158 results on '"Boutis K"'
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2. 306EMF Defining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians
- Author
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Stolz, L., primary, Boyd, J., additional, Baez, J., additional, Minges, P., additional, Swarm, M., additional, and Boutis, K., additional
- Published
- 2021
- Full Text
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3. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research
- Author
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Maas, A, Menon, D, Adelson, P, Andelic, N, Bell, M, Belli, A, Bragge, P, Brazinova, A, Büki, A, Chesnut, R, CITERIO, GIUSEPPE, Coburn, M, Cooper, D, Crowder, A, Czeiter, E, Czosnyka, M, Diaz arrastia, R, Dreier, J, Duhaime, A, Ercole, A, Van Essen, T, Feigin, V, Gao, G, Giacino, J, Gonzalez lara, L, Gruen, R, Gupta, D, Hartings, J, Hill, S, Jiang, J, Ketharanathan, N, Kompanje, E, Lanyon, L, Laureys, S, Lecky, F, Levin, H, Lingsma, H, Maegele, M, Majdan, M, Manley, G, Marsteller, J, Mascia, L, Mcfadyen, C, Mondello, S, Newcombe, V, Palotie, A, Parizel, P, Peul, W, Piercy, J, Polinder, S, Puybasset, L, Rasmussen, T, Rossaint, R, Smielewski, P, Söderberg, J, Stanworth, S, Stein, M, Von Steinbüchel, N, Stewart, W, Steyerberg, E, Stocchetti, N, Synnot, A, Te Ao, B, Tenovuo, O, Theadom, A, Tibboel, D, Videtta, W, Wang, K, Williams, W, Wilson, L, Yaffe, K, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Anke, A, Antoni, A, Van As, A, Audibert, G, Azaševac, A, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Barlow, K, Bartels, R, Bauerfeind, U, Beauchamp, M, Beer, D, Beer, R, Belda, F, Bellander, B, Bellier, R, Benali, H, Benard, T, Beqiri, V, Beretta, L, Bernard, F, Bertolini, G, Bilotta, F, Blaabjerg, M, Den Boogert, H, Boutis, K, Bouzat, P, Brooks, B, Brorsson, C, Bullinger, M, Burns, E, Calappi, E, Cameron, P, Carise, E, Castaño león, A, Causin, F, Chevallard, G, Chieregato, A, Christie, B, Cnossen, M, Coles, J, Collett, J, Della Corte, F, Craig, W, Csato, G, Csomos, A, Curry, N, Dahyot fizelier, C, Dawes, H, Dematteo, C, Depreitere, B, Dewey, D, Van Dijck, J, Đilvesi, Đ, Dippel, D, Dizdarevic, K, Donoghue, E, Duek, O, Dulière, G, Dzeko, A, Eapen, G, Emery, C, English, S, Esser, P, Ezer, E, Fabricius, M, Feng, J, Fergusson, D, Figaji, A, Fleming, J, Foks, K, Francony, G, Freedman, S, Freo, U, Frisvold, S, Gagnon, I, Galanaud, D, Gantner, D, Giraud, B, Glocker, B, Golubovic, J, Gómez López, P, Gordon, W, Gradisek, P, Gravel, J, Griesdale, D, Grossi, F, Haagsma, J, Håberg, A, Haitsma, I, Van Hecke, W, Helbok, R, Helseth, E, Van Heugten, C, Hoedemaekers, C, Höfer, S, Horton, L, Hui, J, Huijben, J, Hutchinson, P, Jacobs, B, Van Der Jagt, M, Jankowski, S, Janssens, K, Jelaca, B, Jones, K, Kamnitsas, K, Kaps, R, Karan, M, Katila, A, Kaukonen, K, De Keyser, V, Kivisaari, R, Kolias, A, Kolumbán, B, Kolundžija, K, Kondziella, D, Koskinen, L, Kovács, N, Kramer, A, Kutsogiannis, D, Kyprianou, T, Lagares, A, Lamontagne, F, Latini, R, Lauzier, F, Lazar, I, Ledig, C, Lefering, R, Legrand, V, Levi, L, Lightfoot, R, Lozano, A, Macdonald, S, Major, S, Manara, A, Manhes, P, Maréchal, H, Martino, C, Masala, A, Masson, S, Mattern, J, Mcfadyen, B, Mcmahon, C, Meade, M, Melegh, B, Menovsky, T, Moore, L, Morgado Correia, M, Morganti kossmann, M, Muehlan, H, Mukherjee, P, Murray, L, Van Der Naalt, J, Negru, A, Nelson, D, Nieboer, D, Noirhomme, Q, Nyirádi, J, Oddo, M, Okonkwo, D, Oldenbeuving, A, Ortolano, F, Osmond, M, Payen, J, Perlbarg, V, Persona, P, Pichon, N, Piippo karjalainen, A, Pili floury, S, Pirinen, M, Ple, H, Poca, M, Posti, J, Van Praag, D, Ptito, A, Radoi, A, Ragauskas, A, Raj, R, Real, R, Reed, N, Rhodes, J, Robertson, C, Rocka, S, Røe, C, Røise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, De Ruiter, G, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Salvato, G, Sánchez porras, R, Sándor, J, Sangha, G, Schäfer, N, Schmidt, S, Schneider, K, Schnyer, D, Schöhl, H, Schoonman, G, Schou, R, Sir, Ö, Skandsen, T, Smeets, D, Sorinola, A, Stamatakis, E, Stevanovic, A, Stevens, R, Sundström, N, Taccone, F, Takala, R, Tanskanen, P, Taylor, M, Telgmann, R, Temkin, N, Teodorani, G, Thomas, M, Tolias, C, Trapani, T, Turgeon, A, Vajkoczy, P, Valadka, A, Valeinis, E, Vallance, S, Vámos, Z, VARGIOLU, ALESSIA, Vega, E, Verheyden, J, Vik, A, Vilcinis, R, Vleggeert