bluuebunny/crossref_metadata_2025_split huggingface dataset:
58 Overweight and obesity in children with autism spectrum disorder: Findings from primary care electronic medical records
Authors: Kinlin Laura M , Carsley Sarah , Keown-Stoneman Charles , Saunders Natasha , Tu Karen , Zwaigenbaum Lonnie , Birken Catherine S 
Published: August 2020

Abstract

Introduction/Background
Paediatric overweight and obesity are important public health problems worldwide. Children with autism spectrum disorder (ASD) may be at increased risk compared to their typically-developing peers; however, prevalence estimates in ASD have varied widely and existing studies have largely been limited by use of an external comparison group.

Objectives
To compare prevalence of overweight and obesity in children and youth (&lt;19 years of age) with and without ASD, using electronic medical record data from paediatric primary care visits.

Design/Methods
This was a cross-sectional analysis of EMRPC (Electronic Medical Records Primary Care) data, representing 385 family physicians in 43 clinics in Ontario, Canada. Age- and sex-standardized body mass index (BMI) z-scores were calculated using abstracted heights and weights from the most recent visit between January 2011 and December 2015. Weight status was determined using World Health Organization growth reference standards. ASD was defined using a previously-validated algorithm in EMRPC, based on an ASD-related term in the ‘Cumulative Patient Profile.’ Chi-square test statistics and multinomial logistic regression were used to compare weight status of those with and without ASD.

Results
In total, 44,625 children and youth were included, 632 [1.42%] with ASD. Distribution of weight status was significantly different between those with and without ASD (p&lt;0.001) [Table 1]. Compared to their typically-developing peers, children with ASD had significantly higher odds of overweight (unadjusted odds ratio [OR] 1.52; 95% confidence interval [CI] 1.24-1.87), obesity (unadjusted OR 2.55 (2.00-3.26) and severe obesity (unadjusted OR 3.09; 95% CI 2.08-4.60); these associations persisted after adjusting for sex, age, neighborhood income quintile and rural residence (Table 2).

Conclusion
Data from a large primary care database suggest that children with ASD are at substantially increased risk of overweight, obesity and severe obesity. Findings support the need for anticipatory guidance, prevention and management strategies specific to this clinical population. Future work will aim to better understand at what age differences in weight status emerge, and what nutritional, behavioural, or medical factors differentially affect weight status in the ASD population.
62 Nutritional assessment of children in Hartley Bay (Gitga’at), BC
Authors: McIntyre Jen , Karakochuk Crystal , Meuter Christa , Duffy Damian , Sauvé Laura 
Published: August 2020

Abstract

Background
Hartley Bay is a small, remote Gitga’at community. As part of “Brighter Smiles”, a multidisciplinary child health partnership between the Gitga’at Nation and BC Children’s Hospital, the community requested a quality assurance project to describe the nutritional status of its children and assess the impact of the existing school based nutrition program.

Objectives
The community wished to explore ways in which the existing nutrition program could be optimized to further meet the nutritional needs of its children in terms of macronutrient, micronutrient and meal content and to explore food beliefs and values.

Design/Methods
Gitga’at health leadership guided the design of the study and community approval was sought at an early stage. All Hartley Bay families with children aged 5-18 were invited to participate. With the support of the teachers, a 24-hour dietary recall survey was completed online during school time using the WEB-Q software program. Nutritional information was then analyzed and compared. Anthropometric data (heights, weights, BMI and blood pressures) were collected during routine clinic visits in September 2018, compared with population based norms and analyzed.

Results
Anthropometric data was collected for 23/30 school aged children. In terms of anthropometrics, 45.5% of girls and 16.7% of boys had a body mass index (BMI) in the healthy range (3rd-85th percentile). Results showed 18.2% girls and 25% of boys had a BMI in the overweight range (85th – 97th percentile), while 36.4% of girls and 58.3% of boys respectively were in the obese or severely obese range. Blood pressures demonstrated that 75% of females and 62.5% of males were normotensive (systolic BC &lt;87%ile). There are many accomplishments of the community highlighted in this study including attitudes towards traditional foods and harvesting, openness to try new foods and spending meal time with family. Four in 18 students were meeting the recommended 5 servings of vegetables/fruits per day. The average intake of sodium for 9-13 year olds was 3g/day (recommended upper limit is 2.2g/day). For 14-18 year olds the average sodium intake was 4.6g/day (recommended upper limit is 2.3g/day). One in 18 students met adequate intake for calcium, 2/18 for fibre and 13/18 for vitamin D. The majority of children in this community are obtaining the recommended percentage energy from fats, carbohydrates and protein.

