bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of injury mechanism with the risk of cervical spine fractures
Authors: Thompson Wendy L. , Stiell Ian G. , Clement Catherine M. , Brison Robert J. ,   Canadian C-Spine Rule Study Group
Published: July 2016

ABSTRACTObjective:A full understanding of an injury event and the mechanical forces involved should be important for predicting specific anatomical patterns of injury. Yet, information on the mechanism of injury is often overlooked as a predictor for specific anatomical injury in clinical decision-making. We measured the relationship between mechanism of injury and risk for cervical spine fracture.Methods:Our case-control study is a secondary analysis of data collected from the Canadian C-Spine Rule (CCR) study. Data were collected from 1996 to 2002 and included patients presenting to the emergency departments of 9 tertiary care centres after sustaining acute blunt trauma to the head or neck. Cases are defined as patients who were categorized in the CCR study with a clinically important cervical spine fracture. Controls had no radiologic evidence of cervical spine injury. Bivariate and multivariate unconditional logistic regression models were used. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).Results:Among the 17 208 patients in the CCR study, 320 (2%) received a diagnosis of a cervical spine fracture. Axial loads, falls, diving incidents and nontraffic motorized vehicle collisions (e.g., collisions involving snowmobiles or all-terrain vehicles) were injury mechanisms that were significantly related to a higher risk of fracture. For motor vehicle collisions, the risk of cervical spine injury increased with the posted speed, being involved in a head-on collision or a rollover, or not wearing a seat belt (p&lt; 0.05). The occurrence of cervical spine fracture was negligible in simple rear-end collisions (1 in 3694 cases; OR 0.015, 95% CI 0.002–0.104]).Conclusion:Our study quantitatively demonstrates the relationship between specific mechanisms of injury and the risk of a cervical spine fracture. A full understanding of the injury mechanism would assist providers of emergency health care in assessing risk for injury in trauma patients.
Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital
Authors: Gravel Jocelyn , Manzano Sergio , Arsenault Michael 
Published: July 2016

ABSTRACTObjective:We evaluated the validity of the Canadian Paediatric Triage and Acuity Scale (Paed-CTAS) for children visiting a pediatric emergency department (ED).Methods:This was a retrospective study evaluating all children who presented to a pediatric university-affiliated ED during a 1-year period. Data were retrieved from the ED database. Information regarding triage and disposition was registered in an ED database by a clerk following patient management. In the absence of a gold standard for triage, admission to hospital, admission to pediatric intensive care unit (PICU) and length of stay (LOS) in the ED were used as surrogate markers of severity. The primary outcome measure was the correlation between triage level (from 1 to 5) and admission to hospital. The correlation between triage level and dichotomous outcomes was evaluated by aχ2test and an analysis of variance (ANOVA) was used to evaluate the association between triage level and ED LOS.Results:Over the 1-year period, 58 529 patients were triaged in the ED. The proportion admitted to hospital was 63% for resuscitation (level 1), 37% for emergent (level 2), 14% for urgent (level 3), 2% for semiurgent (level 4) and 1% for nonurgent (level 5) (p&lt; 0.001). There was also a good correlation between triage levels and LOS and admission to PICU (bothp&lt; 0.001).Conclusion:This computerized version of PaedCTAS demonstrates a strong association with admission to hospital, admission to PICU and LOS in the ED. These results suggest that PaedCTAS is a valid tool for triage of children in a pediatric ED.
Refinement of the Quebec decision rule for radiography in shoulder dislocation
Authors: Émond Marcel , Le Sage Natalie , Lavoie André , Moore Lynne 
Published: July 2016

