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Background: Given limited resources for injury prevention, it is essential to determine which mechanisms of injury to target to provide the most benefit to the largest proportion of the population. We developed objective, evidence-based injury prevention priority scores (IPPSs) for the Canadian population across 4 prevention perspectives: mortality, injury severity, resource use and societal cost. Methods: We performed a retrospective cohort study of all injuries in Canada from 2009/10 to 2013/14. Hospital admissions were obtained from the Discharge Abstract Database, and deaths from the Statistics Canada Canadian Vital Statistics Death Database. For each mechanism of injury, we calculated an IPPS as a balanced measure of injury frequency and 1) mortality rate, 2) median 1 - ICISS (Injury Severity Score derived from the International Statistical Classification of Diseases and Related Health Problems, 10th revision, enhanced Canadian version), 3) median cost per hospital stay or 4) median potential years of life lost (PYLL), providing a ranking of mechanisms of injury in priority order. The IPPS by definition has a mean of 50 and a standard deviation of 10. The higher the IPPS, the higher the priority for injury prevention. Results: A total of 694 535 injuries were identified over the study period. The most frequent mechanism of injury was falls (391 068 [56.3%]). The overall mortality rate was 0.09 deaths/injured person, the median 1 - ICISS was 0.017, the median cost was $5217, and the median PYLL was 0. The mechanisms with the 3 highest IPPSs were falls (75), self-harm (67) and drowning (66) for mortality; falls (77), drowning (70) and suffocation (61) for severity; falls (80), suffocation (63) and fire (60) for resource use; and falls (72), assault (62), and firearms and legal interventions (59 in both cases) for societal cost. Conclusion: This study produced IPPSs for traumatic injuries in Canada that provide objective and quantifiable methods for identifying mechanisms of injury to target for specific prevention initiatives. Preventing falls would provide the most benefit to the largest proportion of Canadians and should be prioritized in injury-prevention policy. Contexte : ?‰tant donné le peu de ressources allouées à la prévention des blessures, il est important de déterminer quels mécanismes sont à l'origine des blessures et de cibler les mesures correctives qui bénéficieront au plus grand nombre de citoyens. Nous avons conçu des scores objectifs de priorité en matière de prévention des blessures fondés sur des données probantes (SPPB) pour la population canadienne sous 4 angles différents : mortalité, gravité des blessures, utilisation des ressources et coûts sociétaux. Méthodes : Nous avons procédé à une étude de cohorte rétrospective sur toutes les blessures recensées au Canada de 2009/10 à 2013/14. Les données sur les hospitalisations proviennent de la Base de données sur les congés des patients et les données sur les décès, de la Base canadienne de données sur les décès de la Statistique de l'état civil (Statistique Canada). Pour chaque mécanisme, nous avons calculé un SPPB comme évaluation raisonnable de la fréquence des blessures et 1) le taux de mortalité, 2) le score 1 - ICISS médian de gravité des blessures (dérivé de la International Statistical Classification of Diseases and Related Health Problems, 10th revision, version canadienne augmentée), 3) le coût médian des hospitalisations et 4) le nombre médian d'années potentielles de vie perdues (APVP), ce qui classifiait les mécanismes par ordre de priorité. Par définition, le SPPB a une moyenne de 50 et un écart-type de 10. Le SPPB est directement proportionnel à l'ordre de priorité pour la prévention des blessures. Résultats : En tout 694 535 blessures ont été recensées pour la période de l'étude. Le mécanisme le plus souvent en cause était les chutes (391 068 [56,3%]). Le taux de mortalité global était de 0,09 décès/personne blessée, le score 1 - ICISS médian, de 0,017, le coût médian, de 5217 S, et le nombre médian d'APVP, de 0. Les mécanismes présentant les 3 scores SPPB les plus élevés étaient chutes (75), blessure auto-infligée (67) et noyade (66) sous l'angle de la mortalité; chutes (77), noyade (70) et suffocation (61) sous l'angle de la gravité; chutes (80), suffocation (63) et incendie (60) sous l'angle de l'utilisation des ressources; et chutes (72), agressions (62) et armes à feu et interventions policières (59 dans chaque cas) sous l'angle des coûts sociétaux. Conclusion : Cette étude a produit des SPPB pour les traumatismes physiques au Canada qui permettent de quantifier objectivement les mécanismes des blessures et de cibler des mesures préventives précises. C'est la prévention des chutes qui serait bénéfique au plus grand nombre de Canadiens et qui devrait être priorisée par les politiques de prévention des blessures., Unintentional injuries are the leading cause of death among people younger than 44 years of age. (1,2) They account for about 4.8 million deaths and affect 973 million people annually [...]