Conclusion
A significant proportion of Hartley Bay children had anthropometric measurements suggesting they were at risk for long term negative health outcomes. The study also indicated areas to improve, with suboptimal micronutrient intake. Successes of the community were also highlighted. The data was presented to Hartley Bay health staff, Elders and community members so that it can be used collaboratively by the health staff and community leadership to work on community-designed programs for health promotion.
72 Validating MyHEARTSMAP, an emergency psychosocial self-assessment and management tool, among youth with minor traumatic brain injuries or minor orthopaedic injuries seen in the Paediatric Emergency Department
Authors: Lamoureux Erik , Ishikawa Takuro , Yeates Keith , Beauchamp Miriam , Craig William , Gravel Jocelyn , Zemek Roger , Doan Quynh 
Published: August 2020

Abstract

Background
Fewer than 20% of the estimated 1.2 million Canadian youths living with mental health (MH) concerns receive adequate care. Paediatric emergency department (PED) visits related to MH are increasing across North America. The online self-assessment tool, MyHEARTSMAP, was developed to facilitate screening of MH concerns in the PED and general practice. MyHEARTSMAP assesses 10 psychosocial areas, mapping to four domains of MH (Psychiatry, Function, Social, and Youth Health) to provide domain-specific recommendations for patient management (Figure A).

Objectives
We evaluated the convergent validity of MyHEARTSMAP when compared to established psychosocial self-assessment tools: Paediatric Quality of Life (PedsQL) and Strengths and Difficulties Questionnaire (SDQ).

Design/Methods
We conducted a cross-sectional study among youths and parents enrolled in a larger cohort study: Advancing Concussion Assessment in Paediatrics (A-CAP). Participants were children aged 8 to 16 years old with mild traumatic brain injury or orthopaedic injury and their parents. Participants were recruited from two PEDs in Alberta and British Columbia and were asked to complete MyHEARTSMAP, in addition to the PedsQL and SDQ completed in their A-CAP study procedures. We evaluated three MH domains from MyHEARTSMAP (PSYCHIATRY FUNCTION, AND SOCIAL) to their corresponding score sections in PedsQL (EMOTIONAL, SCHOOL, and SOCIAL) and SDQ (EMOTIONAL, none, and CONDUCT and PEER). We calculated Pearson correlation coefficients between these corresponding domains and sections.

Results
We recruited 40 child and parent pairs from Alberta and 82 from BC. The children were on average aged 12.6 years old (SD 2.2) and 44% were female. The tools screened participants as “at-risk” for various MH concerns at a rate of 26.7% to 60.8% for MyHEARTSMAP, 2.5% to 13.9% for PedsQL, and 12.3% to 16.0% for SDQ. Overall, MyHEARTSMAP was moderately correlated with PedsQL (mean ±95% CI: r = 0.405±0.151) and SDQ (mean ±95% CI: r = 0.322±0.162). Correlations (±95% CI) by MyHEARTSMAP domain for the child and parent versions, respectively, were as follows: PSYCHIATRY PedsQL (r = 0.483±0.140 / 0.509±0.134) and SDQ (r = 0.417±0.150 / 0.598±0.116); FUNCTION PedsQL (r = 0.578±0.122 / 0.455±0.143); SOCIAL PedsQL (r = 0.249±0.170 / 0.158±0.175) and SDQ (r = 0.207±0.172 / 0.067±0.178).