ABSTRACTObjective:We prospectively derived a clinical decision rule to guide pre- and postreduction radiography for emergency department (ED) patients with anterior glenohumeral dislocation.Methods:This prospective cohort derivation study took place at 4 university-affiliated EDs over a 3-year period and enrolled consenting patients with anterior glenohumeral dislocation who were 18 years of age or older. We compared patients with a clinically important fracture-dislocation with those who had an uncomplicated dislocation to provide the clinical decision rule components using recursive partitioning. The final rule involved age, mechanism, prior dislocation and humeral ecchymosis.Results:A total of 222 patients were included in the study. Forty (18.0%) had clinically important fracture-dislocation. A clinical decision rule using 4 factors reached a sensitivity of 100% (95% confidence interval [CI] 89.4%–100%), a specificity of 34.2% (95% CI 27.7%–41.2%), a negative predictive value of 99.2% (95% CI 92.8%–99.9%) and a negative likelihood ratio of 0.04 (95% CI 0.002–0.27). Patients younger than 40 years are at high risk for clinically important fracture-dislocation only if the mechanism of injury involves substantial force (i.e., a fall greater than their own height, a sport injury, an assault or a motor vehicle collision). Patients 40 years of age or older are at high risk only in the presence of humeral ecchymosis or after their first dislocation. Projected use of the rule would reduce the absolute number of prereduction radiographs by 27.9% and of postreduction by 81.9%.Conclusion:The Quebec shoulder dislocation rule for patients with acute anterior glenohumeral dislocation holds promise to reduce unnecessary imaging, pending validation.
Use of personal protective equipment during infectious disease outbreak and nonoutbreak conditions: a survey of emergency medical technicians
Authors: Visentin Laura M. , Bondy Susan J. , Schwartz Brian , Morrison Laurie J. 
Published: July 2016

ABSTRACTObjective:We sought to assess the knowledge of, use of and barriers to the use of personal protective equipment for airway management among emergency medical technicians (EMTs) during and since the 2003 Canadian outbreak of Severe Acute Respiratory Syndrome (SARS).Methods:Using a cross-sectional survey, EMTs in Toronto, Ont., were surveyed 1 year after the SARS outbreak during mandatory training on the use of personal protective equipment in airway management during the outbreak and just before taking the survey. Practices that were addressed reflected government directives on the use of this equipment. Main outcome measures included the frequency of personal protective equipment use and, as applicable, why particular items were not always used.Results:The response rate was 67.3% (n= 230). During the SARS outbreak, an N95-type particulate respirator was reported to bealwaysused by 91.5% of respondents. Conversely, 72.9% of the respondents reported that theyneverused the open face hood. Equipment availability and vision impairment were often cited as impediments to personal protective equipment use. In nonoutbreak conditions, only the antimicrobial airway filter was most often reported to bealwaysused (52.0%), while other items were used at an intermediate frequency. The most common reason for notalwaysdonning equipment was that paramedics deemed it unnecessary for the situation.Conclusion:Personal protective equipment is not consistently employed as per medical directives. Reasons given for nonuse included nonavailability, judgment of nonnecessity or technical difficulties. There are important public health implications of noncompliance.
CAEP Position Statement on Gun Control
Authors: Snider Carolyn E. , Ovens Howard , Drummond Alan , Kapur Atul K. 
Published: July 2016

EXECUTIVE SUMMARYFirearm-related injury and death continue to be a significant problem in Canada. Since the 1990s Canadian emergency physicians (EPs) have played an active role in advocating for gun control. This paper updates the Canadian Association of Emergency Physician's (CAEP's) position on gun control. Despite a media focus on homicide, the majority of firearm-related deaths are a result of suicide. Less than 40% of firearm-related injuries are intentionally inflicted by another person. Since the implementation of Canada's gun registry in 1995, there has been a significant reduction in firearm-related suicides and intimate partner homicides. Proposed weakening of gun laws in Canada will have a significant impact on firearm-related mortality and injury. There must be instead an expansion of programs focused on prevention of suicide, intimate partner violence and gang-related violence.The majority of intentional or unintentional firearm-related injuries involve a violation of safe storage or handling practice. The potential for future harm because of unsafe storage or handling or through gang conflict retribution supports our position that health care facilities report gunshot wounds (GSWs). Moreover, a nationwide surveillance system is necessary to support research and to guide future public policy development and legislation.As EPs we must advocate for injury control. All firearm injuries and deaths are preventable, and we must advocate for a multifaceted approach in order to minimize this risk to our patients.
The appropriateness of referrals to a pediatric emergency department via a telephone health line
Authors: Al-Abdullah Tawfik , Plint Amy C. , Shaw Alyson , Correll Rhonda , Gaboury Isabelle , Pitters Carrol , Bottaglia Anna , Clifford Tammy 
Published: July 2016

ABSTRACTObjective:We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral.Methods:A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED.Results:Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p= 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%,p&lt; 0.001) or by self- or parent-referral (63%,p= 0.002). There was no significant difference between these latter 2 referral routes (p= 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes.Conclusion:There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.
Treatment of severe accidental hypothermia with intermittent hemodialysis
Authors: Sultan Nabil , Theakston Karl D. , Butler Ron , Suri Rita S. 
Published: July 2016