lankamp, C, Vogt, L, Volovici, V, Voormolen, D, Vulekovic, P, Vande Vyvere, T, Van Waesberghe, J, Wessels, L, Wildschut, E, Williams, G, Winkler, M, Wolf, S, Wood, G, Xirouchaki, N, Younsi, A, Zaaroor, M, Zelinkova, V, Zemek, R, Zumbo, F, Citerio, G, Vargiolu, A, Zumbo, F., Maas, Andrew I R, Menon, David K, Adelson, P David, Andelic, Nada, Bell, Michael J, Belli, Antonio, Bragge, Peter, Brazinova, Alexandra, Büki, Andrá, Chesnut, Randall M, Citerio, Giuseppe, Coburn, Mark, Cooper, D Jamie, Crowder, A Tamara, Czeiter, Endre, Czosnyka, Marek, Diaz-Arrastia, Ramon, Dreier, Jens P, Duhaime, Ann-Christine, Ercole, Ari, van Essen, Thomas A, Feigin, Valery L, Gao, Guoyi, Giacino, Joseph, Gonzalez-Lara, Laura E, Gruen, Russell L, Gupta, Deepak, Hartings, Jed A, Hill, Sean, Jiang, Ji-yao, Ketharanathan, Naomi, Kompanje, Erwin J O, Lanyon, Linda, Laureys, Steven, Lecky, Fiona, Levin, Harvey, Lingsma, Hester F, Maegele, Marc, Majdan, Marek, Manley, Geoffrey, Marsteller, Jill, Mascia, Luciana, Mcfadyen, Charle, Mondello, Stefania, Newcombe, Virginia, Palotie, Aarno, Parizel, Paul M, Peul, Wilco, Piercy, Jame, Polinder, Suzanne, Puybasset, Loui, Rasmussen, Todd E, Rossaint, Rolf, Smielewski, Peter, Söderberg, Jeannette, Stanworth, Simon J, Stein, Murray B, von Steinbüchel, Nicole, Stewart, William, Steyerberg, Ewout W, Stocchetti, Nino, Synnot, Anneliese, Te Ao, Braden, Tenovuo, Olli, Theadom, Alice, Tibboel, Dick, Videtta, Walter, Wang, Kevin K W, Williams, W Huw, Wilson, Lindsay, Yaffe, Kristine, InTBIR Participants, Investigator, Beretta, Luigi, InTBIR Participants Investigators, Menon, David [0000-0002-3228-9692], Czosnyka, Marek [0000-0003-2446-8006], Ercole, Ari [0000-0001-8350-8093], Newcombe, Virginia [0000-0001-6044-9035], Smielewski, Peter [0000-0001-5096-3938], Apollo - University of Cambridge Repository, Maas A.I.R., Menon D.K., David Adelson P.D., Andelic N., Bell M.J., Belli A., Bragge P., Brazinova A., Buki A., Chesnut R.M., Citerio G., Coburn M., Jamie Cooper D., Tamara Crowder A., Czeiter E., Czosnyka M., Diaz-Arrastia R., Dreier J.P., Duhaime A.-C., Ercole A., van Essen T.A., Feigin V.L., Gao G., Giacino J., Gonzalez-Lara L.E., Gruen R.L., Gupta D., Hartings J.A., Hill S., Jiang J.-Y., Ketharanathan N., Kompanje E.J.O., Lanyon L., Laureys S., Lecky F., Levin H., Lingsma H.F., Maegele M., Majdan M., Manley G., Marsteller J., Mascia L., McFadyen C., Mondello S., Newcombe V., Palotie A., Parizel P.M., Peul W., Piercy J., Polinder S., Puybasset L., Rasmussen T.E., Rossaint R., Smielewski P., Soderberg J., Stanworth S.J., Stein M.B., von Steinbuchel N., Stewart W., Steyerberg E.W., Stocchetti N., Synnot A., Te Ao B., Tenovuo O., Theadom A., Tibboel D., Videtta W., Wang K.K.W., Huw Williams W., Wilson L., Yaffe K., Adams H., Allanson J., Coles J., Hutchinson P.J., Kolias A.G., Sahakian B.J., Stamatakis E., Williams G., Agnoletti V., Martino C., Masala A., Teodorani G., Zumbo F., Amrein K., Ezer E., Kolumban B., Kovacs N., Melegh B., Nyiradi J., Sorinola A., Vamos Z., Andaluz N., Anke A., Frisvold S.K., Antoni A., van As A.B., Figaji A., Audibert G., Azasevac A., Dilvesi D., Golubovic J., Jelaca B., Karan M., Kolundzija K., Negru A., Vulekovic P., Azouvi P., Azzolini M.L., Beretta L., Baciu C., Beqiri V., Chevallard G., Chieregato A., Sacchi M., Badenes R., Belda F.J., Bilotta F., Lozano A., Barlow K.M., Schneider K.J., Bartels R., den Boogert H., Hoedemaekers C., Sir O., Bauerfeind U., Lefering R., Schafer N., Beauchamp M., Gravel J., Beer D., Beer R., Helbok R., Hofer S., Bellander B.-M., Nelson D., Bellier R., Benard T., Carise E., Dahyot-Fizelier C., Giraud B., Benali H., Bernard F., Bertolini G., Masson S., Blaabjerg M., Rosenlund C., Schou R.F., Boutis K., Bouzat P., Francony G., Manhes P., Payen J.-F., Brooks B., Dewey D., Emery C.A., Freedman S., Kramer A., Brorsson C., Koskinen L.-O., Sundstrom N., Bullinger M., Burns E., Calappi E., Ortolano F., Cameron P., Castano-Leon A.M., Gomez Lopez P.A., Lagares A., Causin F., Freo U., Persona P., Rossi S., Christie B., Cnossen M., Dippel D., Foks K., Haagsma J.A., Haitsma I., Huijben J.A., van der Jagt M., Nieboer D., Volovici V., Voormolen D.C., Collett J., Dawes H., Esser P., van Heugten C., Della Corte F., Grossi F., Craig W., Csato G., Csomos A., Curry N., Dematteo C., Meade M., Depreitere B., van Dijck J., de Ruiter G.C.W., Vleggeert-Lankamp C., Dizdarevic K., Donoghue E., Gantner D., Murray L., Trapani T., Vallance S., Duek O., Lazar I., Duliere G.