Conclusion
In conclusion, MyHEARTSMAP PSYCHIATRY and FUNCTION domains have moderate convergent validity to PedsQL and SDQ. Unlike PedsQL and SDQ, the evaluation of social issues in MyHEARTSMAP is MH-specific, resulting in low convergent validity for the SOCIAL domain.
75 Paediatric Cannabinoid Hyperemesis Syndrome in the Emergency Department: a 5-year Retrospective Review
Authors: Foster Daniel , Van Aarsen Kristine , Yan Justin , Teefy John , Lynch Tim 
Published: August 2020

Abstract

Background
Cannabinoid Hyperemesis Syndrome (CHS) in paediatric patients is poorly characterized. Identification and treatment of adolescents presenting to the emergency department (ED) for suspected CHS is challenging. Given the paucity of literature on paediatric CHS and the recent legalization of cannabis, it is important to gain a better understanding of this disorder.

Objectives
The objective of this study was to describe demographics and ED visit data of paediatric patients presenting to the ED with suspected CHS.

Design/Methods
A retrospective chart review was conducted of paediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one paediatric (annual census 38,500) and one paediatric and adult (annual census 60,000) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant.

Results
A total of 242 patients met criteria for review. Thirty-nine were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female), 87% were triaged as either CTAS-2 or CTAS-3 and 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. Sixty-nine percent of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). Eighty-nine percent of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous fluids, and 22% receiving analgesics. Normal saline was the most used intravenous fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74% (with 31% of these given the formal diagnosis of CHS). Sixty-two percent of patients had another visit to the ED within 30 days (59% of these for similar symptoms).

Conclusion
This study of paediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly 1/3rd. Many received extensive workups and most had multiple clustered visits to the ED.
81 Retropharyngeal and Parapharyngeal Infections in Children
Authors: Ratnapalan Savithiri , Thevaranjan Jeffrey , Diallo Mamadou 
Published: August 2020

Abstract

Background
Retropharyngeal and parapharyngeal infections are uncommon but life-threatening deep neck space bacterial infections that need prompt diagnosis and treatment for good outcomes. The retropharyngeal space contains chains of lymph nodes in young children, that atrophy and involute usually by four to five years of age. As these retropharyngeal nodes drain the nasopharynx, adenoids, posterior paranasal sinuses, and middle ear, they can get infected and suppurate following upper respiratory infections. The retropharyngeal space communicates laterally with the parapharyngeal space.

Objectives
To describe the presentations, diagnosis and management of retropharyngeal and parapharyngeal infections in children presenting to a tertiary care pediatric emergency department.

Design/Methods
A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 2008 to 2018 was performed. Data on demographic information, presenting symptoms, management and outcomes were extracted and analysed.

Results
200 children were identified with retropharyngeal or parapharyngeal abscess during the study period. The median age was 4.04 years (2.54, 5.62): 6.50% were under 1 year of age and 5.50% were between 10-16 years of age. Fever was present in 98.5 % (197) of children, 50% had feeding issues and 36.5% (73) had neck swelling at presentation. CT scans were performed in 74% (147) of children. There were 167 retropharyngeal infections, 19 parapharyngeal infections and 4 patients had both retropharyngeal and parapharyngeal infections. All patients were admitted and treated with parenteral antibiotics, the most common being intravenous Clindamycin (in 134), followed by a combination of Ceftriaxone and Clindamycin (in 44). One third of them (66) underwent surgical drainage.

Conclusion
About 12 % of retropharyngeal and parapharyngeal infections can occur in infants under a year of age or in adolescents. Most paediatric patients with retropharyngeal and parapharyngeal abscesses can be treated non-operatively with parenteral antibiotics and do not require surgery.
84 Impact of young age on outcomes of emergency department procedural sedation
Authors: Schlegelmilch Michael , Bhatt Maala , Roback Mark 
Published: August 2020

Abstract

Background
Procedural sedation in the emergency department (ED) for children undergoing painful procedures is common practice, however little is known about sedation in very young children.

Objectives
We examined the effect of young age on emergency department sedation outcomes.

