia (PSA) and to describe adherence to preprocedural fasting guidelines and factors affecting the physicians' decisions.
A survey of Canadian PEM physicians who perform PSA was conducted. Respondents were asked about their PSA practices. Risk tolerance was assessed using an economics-based stated preference elicitation method called a discrete choice experiment (DCE). Using a hypothetical clinical situation of a healthy child needing PSA, three fasting scenarios (ingestion of full meal
PubMed ID
21175519 View in PubMed
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Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments.

https://arctichealth.org/en/permalink/ahliterature188313
Source
Pediatrics. 2002 Oct;110(4):e49
Publication Type
Article
Date
Oct-2002
Author
David W Johnson
Carol Adair
Rollin Brant
Joanne Holmwood
Ian Mitchell
Author Affiliation
Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. david.johnson@calgaryhealthregion.ca
Source
Pediatrics. 2002 Oct;110(4):e49
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Bronchiolitis - diagnosis - epidemiology - therapy
Child
Cohort Studies
Comorbidity
Cross-Sectional Studies
Emergency Service, Hospital - statistics & numerical data - utilization
Hospital Administration - methods - statistics & numerical data
Humans
Patient Admission - statistics & numerical data
Pediatrics - methods - statistics & numerical data
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Abstract
It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.
Retrospective cohort review of emergency department visits from April 1992 to March 1997.
Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses approximately 850 000 people.
All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).
Population-standardized estimates of admission rates.
The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, population-standardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.
Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments.
PubMed ID
12359822 View in PubMed
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Suspected peritonsillar abscess in children.

https://arctichealth.org/en/permalink/ahliterature162165
Source
Pediatr Emerg Care. 2007 Jul;23(7):431-8
Publication Type
Article
Date
Jul-2007
Author
Kelly R Millar
David W Johnson
Derek Drummond
James D Kellner
Author Affiliation
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. Kelly.Millar@CalgaryHealthRegion.ca
Source
Pediatr Emerg Care. 2007 Jul;23(7):431-8
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenal Cortex Hormones - therapeutic use
Age Distribution
Alberta - epidemiology
Ambulatory Care
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Peritonsillar Abscess - drug therapy - epidemiology - physiopathology
Recurrence
Retrospective Studies
Abstract
(1) To describe the demographic features and clinical course of children diagnosed with suspected peritonsillar abscess (PTA), (2) to determine the incidence of suspected and confirmed PTA in children younger than 18 years, and (3) to examine the factors associated with corticosteroid use and outpatient management of suspected PTA.
We conducted a population-based, retrospective chart review. The study was conducted within the Calgary Health Region (CHR). Patients met inclusion criteria if they were younger than 18 years, resided in the CHR, and were diagnosed with PTA (International Classification of Diseases, Ninth Revision 475) in the CHR between March 1994 and December 2001.
We identified 229 children (cases) who presented with 249 unique episodes of suspected PTA. The incidence of suspected PTA among children in the CHR was 14 cases per 100,000 person-years at risk. The incidence was highest among adolescents (40 cases per 100,000 person-years). The incidence of confirmed PTA was 3 cases per 100,000 person-years at risk. Among those with suspected PTA, surgical intervention, intravenous antibiotics, and corticosteroids were provided to 34%, 87%, and 37%, respectively. One hundred fifty-seven patients (69%) were initially managed as outpatients. Of these, 12 (8%) had subsequent uncomplicated hospital admissions.
Peritonsillar abscess is primarily a problem of adolescence, but the disease does occur in young children. Corticosteroid use was common but without either clear benefit or adverse outcomes. Two thirds of patients were managed as outpatients without any apparent increase in adverse outcomes.
PubMed ID
17666922 View in PubMed
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Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol.

https://arctichealth.org/en/permalink/ahliterature128460
Source
Implement Sci. 2011;6:133
Publication Type
Article
Date
2011
Author
Shannon D Scott
Jeremy Grimshaw
Terry P Klassen
Alberto Nettel-Aguirre
David W Johnson
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. shannon.scott@ualberta.ca
Source
Implement Sci. 2011;6:133
Date
2011
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Child
Child Welfare
Child, Preschool
Clinical Protocols
Cooperative Behavior
Critical Pathways
Data Collection
Decision Making
Focus Groups
Guideline Adherence - statistics & numerical data
Humans
Organizational Innovation
Pediatrics - methods - standards
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Qualitative Research
Abstract
Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT). Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation.
Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT) survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG) and clinical pathways (CPs) uptake based upon the cross-case comparisons.
This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.
Notes
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PubMed ID
22204440 View in PubMed
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The treatment of pediatric gastroenteritis: a comparative analysis of pediatric emergency physicians' practice patterns.