-L., Marechal H., Dzeko A., Eapen G., Jankowski S., English S., Fergusson D., Osmond M., Fabricius M., Kondziella D., Feng J., Hui J., Fleming J., Latini R., Gagnon I., Ptito A., Galanaud D., Glocker B., Kamnitsas K., Ledig C., Rueckert D., Gordon W.A., Gradisek P., Griesdale D., Haberg A.K., van Hecke W., Smeets D., Verheyden J., Vyvere T.V., Helseth E., Roe C., Roise O., Horton L., Jacobs B., van der Naalt J., Janssens K., De Keyser V., Menovsky T., Van Praag D., Jones K.M., Kaps R., Katila A., Posti J., Takala R., Kaukonen K.-M., Kivisaari R., Piippo-Karjalainen A., Raj R., Tanskanen P., Kutsogiannis D., Kyprianou T., Lamontagne F., Lauzier F., Moore L., Turgeon A., Legrand V., Levi L., Zaaroor M., Lightfoot R., Macdonald S., Major S., Vajkoczy P., Wessels L., Winkler M.K.L., Wolf S., Manara A., Thomas M., Mattern J., Sakowitz O., Vogt L., Younsi A., McFadyen B., McMahon C., Correia M.M., Morganti-Kossmann M.C., Rosenfeld J.V., Muehlan H., Schmidt S., Mukherjee P., Noirhomme Q., Oddo M., Okonkwo D.O., Oldenbeuving A.W., Roks G., Schoonman G.G., Perlbarg V., Pichon N., Pili-Floury S., Pirinen M., Ples H., Poca M.A., Radoi A., Sahuquillo J., Ragauskas A., Rocka S., Real R.G.L., Telgmann R., Reed N., Rhodes J., Robertson C., Rosand J., Rosenthal G., Salvato G., Sanchez-Porras R., Sandor J., Sangha G., Schnyer D., Schohl H., Skandsen T., Stevanovic A., van Waesberghe J.V., Stevens R.D., Taccone F.S., Taylor M.S., Zelinkova V., Temkin N., Tolias C.M., Valadka A.B., Valeinis E., Vargiolu A., Vega E., Vik A., Vilcinis R., Wildschut E., Wood G., Xirouchaki N., Zemek R., Maas, A, Menon, D, Adelson, P, Andelic, N, Bell, M, Belli, A, Bragge, P, Brazinova, A, Büki, A, Chesnut, R, Citerio, G, Coburn, M, Cooper, D, Crowder, A, Czeiter, E, Czosnyka, M, Diaz arrastia, R, Dreier, J, Duhaime, A, Ercole, A, Van Essen, T, Feigin, V, Gao, G, Giacino, J, Gonzalez lara, L, Gruen, R, Gupta, D, Hartings, J, Hill, S, Jiang, J, Ketharanathan, N, Kompanje, E, Lanyon, L, Laureys, S, Lecky, F, Levin, H, Lingsma, H, Maegele, M, Majdan, M, Manley, G, Marsteller, J, Mascia, L, Mcfadyen, C, Mondello, S, Newcombe, V, Palotie, A, Parizel, P, Peul, W, Piercy, J, Polinder, S, Puybasset, L, Rasmussen, T, Rossaint, R, Smielewski, P, Söderberg, J, Stanworth, S, Stein, M, Von Steinbüchel, N, Stewart, W, Steyerberg, E, Stocchetti, N, Synnot, A, Te Ao, B, Tenovuo, O, Theadom, A, Tibboel, D, Videtta, W, Wang, K, Williams, W, Wilson, L, Yaffe, K, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Anke, A, Antoni, A, Van As, A, Audibert, G, Azaševac, A, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Barlow, K, Bartels, R, Bauerfeind, U, Beauchamp, M, Beer, D, Beer, R, Belda, F, Bellander, B, Bellier, R, Benali, H, Benard, T, Beqiri, V, Beretta, L, Bernard, F, Bertolini, G, Bilotta, F, Blaabjerg, M, Den Boogert, H, Boutis, K, Bouzat, P, Brooks, B, Brorsson, C, Bullinger, M, Burns, E, Calappi, E, Cameron, P, Carise, E, Castaño león, A, Causin, F, Chevallard, G, Chieregato, A, Christie, B, Cnossen, M, Coles, J, Collett, J, Della Corte, F, Craig, W, Csato, G, Csomos, A, Curry, N, Dahyot fizelier, C, Dawes, H, Dematteo, C, Depreitere, B, Dewey, D, Van Dijck, J, Đilvesi, Đ, Dippel, D, Dizdarevic, K, Donoghue, E, Duek, O, Dulière, G, Dzeko, A, Eapen, G, Emery, C, English, S, Esser, P, Ezer, E, Fabricius, M, Feng, J, Fergusson, D, Figaji, A, Fleming, J, Foks, K, Francony, G, Freedman, S, Freo, U, Frisvold, S, Gagnon, I, Galanaud, D, Gantner, D, Giraud, B, Glocker, B, Golubovic, J, Gómez López, P, Gordon, W, Gradisek, P, Gravel, J, Griesdale, D, Grossi, F, Haagsma, J, Håberg, A, Haitsma, I, Van Hecke, W, Helbok, R, Helseth, E, Van Heugten, C, Hoedemaekers, C, Höfer, S, Horton, L, Hui, J, Huijben, J, Hutchinson, P, Jacobs, B, Van Der Jagt, M, Jankowski, S, Janssens, K, Jelaca, B, Jones, K, Kamnitsas, K, Kaps, R, Karan, M, Katila, A, Kaukonen, K, De