Background: Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for [...]

Objective: We aim to assess the impact of several accreditation cycles of trauma centers on patient outcomes, specifically in-hospital mortality, complications and hospital length of stay.Design: Interrupted time series.Setting: British Columbia, Canada.Participants: Trauma patients admitted to all level I and level II trauma centers between January 2008 and March 2018.Exposure: Accreditation.Main Outcomes and Measures: We first computed quarterly estimates of the proportions of in-hospital mortality, complications and survival to discharge standardized for change in patient case-mix using prognostic scores and the Aalen-Johansen estimator of the cumulative incidence function. Piecewise regressions were then used to estimate the change in levels and trends for patient outcomes following accreditation.Results: For in-hospital mortality and major complications, the impact of accreditation seems to be associated with short- and long-term reductions after the first cycle and only short-term reductions for subsequent cycles. However, the 95% confidence intervals for these estimates were wide, and we lacked the precision to consistently conclude that accreditation is beneficial.Conclusions: Applying a quasi-experimental design to time series accounting for changes in patient case-mix, our results suggest that accreditation might reduce in-hospital mortality and major complications. However, there was uncertainty around the estimates of accreditation. Further studies looking at clinical processes of care and other outcomes such as patient or health staff satisfaction are needed. [ABSTRACT FROM AUTHOR]

Background All-Terrain Vehicles (ATVs) are a leading cause of serious injury in children and youth. Certain Canadian regions have implemented legislation to promote safety, including age restrictions, mandatory training and helmet use. Jurisdictions with more stringent ATV safety legislation have been shown to have reduced injury rates in the short term. Objectives To estimate the burden of ATV-related serious injury and death in Canada and to identify Canadian physicians' knowledge of ATV-related legislation, safety and health promotion practices. Methods A one-time survey was distributed to practicing paediatricians and paediatric subspecialists participating in the Canadian Paediatric Surveillance Program (CPSP) in October 2016. Results Of 2793 physicians contacted, 904 responded (32.4%). There were 181 reported cases of serious and/or fatal ATV-related injuries, including 6 deaths. Children aged 10 to 14 represented the most number of cases (n=82, 45.3%), followed by 15 to 19 (n=48, 26.5%) and 5 to 9 (n=40, 22.1%). Most cases occurred in July/August (48.3%) and May/June (25.2%), were in males (n=133, 78.2%), and occurred during recreational activity (n=139, 83.2%) or organized racing (n=6, 3.6%). In 99 cases (58.9%), the child was the driver of the ATV. Only two-thirds of respondents (67.5%) knew that ATVs should not carry passengers while under half (42.2%) never discussed ATV safety with their patients. Conclusions ATV-related injuries and deaths in Canadian children remain a serious public health problem. Education of health care practitioners, including paediatricians, is needed to promote safety. Despite efforts to reduce ATV-related injuries, there remains a significant number of serious injuries and/deaths related to their use. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Pain is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: In Canada injuries are a leading cause of death and morbidity among the paediatric population. Trauma systems have been established across North America to provide comprehensive injury care and to lead injury control efforts. However, not all populations have equal access to trauma care services. This is an observational study with the aim of assessing the impact of geographical access to paediatric trauma centres (PTCs) on patient outcomes, and to determine spatial access to PTCs across Canada. Setting: To examine the relationship between access to PTC and injury outcome, length of stay at the PTC was determined for all injured patients who live within and outside of 60 min driving time of the PTC. To determine spatial access to PTCs across Canada, a list of level 1 and 2 PTCs was identified across Canada. A 1 h driving time catchment was created around each PTC in order to estimate spatial accessibility. Participants: Hospital administration data sets from British Columbia (BC) and the Nova Scotia (NS) trauma registry were used to assess the impact of spatial access on paediatric injury (ages 0-15 years) outcomes. The data sets provided case-level data including the Injury Severity Score, postal code of place of residence, age and length of hospital stay. Results: In NS and BC, average length of stay at the hospital is significantly lower inside 60 min driving time compared to outside of 60 min driving time from a PTC (p<0.05, using a non-parametric t test). In Canada, approximately 65% of the paediatric population resides within 1 h of a PTC. Conclusions: This paper highlights differences in injury outcomes as a result of access. However, further investigation is needed as other considerations such as type of injury, age and/or gender may also affect injury outcomes. [ABSTRACT FROM AUTHOR]