https://arctichealth.org/en/permalink/ahliterature138383
Source
Acad Emerg Med. 2011 Jan;18(1):38-45
Publication Type
Article
Date
Jan-2011
Author
Stephen B Freedman
Vithika Sivabalasundaram
Vanessa Bohn
Elizabeth C Powell
David W Johnson
Kathy Boutis
Author Affiliation
Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. stephen.freedman@sickkids.ca
Source
Acad Emerg Med. 2011 Jan;18(1):38-45
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Antiemetics - therapeutic use
Canada
Child
Child, Preschool
Cross-Sectional Studies
Emergency Medicine - standards
Emergency Service, Hospital - standards
Fluid Therapy - methods - utilization
Gastroenteritis - therapy
Humans
Infant
Ondansetron - therapeutic use
Pediatrics - standards
Physician's Practice Patterns - standards
Probiotics - therapeutic use
United States
Abstract
Acute gastroenteritis is a very common emergency department (ED) diagnosis accounting for greater than 1.5 million outpatient visits and 200,000 hospitalizations annually among children in the United States. Although guidelines exist to assist clinicians, they do not clearly address topics for which evidence is new or limited, including the use of antiemetic agents, probiotics, and intravenous (IV) fluid rehydration regimens. This study sought to describe the ED treatments administered to children with acute gastroenteritis and to compare management between Canadian and U.S. physicians practicing pediatric emergency medicine (PEM).
Members of PEM research networks located in Canada and the United States were invited to participate in a cross-sectional, Internet-based survey. Participants were included if they are attending physicians and provide care to patients
PubMed ID
21182566 View in PubMed
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Practice patterns in asthma discharge pharmacotherapy in pediatric emergency departments: a pediatric emergency research Canada study.

https://arctichealth.org/en/permalink/ahliterature120704
Source
Acad Emerg Med. 2012 Sep;19(9):E1019-26
Publication Type
Article
Date
Sep-2012
Author
Suzanne Schuh
Roger Zemek
Amy Plint
Karen J L Black
Stephen Freedman
Robert Porter
Serge Gouin
David W Johnson
Author Affiliation
Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
Source
Acad Emerg Med. 2012 Sep;19(9):E1019-26
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Administration, Oral
Adolescent
Adrenal Cortex Hormones - administration & dosage
Age Factors
Albuterol - administration & dosage
Anti-Asthmatic Agents - administration & dosage
Asthma - diagnosis - drug therapy
Canada
Child
Child, Preschool
Cohort Studies
Confidence Intervals
Continuity of Patient Care
Databases, Factual
Emergency Medicine - standards - trends
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Length of Stay
Male
Metered Dose Inhalers
Odds Ratio
Patient Discharge
Physician's Practice Patterns
Retrospective Studies
Risk assessment
Severity of Illness Index
Sex Factors
Treatment Outcome
Abstract
The objective was to examine utilization of ß2 agonists via metered dose inhalers with oral and inhaled corticosteroids (ICS) at discharge in children with acute asthma.
This was a retrospective medical record review at six pediatric emergency departments (EDs) of otherwise healthy children 2 to 17 years of age discharged with acute asthma. Data were extracted on history, disease severity, and pharmacotherapy used in the ED and at discharge. The primary outcome was the proportion of children prescribed "comprehensive therapy," i.e., albuterol via metered dose inhaler (MDI) with oral and ICS.
The overall rate of comprehensive therapy was 382 of 654 (58%), which varied from 30% to 84% (p
PubMed ID
22978728 View in PubMed
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A 4-year review of pediatric mental health emergencies in Alberta.

https://arctichealth.org/en/permalink/ahliterature148300
Source
CJEM. 2009 Sep;11(5):447-54
Publication Type
Article
Date
Sep-2009
Author
Amanda S Newton
Samina Ali
David W Johnson
Christina Haines
Rhonda J Rosychuk
Rachel A Keaschuk
Philip Jacobs
Terry P Klassen
Author Affiliation
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta. mandi.newton@ualberta.ca
Source
CJEM. 2009 Sep;11(5):447-54
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Alberta - epidemiology
Analysis of Variance
Child
Child, Preschool
Emergencies
Emergency Service, Hospital - utilization
Humans
Infant
Mental Disorders - epidemiology
Risk factors
Abstract
We sought to determine and compare rates of pediatric mental health presentations and associated costs in emergency departments (EDs) in Alberta.
We examined 16 154 presentations by 12 589 patients (patient age
PubMed ID
19788789 View in PubMed
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Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care.

https://arctichealth.org/en/permalink/ahliterature144414
Source
Acad Emerg Med. 2010 Feb;17(2):177-86
Publication Type
Article
Date
Feb-2010
Author
Amanda S Newton
Samina Ali
David W Johnson
Christina Haines
Rhonda J Rosychuk
Rachel A Keaschuk
Philip Jacobs
Mario Cappelli
Terry P Klassen
Author Affiliation
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. mandi.newton@ualberta.ca
Source
Acad Emerg Med. 2010 Feb;17(2):177-86
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Alberta
Child
Child, Preschool
Emergency Service, Hospital - utilization
Female
Hospitals, General - statistics & numerical data
Hospitals, Pediatric
Humans
Infant
Logistic Models
Male
Mental Health Services - organization & administration - statistics & numerical data
Mood Disorders
Multivariate Analysis
Retrospective Studies
Triage
Abstract
The objective of this study was to investigate predictors of emergency department (ED) return visits for pediatric mental health care. The authors hypothesized that through the identification of clinical and health system variables that predict return ED visits, which children and adolescents would benefit from targeted interventions for persistent mental health needs could be determined.
Data on 16,154 presentations by 12,589 pediatric patients (
PubMed ID
20370747 View in PubMed
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17 records – page 1 of 2.