Keyser, V, Kivisaari, R, Kolias, A, Kolumbán, B, Kolundžija, K, Kondziella, D, Koskinen, L, Kovács, N, Kramer, A, Kutsogiannis, D, Kyprianou, T, Lagares, A, Lamontagne, F, Latini, R, Lauzier, F, Lazar, I, Ledig, C, Lefering, R, Legrand, V, Levi, L, Lightfoot, R, Lozano, A, Macdonald, S, Major, S, Manara, A, Manhes, P, Maréchal, H, Martino, C, Masala, A, Masson, S, Mattern, J, Mcfadyen, B, Mcmahon, C, Meade, M, Melegh, B, Menovsky, T, Moore, L, Morgado Correia, M, Morganti kossmann, M, Muehlan, H, Mukherjee, P, Murray, L, Van Der Naalt, J, Negru, A, Nelson, D, Nieboer, D, Noirhomme, Q, Nyirádi, J, Oddo, M, Okonkwo, D, Oldenbeuving, A, Ortolano, F, Osmond, M, Payen, J, Perlbarg, V, Persona, P, Pichon, N, Piippo karjalainen, A, Pili floury, S, Pirinen, M, Ple, H, Poca, M, Posti, J, Van Praag, D, Ptito, A, Radoi, A, Ragauskas, A, Raj, R, Real, R, Reed, N, Rhodes, J, Robertson, C, Rocka, S, Røe, C, Røise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, De Ruiter, G, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Salvato, G, Sánchez porras, R, Sándor, J, Sangha, G, Schäfer, N, Schmidt, S, Schneider, K, Schnyer, D, Schöhl, H, Schoonman, G, Schou, R, Sir, Ö, Skandsen, T, Smeets, D, Sorinola, A, Stamatakis, E, Stevanovic, A, Stevens, R, Sundström, N, Taccone, F, Takala, R, Tanskanen, P, Taylor, M, Telgmann, R, Temkin, N, Teodorani, G, Thomas, M, Tolias, C, Trapani, T, Turgeon, A, Vajkoczy, P, Valadka, A, Valeinis, E, Vallance, S, Vámos, Z, Vargiolu, A, Vega, E, Verheyden, J, Vik, A, Vilcinis, R, Vleggeert lankamp, C, Vogt, L, Volovici, V, Voormolen, D, Vulekovic, P, Vande Vyvere, T, Van Waesberghe, J, Wessels, L, Wildschut, E, Williams, G, Winkler, M, Wolf, S, Wood, G, Xirouchaki, N, Younsi, A, Zaaroor, M, Zelinkova, V, Zemek, R, Zumbo, F, Pediatric Surgery, Intensive Care, and Public Health
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medicine.medical_specialty ,EVIDENCE-BASED MEDICINE ,Treatment outcome ,Poison control ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,EMERGENCY-DEPARTMENT VISITS ,Review ,PLACEBO-CONTROLLED TRIAL ,Middle income country ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Brain Injuries, Traumatic ,Journal Article ,medicine ,traumatic barin injury ,Humans ,030212 general & internal medicine ,Clinical care ,Neurologic disease ,Psychiatry ,DIAGNOSTIC MANAGEMENT STRATEGIES ,business.industry ,RANDOMIZED CONTROLLED-TRIAL ,ACUTE SUBDURAL-HEMATOMA ,SEVERE HEAD-INJURY ,ROAD TRAFFIC INJURIES ,brain injury ,Hospital care ,3. Good health ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Brain Injuries ,Health care cost ,PATIENT-REPORTED OUTCOMES ,Human medicine ,Neurology (clinical) ,business ,Humanities ,030217 neurology & neurosurgery ,GLASGOW COMA SCALE - Abstract
Executive summary A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world’s population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders— policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI. The epidemiology of TBI is changing: in high-income countries, the number of elderly people with TBI is increasing, mainly due to falls, while in LMICs, the burden of TBI from road traffic incidents is increasing. Data on the frequency of TBI and TBI-related deaths and on the economic impact of brain trauma are often incomplete and vary between countries. Improved, accurate epidemiological monitoring and robust healtheconomic data collection are needed to inform healthcare policy and prevention programmes. Highly developed and coordinated systems of care are crucial for management of patients with TBI. However, in practice, implementation of such frameworks varies greatly and disconnects exist in the chain of care. Optimisation of systems of care should be high on the policy agenda and could yield substantial gains in terms of both patient outcomes and costs to society. TBI is a complex condition, and strong evidence to support treatment guidelines and recommendations is scarce. Most multicentre clinical trials of medical and surgical interventions have failed to show efficacy, despite promising preclinical results. At the bedside, treatment strategies are generally based on guidelines that promote a one-size-fits-all approach and are insufficiently targeted to the needs of individual patients. Attempts to individualise treatment are challenging owing to the diversity of TBI, and are hampered by the use of