Bicycling is a popular activity and a healthy, environmentally friendly form of transportation. However, it is also a leading cause of sport and recreational injury in children and adolescents. Head injuries are among the most severe injuries sustained while bicycling, justifying the implementation of bicycle helmet legislation by many provinces. There is evidence that bicycle helmet legislation increases helmet use and reduces head injury risk. Evidence for unintended consequences of helmet legislation, such as reduced bicycling and greater risk-taking, is weak and conflicting. Both research evidence to date and recognition of the substantial impact of traumatic brain injuries support the recommendation for all-ages bicycle helmet legislation. [ABSTRACT FROM AUTHOR]

Copyright of Paediatrics & Child Health (1205-7088) is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but the extent to which these or other guidelines are used is unknown. Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C-spines of patients < 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging. Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method. Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%). Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria. [ABSTRACT FROM AUTHOR]

Extracorporeal life support cannulation during active cardiopulmonary resuscitation (eCPR) is challenging at best. We report a CASE of inadvertent cannulation of the azygos vein during eCPR in a neonate. [ABSTRACT FROM AUTHOR]

Les véhicules tout-terrains (VTT) sont largement utilisés au Canada dans le cadre des loisirs, du transport et du travail, tel que l'agriculture. En qualité de véhicules automobiles, ils peuvent être particulièrement dangereux lorsqu'ils sont utilisés par des enfants et des jeunes adolescents qui ne possèdent pas les connaissances, la taille physique, la force et les compétences cognitives et motrices nécessaires pour les conduire en toute sécurité. La magnitude du risque de blessures pour les jeunes conducteurs est exposée de manière explicite dans les avertissements figurant dans le manuel du conducteur et sur les étiquettes des modèles les plus récents. Elle est également et démontrée par le nombre important d'hospitalisations et de décès pédiatriques attribuables à des traumatismes liés aux VTT. Cependant, le port du casque est loin d'être universel chez les jeunes conducteurs, et les comportements de conduite non sécuritaires demeurent courants, tels que la conduite sans supervision ou avec des passagers. Malgré les avertissements de l'industrie et l'éducation publique qui font ressortir l'importance de comportements sécuritaires et les risques de graves blessures chez les enfants et les adolescents, on continue de recenser des blessures et des décès liés aux VTT. Tant que des mesures n'auront pas été prises pour réduire ces blessures de manière substantielle et efficace, il est essentiel de limiter la conduite par des jeunes, notamment ceux de moins de 16 ans, afin de réduire le fardeau des traumatismes liés aux VTT chez les enfants et les adolescents. Le présent document remplace le document de principes de la Société canadienne de pédiatrie publié en 2004. [ABSTRACT FROM AUTHOR]

Dans un climat d'inquiétude croissante à l'égard de l'obésité juvénile et de l'inactivité, les terrains de jeux permettent aux enfants d'être actifs. Ils comportent toutefois aussi des risques, les blessures causées par des chutes étant de loin les plus courants. Les recherches démontrent la possibilité de réduire les blessures dans les terrains de jeux si on abaisse la hauteur des structures de jeu et si on utilise des surfaces molles et profondes pour amortir les chutes. L'Association canadienne de normalisation a publié des normes volontaires qu'elle a mises à jour plusieurs fois pour tenir compte de ces risques. Afin de contribuer à les réduire, les parents peuvent respecter des stratégies simples. Le présent document de principes souligne le fardeau des blessures subies dans les terrains de jeux. Il procure également aux parents et aux dispensateurs de soins des occasions de réduire l'incidence et la gravité des blessures grâce à l'éducation et à la défense d'intérêts, ainsi que de mettre en œuvre des normes de sécurité probantes et des stratégies plus sécuritaires dans les terrains de jeux locaux. Enfin, il remplace le document de principes de la Société canadienne de pédiatrie publié en 2002 sur le sujet. [ABSTRACT FROM AUTHOR]