Design/Methods
This is a secondary analysis of an observational cohort study of children 0-18 years undergoing procedural sedation in six pediatric EDs across Canada. We compared presedation state, indication for sedation, medications, sedation efficacy and four main post-sedation outcomes (serious adverse events (SAE), significant interventions, oxygen desaturation and vomiting) between patients who ≤ 2 years with those &gt; 2 years. Pre-sedation state, medications, indication for sedation and time intervals were summarized using frequency and percentage and compared with chi2 test. Logistic regression was used to examine associations between age group and outcomes.

Results
6295 patients were included: 5349 (85%) were &gt; 2 years and 946 (15%) were ≤ 2 years. Children ≤2 years were sedated most commonly for laceration repair (n=450; 47.6%), orthopedic reduction (165; 17.4%) and abscess incision and drainage (136; 14.4%). Children &gt;2years were sedated most commonly for orthopedic reductions (3983; 74.5%). Ketamine was the most common medication in both groups, but was used most frequently in children ≤ 2 years (80.9% vs 58.9%; p&lt;0.001). There was no difference in the incidence of SAE, significant interventions or oxygen desaturation between age groups, however, children ≤ 2 years were less likely to vomit (Table 1). Young children had decreased odds of a successful sedation (OR 0.48; 95%CI: 0.37 to 0.63). On average, patients ≤ 2 years were sedated for 7 minutes less (74.1 vs 81.0 p&lt;0.001) and discharged 10 minutes sooner (90.1 vs 100.8 p&lt;0.001).

Conclusion
Children ≤ 2 years most commonly received ED sedation for laceration repair using ketamine. Young age was not associated with a significant difference in SAEs, significant intervention or desaturation but was associated with decreased odds of vomiting and of successful sedation.
85 Parent and youth experiences of emergency department care for suspected long bone fractures in children
Authors: Gaucher Nathalie , Trottier Evelyne D , Ridha Zainab , Simard Francois , Duran Brenda , Pinard Celine , Larose Guylaine , D’Arsenault Michael , Angelo Antonio , Janvier Annie 
Published: August 2020

Abstract

Background
Long bone fractures are a frequent reason for visits to the pediatric emergency department (ED) where patients obtain the definitive care they require. Youth are rarely involved in quality assessment and improvement initiatives.

Objectives
To describe parent and youth experiences of their ED care for suspected long bone fractures.

Design/Methods
This prospective survey study of parents/youth consulting a tertiary care pediatric ED used surveys co-constructed by ED clinicians and parent partners. English/French speaking patients aged 10 to 18 years old with suspected long-bone fracture at triage – and their parents – were eligible to complete the survey during their ED stay. Electronic surveys were developed for parents and youth and pre-tested with 12 youth and 14 parents. Descriptive data was generated using SPSS v.25 (IBM Inc.).

Results
Three hundred surveys were distributed to eligible participants from March 2018 to June 2019 and 249 surveys were completed (148 parents, 101 youth). At least one member from 189 families completed a survey. Parents and youth participants had median ages of 44 and 12 years old, respectively. Most patients (98%) had a radiograph as part of their work-up, usually in the ED (76%); Twenty-seven percent were referred with radiographs. Most families (61%) received a diagnosis of long-bone fracture and were referred to orthopaedics for outpatient follow-up. Families’ median length of stay was 4h08min (range 43 min-14h30min). Parents (88mm) and youth (81mm) reported high median satisfaction with their overall ED care on 100 mm visual analog scales. Most parents (81%) and youth (75%) reported receiving just enough information from ED staff, though only half (50%) of the parents received information on how to care for their child at home. More than 90% of parents believed that the ED team treated their child’s pain. Eighty-one percent of youth reported that pain was treated sufficiently although 63% believed it had been treated quickly. Most parents (56%) and youth (72%) reported their ED stay was longer than anticipated; parents’ perceptions did not correlate with ED length of stay on logistic regression (p=0.014), while youth’s did (p=0.009). Few parents (33%) or youth (32%) reported receiving regular information on ED wait times.