simplistic methods to characterise its initial type and severity. Advances in genomics, blood biomarkers, magnetic resonance imaging (MRI), and pathophysiological monitoring, combined with informatics to integrate data from multiple sources, offer new research avenues to improve disease characterisation and monitoring of disease evolution. These tools can also aid understanding of disease mechanisms and facilitate targeted treatment strategies for individual patients. Individualised management in the postacute phase and evaluation of the effectiveness of treatment and care processes depend on accurate quantification of outcomes. In practice, however, the use of simplistic methods hinders efforts to quantify outcomes after TBI of all severities. Development and validation of multidimensional approaches will be essential to improve measurement of clinical outcomes, for both research and patient care. In particular, we need to find better ways to characterise the currently under-recognised risk of long-term disabling sequelae in patients with relatively mild injuries. Prognostic models are important to help clinicians to provide reliable information to patients and relatives, and to facilitate comparative audit of care between centres and countries. There is an urgent need for further development, validation, and implementation of prognostic models in TBI, particularly for less severe TBI. This multitude of challenges in TBI—encompassing systems of care, clinical management, and research strategy—demands novel approaches to the generation of new evidence and its implementation in clinical practice. Comparative effectiveness research (CER) offers opportunities to capitalise on the diversity of TBI and systems of care and enables assessment of therapies in real-world conditions; high-quality CER studies can provide strong evidence to support guideline recommendations. The global challenges posed by TBI necessitate global collaborations and a change in research culture to endorse broad data sharing. This Commission covers a range of topics that need to be addressed to confront the global burden of TBI and reduce its effects on individuals and society: epidemiology (section 1); health economics (section 2); prevention (section 3); systems of care (section 4); clinical management (section 5); characterisation of TBI (section 6); outcome assessment (section 7); prognosis (section 8); and new directions for acquiring and implementing evidence (section 9). Table 1 summarises key messages from the Commission and provides recommendations to advance clinical care and research in TBI. We must increase awareness of the scale of the challenge posed by TBI. If we are to tackle the individual and societal burden of TBI, these efforts need to go beyond a clinical and research audience and address the public, politicians, and other stakeholders. We need to develop and implement policies for better prevention and systems of care in order to improve outcomes for individuals with TBI. We also need a commitment to substantial long-term investment in TBI research across a range of disciplines to determine best practice and facilitate individualised management strategies. A combination of innovative research methods and global collaboration, and ways to effectively translate progress in basic and clinical research into clinical practice and public health policy, will be vital for progress in the field.
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- 2017
4. A Splint Was Not Inferior to a Cast for Distal Radial Fracture in Children
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Boutis, K, Willan, A, Babyn, P, Goeree, R, Howard, A, and Price, Charles T
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- 2011
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5. LO59: Retention of critical procedural skills post-simulation training: a systematic review
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Legoux, C., primary, Gerein, R., additional, Boutis, K., additional, and Plint, A., additional
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- 2019
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6. VISUALIZING THOUGHT IN MEDICAL EDUCATION: How Does Drawing Enhance the Learning of Diagnostic Skills in Radiology?