ABSTRACTThe optimal management of moderate-to-severe hypothermia with hemodynamic instability remains unclear. Although cardiopulmonary bypass offers the most rapid rate of rewarming and has been suggested as the method of choice in the presence of circulatory arrest, there is no evidence to support the use of this highly invasive technique over other rewarming modalities in the absence of circulatory collapse. We report the successful treatment of hemodynamically unstable hypothermia with conventional hemodialysis in a patient with normal renal function, after initial efforts of rewarming using conventional strategies had failed. This case report and review of the literature highlights the advantages and the challenges of using hemodialysis in this setting, and suggests a potential role for hemodialysis in the routine management of moderate-to-severe hypothermia in the absence of circulatory arrest.
Emergency medicine as a career choice: a descriptive study of Canadian medical students
Authors: Scott Ian M. , Abu-Laban Riyad B. , Gowans Margot C. , Wright Bruce J. , Brenneis Fraser R. 
Published: July 2016

ABSTRACTBackground:Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine.Methods:We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data.Results:Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%–7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important.Conclusion:Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.
Impact of a nurse practitioner on patient care in a Canadian emergency department
Authors: Steiner Ivan P. , Nichols Darren N. , Blitz Sandra , Tapper Lloyd , Stagg Andrew P. , Sharma Leneela , Policicchio Carla 
Published: July 2016

ABSTRACTObjective:Our objective was to determine whether the addition of a broad-scope nurse practitioner (NP) would improve emergency department (ED) wait times, ED lengths of stay (LOS) and left-without-treatment (LWOT) rates. We hypothesized that the addition of a broad-scope NP during weekday ED shifts would result in shorter patient wait times, reduced LOS and fewer patients leaving the ED without treatment.Methods:This prospective observational study was conducted in a busy urban free-standing community ED. Intervention shifts, with NP coverage, were compared with control shifts (similar shifts with emergency physicians [EPs] working independently). Primary outcomes included patient wait times, ED LOS and LWOT rates. Patient demographics, triage category, the provider seen, the time to provider and ED LOS were captured using an electronic database.Results:The addition of an NP was associated with a 12% increase in patient volume per shift and a 7-minute reduction in mean wait times for low-acuity patients. However, overall patient wait times and ED LOS did not differ between intervention and control shifts. During intervention shifts, EPs saw a smaller proportion of low-acuity patients and there was a trend toward a lower proportion of LWOT patients (11.9% v. 13.7%,p= 0.10).Conclusion:Adding a broad-scope NP to the ED staff may lower the proportion of patients who leave without treatment, reduce the proportion of low-acuity patients seen by EPs and expedite throughput for a subgroup of less urgent patients. However, it did not reduce overall wait times or ED LOS in this setting.
Multicentre evaluation of an emergency department asthma care pathway for adults
Authors: Lougheed M. Diane , Olajos-Clow Jennifer , Szpiro Kim , Moyse Patricia , Julien Brianna , Wang Miao , Day Andrew G. ,   Ontario Respiratory Outcomes Research Network
Published: July 2016