Conclusion
Parent and youth perspectives of their ED care are complementary, and both should be considered in patient-oriented quality improvement initiatives.
89 Validation of the Severe Illness Getting Noticed Sooner (SIGNS) for Kids Tool in Children with Severe Illness
Authors: Gray Seth , Middaugh Kristen , Marsot-Shiffman Leah , He Calvin , Tremblay Ciara , Parshuram Christopher 
Published: August 2020

Abstract

Background
Severe illness in children is associated with significant risk of permanent disability, cardiac arrest, and death. The Severe Illness Getting Noticed Sooner (SIGNS) for Kids was created by an expert panel to help parents and other caregivers identify and articulate signs of severe illness to enable timely escalation of care. SIGNS for Kids consists of 5 major items: Behaviour, Breathing, Skin, Fluids, and Response to usually effective treatments. Expert development ensured face validity, however there is no formal validity evidence to suggest the tool can identify children with severe illness.

Objectives
To provide preliminary validity evidence of the sensitivity of the SIGNS criteria as markers of severe illness.

Design/Methods
A retrospective review of paediatric deaths was performed using records from the coroner’s office. Eligible patients had an index event described and were &lt;18 years and &gt;36 weeks gestational age at the time of event, had observations/reports for &gt; 6 hours prior to the index event, and were not in an intensive care unit (ICU) or under anaesthetist supervision. The index events were defined as cardiac arrest, respiratory arrest, intubation, transfer to ICU, interfacility transfer, or urgent surgical procedure. Traumatic events and infants with sudden unexplained death were excluded from analysis. The main outcome was the presence of SIGNS items. Secondary measures were the time before index events that each of the SIGNS were present, and the time to death from the index event. Analyses were descriptive.

Results
Two hundred records were screened. After exclusion of 145 cases with incomplete records or traumatic deaths and 5 infants with sudden unexplained death, the records of 50 children met inclusion criteria. One or more SIGNS criteria were present before index event in 48 (96%). Breathing abnormality n=26 (52%) was the most frequently observed item with a mean (SD) duration of 47 (51) hours prior to index event. Over half (n=28, 56%) had SIGNS documented for ≥24 hours before initial escalation and 42 (84%) died within 48 hours after index event.

Conclusion
Forty-eight of 50 children had SIGNS criteria present before index event, and half had SIGNS present &gt;24 hours. These data provide evidence of the sensitivity of the SIGNS criteria as markers of severe illness. Future studies will focus on establishing specificity and construct validity as well as caregiver usability prior to implementation of the screening tool.
97 Electrocardiographic features at rest and during exercise in young adults born preterm below 30 weeks of gestation
Authors: Gervais Anne-Sophie , Flahault Adrien , Tevy Chan , Bastien-Tardif Camille , Al-Simaani Amy , Cloutier Anik , Thuy Mai Luu , Sylvia Abadir , Anne-Monique Nuyt 
Published: August 2020

Abstract

Introduction/Background
Preterm birth has adverse consequences on the cardiovascular system. Whether premature birth is associated with conduction and repolarisation abnormalities past childhood and into adulthood still needs to be demonstrated. An exercise test could reveal such abnormalities.

Objectives
We aimed to assess electrocardiographic changes, particularly corrected QT (QTc) prolongation, in a cohort of young adults born preterm, at rest and during exercise.

Design/Methods
We analysed the ECG of young adults (23.9±3.1 years) born term (≥37 weeks, n=53) and preterm (&lt;30 weeks, n=49) at rest, peak exercise and 3 minutes into recovery during an exercise test on a cycle ergometer. We measured PR, QRS and QT intervals, calculated the QTc, and determined blood calcium, magnesium, potassium and fasting glucose.

Results
Mean gestational age was 39.7±1.1 and 27.3±1.3 weeks for the term and the preterm groups, respectively. Apart from an increased heart rate at rest in individuals born preterm, no significant difference was found between both groups for any other ECG parameters at rest (Table 1). None of the participants had a severely prolonged QTc (&gt;500ms) at rest; exercise revealed severely prolonged QTc in two participants including one in the preterm group. The use of QT-prolonging medications did not influence ECG parameters in either groups.

Conclusion
We observed no significant difference in electrocardiographic measurements between young adults born preterm and term. Current results do not support avoidance of QT-prolonging medications in individuals born preterm.