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Cirigliano, M., primary, Pusic, M., additional, Plass, J., additional, Matuk, C., additional, Shiau, M., additional, Pecaric, M., additional, and Boutis, K., additional
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- 2018
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7. MP20: ImageSim - performance-based medical image interpretation learning system
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Boutis, K., primary, Pecarcic, M., additional, and Pusic, M., additional
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- 2018
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8. LO41: Competency-based learning of pediatric musculoskeletal radiographs
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Boutis, K., primary, Lee, M., additional, Pusic, M., additional, Pecarcic, M., additional, Carrier, B., additional, Dixon, A., additional, and Stimec, J., additional
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- 2018
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9. LO81: Bridging the GAP: A deliberate practice method for learning Genital Abnormalities in Prepubescent girls
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Boutis, K., primary, Davis, A., additional, Pecarcic, M., additional, Pusic, M., additional, Shouldice, M., additional, Smith, T., additional, and Brown, J., additional
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- 2018
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10. LO44: Optimizing skill retention in radiograph interpretation: a multicentre randomized control trial
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Boutis, K., primary, Carrier, B., additional, Stimec, J., additional, Pecarcic, M., additional, Willan, A., additional, and Pusic, M., additional
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- 2018
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11. LO79: Climbing the learning curve teaching the pediatric emergency physician how to interpret point-of-care ultrasound images
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Kwan, C., primary, Weerdenburg, K., additional, Pecarcic, M., additional, Pusic, M., additional, Tessaro, M., additional, Salehmohamed, H., additional, and Boutis, K., additional
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- 2018
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12. LO86: The diagnosis of concussion in pediatric emergency departments: a prospective multicenter study
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Boutis, K., primary, Gravel, J., additional, Freedman, S., additional, Craig, W., additional, Tang, K., additional, DeMatteo, C., additional, Dubrovsky, S., additional, Beer, D., additional, Sangha, G., additional, and Zemek, R., additional
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- 2018
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13. A CHILDREN’S HOSPITAL’S EXPERIENCE PROMOTING VALUE AT THE BEDSIDE - A CHOOSING WISELY INITIATIVE
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Ostrow, O, primary, Beck, C, additional, Boutis, K, additional, Mahant, S, additional, Savlov, D, additional, and Friedman, JN, additional
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- 2017
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14. P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department
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Al-Sani, F., primary, Ben-Yakov, M., additional, Harvey, G., additional, Gantz, J., additional, Jacobson, D., additional, Boutis, K., additional, Ostrow, O., additional, and Principi, T., additional
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- 2017
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15. 117: Parental Knowledge of Trampoline Safety in Children
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Beno, S, primary, Colaco, K, additional, Barra, L, additional, Ackery, A, additional, and Boutis, K, additional
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- 2015
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16. 159: From the Emergency Department to a Community office – Primary Care Physician Follow Up of Buckle Fractures of the Distal Radius
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Koelink, E, primary, Barra, L, additional, Stimec, J, additional, Howard, A, additional, Schuh, S, additional, and Boutis, K, additional
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- 2015
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17. 118: Injury Prevention and Control Education in Paediatric and Paediatric Emergency Medicine Training Programs in Canada
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Beno, S, primary, Principi, T, additional, Ali, S, additional, Rosenfield, D, additional, and Boutis, K, additional
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- 2015
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18. 189: Parental Knowledge of Concussion
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Weerdenberg, K, primary, Schneeweiss, S, additional, Koo, E, additional, and Boutis, K, additional
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- 2014
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19. Validity of the Canadian Triage and Acuity Scale for Children: A Multi-Centre, Database Study
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Gravel, J, primary, Fitzpatrick, E, additional, Millar, K, additional, Curtis, S, additional, Joubert, G, additional, Boutis, K, additional, Guimont, C, additional, Goldman, RD, additional, Dubrovsky, S, additional, Porter, R, additional, Beer, D, additional, and Osmond, MH, additional
- Published
- 2012
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20. Intention-to-treat and per-protocol analysis
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Boutis, K., primary and Willan, A., additional
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- 2011
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21. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial
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Boutis, K., primary, Willan, A., additional, Babyn, P., additional, Goeree, R., additional, and Howard, A., additional
- Published
- 2010
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22. The Treatment of Pediatric Gastroenteritis — A Survey of North American Pediatric Emergency Physicians
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Freedman, S, primary, Sivabalasundaram, V, additional, Bohn, V, additional, Powell, E, additional, Johnson, D, additional, and Boutis, K, additional
- Published
- 2010
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23. A Palatability of Oral Rehydration Solutions (Pors) Study
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Freedman, S, primary, Cho, D, additional, Boutis, K, additional, Stephens, D, additional, and Schuh, S, additional
- Published
- 2009
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24. Should this Head Injured Child Receive a Head Ct? a Systematic Review of Clinical Prediction Rules
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Maguire, JL, primary, Boutis, K, additional, Laupacis, A, additional, and Parkin, P, additional
- Published
- 2009
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25. The impact of SARS on a tertiary care pediatric emergency department
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Boutis, K., primary
- Published
- 2004
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26. 306EMFDefining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians
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Stolz, L., Boyd, J., Baez, J., Minges, P., Swarm, M., and Boutis, K.
- Published
- 2021
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27. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?
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Cuomo AV, Howard A, Hsueh S, and Boutis K
- Published
- 2012
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28. North American Practice Patterns of Intravenous Magnesium Therapy in Severe Acute Asthma in Children.
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Schuh S, Macias C, Freedman SB, Plint AC, Zorc JJ, Bajaj L, Black KJ, Johnson DW, and Boutis K
- Published
- 2010
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29. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula.
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Boutis K, Narayanan UG, Dong FF, Mackenzie H, Yan H, Chew D, and Babyn P
- Published
- 2010
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30. Assessing the Palatability of Oral Rehydration Solutions in School-aged Children: A Randomized Crossover Trial.
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Freedman SB, Cho D, Boutis K, Stephens D, and Schuh S
- Published
- 2010
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31. Common pediatric fractures treated with minimal intervention.
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Boutis K and Boutis, Kathy
- Published
- 2010
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32. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study.