ABSTRACTObjective:We sought to determine whether a standardized emergency department (ED) asthma care pathway (ACP) for adults would be accepted by ED staff, improve adherence to Canadian ED asthma management guidelines and improve patient outcomes.Methods:Ten Ontario hospital EDs (5 intervention, 5 control) participated in a 5-month pre–post intervention study. Emergency department management, admissions, repeat ED visits and ED length of stay were compared between sites and by ACP use versus nonuse at intervention sites.Results:The ACP was used in 101 of 383 visits (26.4%) at 5 intervention sites. Use of the ACP varied significantly between sites, ranging from 6% to 60% (p&lt; 0.001). When compared with control sites, there were significant increases in the use of metered dose inhalers (MDIs), inhaled steroids, referrals, documentation of teaching, patient recollection of teaching (all with a p &lt; 0.001) and oxygen (p= 0.001). Use of peak expiratory flow rate (PEFR) measurements decreased in both intervention and control sites. Increased PEFR documentation and systemic steroid use in the ED and on discharge were only found in patients who were on the ACP at intervention sites. Admissions increased from 3.9% to 9.4% at intervention sites in contrast to control sites, where they remained fairly stable (p= 0.016), but did not differ by ACP use. The length of stay for discharged patients increased by a mean of 16 minutes for ACP patients at intervention sites (p= 0.002). There were no statistically significant differences in repeat ED visits.Conclusion:Adoption of a standardized ED ACP for adults is highly variable. Despite modest uptake, which averaged 26%, beneficial changes in specific aspects of asthma care delivery were found, notably in referrals and recollection of teaching done during the ED visit, without a substantial increase in ED length of stay. These changes may lead to improvements in outcomes, such as reduced relapse rates, which this study was not designed or powered to detect. Provincial and national implementation strategies that address barriers to clinical pathway adoption are warranted and have the potential to improve adherence to guidelines and outcomes for asthma patients.
Underuse of prehospital strategies to reduce time to reperfusion for ST-elevation myocardial infarction patients in 5 Canadian provinces
Authors: Schull Michael J. , Vaillancourt Samuel , Donovan Linda , Boothroyd Lucy J. , Andrusiek Dug , Trickett John , Sookram Sunil , Travers Andrew , Vermeulen Marian J. , Tu Jack V. ,   Canadian Cardiovascular Outcomes Research Team
Published: July 2016

ABSTRACTObjective:Timely reperfusion therapy for ST-elevation myocardial infarction (STEMI) is an important determinant of outcome, yet targets for time to treatment are frequently unmet in North America. Prehospital strategies can reduce time to reperfusion. We sought to determine the extent to which emergency medical services (EMS) use these strategies in Canada.Methods:We carried out a cross-sectional survey in 2007 of ground EMS operators in British Columbia, Alberta, Ontario, Quebec and Nova Scotia. We focused on the use of 4 prehospital strategies: 1) 12-lead electrocardiogram (ECG), 2) routine expedited emergency department (ED) transfer of STEMI patients (from a referring ED to a percutaneous coronary intervention [PCI] centre), 3) prehospital bypass (ambulance bypass of local EDs to transport patients directly to PCI centres) and 4) prehospital fibrinolysis.Results:Ninety-seven ambulance operators were surveyed, representing 15 681 paramedics serving 97% of the combined provincial populations. Of the operators surveyed, 68% (95% confidence interval [CI] 59%–77%) had ambulances equipped with 12-lead ECGs, ranging from 40% in Quebec to 100% in Alberta and Nova Scotia. Overall, 47% (95% CI 46%-48%) of paramedics were trained in ECG acquisition and 40% (95% CI 39%–41%) were trained in ECG interpretation. Only 18% (95% CI 10%–25%) of operators had prehospital bypass protocols; 45% (95% CI 35%–55%) had protocols for expedited ED transfer. Prehospital fibrinolysis was available only in Alberta. All EMS operators in British Columbia, Alberta and Nova Scotia used at least 1 of the 4 prehospital strategies, and one-third of operators in Ontario and Quebec used 0 of 4. In major urban centres, at least 1 of the 3 prehospital strategies 12-lead ECG acquisition, bypass or expedited transfer was used, but there was considerable variation within and across provinces.Conclusion:The implementation of widely recommended prehospital STEMI strategies varies substantially across the 5 provinces studied, and relatively simple existing technologies, such as prehospital ECGs, are underused in many regions. Substantial improvements in prehospital services and better integration with hospital-based care will be necessary in many regions of Canada if optimal times to reperfusion, and associated outcomes, are to be achieved.
Opposites attract: a case of magnet ingestion
Authors: Wong Helen H.L. , Phillips Bruce A. 
Published: July 2016

ABSTRACT
Foreign-body ingestion is relatively common in the pediatric population and most objects pass through the gastrointestinal tract with minimal complications. Popular toy magnetic construction sets have resulted in numerous reports in the literature of serious complications including death following ingestion of multiple magnets. We report a case of a 5-year-old girl who presented to our emergency department with nonbilious vomiting and mild abdominal pain after accidentally ingesting 2 magnets 10 hours apart. Abdominal radiography showed the presence of 2 magnets, and a laparoscopy revealed multiple areas of bowel wall necrosis and perforation requiring subsequent laparotomy for repair of the bowel wall and retrieval of the magnets. This report aims to alert emergency care physicians of the necessity for early surgical referral with any multiple magnet ingestion to prevent severe complications.