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Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, Mandl KD, and Schuh S
- Published
- 2001
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33. The use of local anesthetic techniques for closed forearm fracture reduction in children: a survey of academic pediatric emergency departments.
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Constantine E, Steele DW, Eberson C, Boutis K, Amanullah S, and Linakis JG
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- 2007
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34. LO25: How safe are our pediatric emergency departments? A multicentre, prospective cohort study
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Plint, A., Calder, L., Cantor, Z., Aglipay, M., Stang, A.S., Newton, A.S., Gouin, S., Boutis, K., Joubert, G., Doan, Q., Dixon, A., Porter, R., Sawyer, S., Bhatt, M., Farion, K., Crawford, T., Dalgleish, D., Johnson, D.W., Klassen, T., and Barrowman, N.
- Abstract
Introduction:Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods:Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results:We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion:While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
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- 2017
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35. The canadian triage and acuity scale for children: a prospective multicenter evaluation.
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Gravel J, Gouin S, Goldman RD, Osmond MH, Fitzpatrick E, Boutis K, Guimont C, Joubert G, Millar K, Curtis S, Sinclair D, and Amre D
- Abstract
STUDY OBJECTIVE: The aims of the study are to measure both the interrater agreement of nurses using the Canadian Triage and Acuity Scale in children and the validity of the scale as measured by the correlation between triage level and proxy markers of severity. METHODS: This was a prospective multicenter study of the reliability and construct validity of the Canadian Triage and Acuity Scale in 9 tertiary care pediatric emergency departments (EDs) across Canada during 2009 to 2010. Participants were a sample of children initially triaged as Canadian Triage and Acuity Scale level 2 (emergency) to level 5 (nonurgent). Participants were recruited immediately after their initial triage to undergo a second triage assessment by the research nurse. Both triages were performed blinded to the other. The primary outcome measures were the interrater agreement between the 2 nurses and the association between triage level and hospitalization. Secondary outcome measures were the association between triage level and health resource use and length of stay in the ED. RESULTS: A total of 1,564 patients were approached and 1,464 consented. The overall interrater agreement was good, as demonstrated by a quadratic weighted [kappa] score of 0.74 (95% confidence interval 0.71 to 0.76). Hospitalization proportions were 30%, 8.3%, 2.3%, and 2.2% for patients triaged at levels 2, 3, 4, and 5, respectively. There was also a strong association between triage levels and use of health care resources and length of stay. CONCLUSION: The Canadian Triage and Acuity Scale demonstrates a good interrater agreement between nurses across multiple pediatric EDs and is a valid triage tool, as demonstrated by its good association with markers of severity. [ABSTRACT FROM AUTHOR]
- Published
- 2012
36. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules.
- Author
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Maguire JL, Boutis K, Uleryk EM, Laupacis A, and Parkin PC
- Abstract
CONTEXT: Given radiation- and sedation-associated risks, there is uncertainty about which children with head trauma should receive cranial computed tomography (CT) scanning. A high-quality and high-performing clinical prediction rule may reduce this uncertainty. OBJECTIVE: To systematically review the quality and performance of published clinical prediction rules for intracranial injury in children with head injury. METHODS: Medline and Embase were searched in December 2008. Studies were selected if they included clinical prediction rules involving children aged 0 to 18 years with a history of head injury. Prediction-rule quality was assessed by using 14 previously published items. Prediction-rule performance was evaluated by rule sensitivity and the predicted frequency of CT scanning if the rule was used. RESULTS: A total of 3357 titles and abstracts were assessed, and 8 clinical prediction rules were identified. For all studies, the rule derivations were reported; no study validated a rule in a separate population or assessed its impact in actual practice. The rules differed considerably in population, predictors, outcomes, methodologic quality, and performance. Five of the rules were applicable to children of all ages and severities of trauma. Two of these were high quality (>or=11 of 14 quality items) and had high performance (lower confidence limits for sensitivity >0.95 and required
or=13). One of these had high quality (11 of 14 quality items) and high performance (lower confidence limit for sensitivity = 0.94 and required 13% to undergo CT). Four of the 8 rules were applicable to young children, but none exhibited adequate quality or performance. CONCLUSIONS: Eight clinical prediction-rule derivation studies were identified. They varied considerably in population, methodologic quality, and performance. Future efforts should be directed toward validating rules with high quality and performance in other populations and deriving a high-quality, high-performance rule for young children. [ABSTRACT FROM AUTHOR] - Published
- 2009
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37. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures.
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Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, and Schuh S
- Abstract
OBJECTIVES: Isolated distal fibular ankle fractures in children are very common and at very low risk for future complications. Nevertheless, standard therapy for these fractures still consists of casting, a practice that carries risks, inconveniences, and use of subspecialty health care resources. Therefore, the main objective of this study was to determine whether children who have these low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast. METHODS: This was a noninferiority, randomized, single-blind trial in which children who were 5 to 18 years of age and treated in a pediatric emergency department for low-risk ankle fractures were randomly assigned to a removable ankle brace or a below-knee walking cast. The primary outcome at 4 weeks was physical function, measured by using the modified Activities Scale for Kids. Additional outcomes included patient preferences and costs. RESULTS: The mean activity score at 4 weeks was 91.3% in the brace group (n = 54), and this was significantly higher than the mean of 85.3% in the cast group (n = 50). Significantly more children who were treated with a brace had returned to baseline activities by 4 weeks compared with those who were casted (80.8% vs 59.5%). Fifty-four percent of the casted children would have preferred the brace, but only 5.7% of children who received the brace would have preferred the cast. The cost-effectiveness acceptability curve was always >80%; therefore, the brace was cost-effective compared with the cast. CONCLUSIONS: The removable ankle brace is more effective than the cast with respect to recovery of physical function, is associated with a faster return to baseline activities, is superior with respect to patient preferences, and is also cost-effective. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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38. Value of information methods for planning and analyzing clinical studies optimize decision making and research planning.
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Willan AR, Goeree R, and Boutis K
- Published
- 2012
39. Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury.
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Lorenzo M, Cory E, Cho R, Pusic M, Fish J, Adelgais KM, and Boutis K
- Abstract
Objective: To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error., Study Design: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity)., Results: Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI -13.5, -16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI -9.8, -12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI -14.8, -18.6). Based on 35 627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury., Conclusions: The education intervention substantially reduced diagnostic error in differentiating the presence vs absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain., Competing Interests: Declaration of Competing Interest Data used for this research was extracted from the ImageSim platform. Dr. Kathy Boutis is married to Dr. Martin Pecaric of Contrail Consulting Inc. Contrail Consulting Inc. provides technical support for ImageSim. This is managed under an agreement with the Hospital for Sick Children. Dr. Boutis and Dr. Pusic are unpaid co-academic directors for ImageSim. This study was funded by the Hospital for Sick Children and Physician Services Incorporated., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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40. A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians.
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Bregman S, Thau E, Pusic M, Perez M, and Boutis K
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- Humans, Child, Clinical Competence, Radiography, Thoracic methods, Physicians
- Abstract
Introduction: There is limited knowledge on pediatric chest radiograph (pCXR) interpretation skill among practicing physicians. We systematically determined baseline interpretation skill, the number of pCXR cases physicians required complete to achieve a performance benchmark, and which diagnoses posed the greatest diagnostic challenge., Methods: Physicians interpreted 434 pCXR cases via a web-based platform until they achieved a performance benchmark of 85% accuracy, sensitivity, and specificity. Interpretation difficulty scores for each case were derived by applying one-parameter item response theory to participant data. We compared interpretation difficulty scores across diagnostic categories and described the diagnoses of the 30% most difficult-to-interpret cases., Results: 240 physicians who practice in one of three geographic areas interpreted cases, yielding 56,833 pCXR case interpretations. The initial diagnostic performance (first 50 cases) of our participants demonstrated an accuracy of 68.9%, sensitivity of 69.4%, and a specificity of 68.4%. The median number of cases completed to achieve the performance benchmark was 102 (interquartile range 69, 176; min, max, 54, 431). Among the 30% most difficult-to-interpret cases, 39.2% were normal pCXR and 32.3% were cases of lobar pneumonia. Cases with a single trauma-related imaging finding, cardiac, hilar, and diaphragmatic pathologies were also among the most challenging., Discussion: At baseline, practicing physicians misdiagnosed about one-third of pCXR and there was up to an eight-fold difference between participants in number of cases completed to achieve the standardized performance benchmark. We also identified the diagnoses with the greatest potential for educational intervention., (Copyright © 2024 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)
- Published
- 2024
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41. Twelve Tips for using Learning Curves in Health Professions Education Research.
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Howard N, Edwards R, Boutis K, Alexander S, and Pusic M
- Abstract
Learning curves can be used to design, implement, and evaluate educational interventions. Attention to key aspects of the method can improve the fidelity of this representation of learning as well as its suitability for education and research purposes. This paper addresses when to use a learning curve, which graphical properties to consider, how to use learning curves quantitatively, and how to use observed thresholds to communicate meaning. We also address the associated ethics and policy considerations. We conclude with a best practices checklist for both educators and researchers seeking to use learning curves in their work., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Howard N et al.)
- Published
- 2023
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42. Interactive computer-assisted learning as an educational method for learning pediatric interproximal dental caries identification.
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Goertzen E, Casas MJ, Barrett EJ, Perschbacher S, Pusic M, and Boutis K
- Subjects
- Humans, Child, Radiography, Bitewing, Prospective Studies, Computers, Dental Caries diagnostic imaging
- Abstract
Objective: We developed a web-based tool to measure the amount and rate of skill acquisition in pediatric interproximal caries diagnosis among pre- and postdoctoral dental students and identified variables predictive for greater image interpretation difficulty., Study Design: In this multicenter prospective cohort study, a convenience sample of pre- and postdoctoral dental students participated in computer-assisted learning in the interpretation of bitewing radiographs of 193 children. Participants were asked to identify the presence or absence of interproximal caries and, where applicable, locate the lesions. After every case, participants received specific visual and text feedback on their diagnostic performance. They were requested to complete the 193-case set but could complete enough cases to achieve a competency performance standard of 75% accuracy, sensitivity, and specificity., Results: Of 130 participants, 62 (47.7%) completed all cases. The mean change from initial to maximal diagnostic accuracy was +15.3% (95% CI, 13.0-17.7), sensitivity was +10.8% (95% CI, 9.0-12.7), and specificity was +15.5% (95% CI, 12.9-18.1). The median number of cases completed to achieve competency was 173 (interquartile range, 82-363). Of these 62 participants, 45 (72.6%) showed overall improvement in diagnostic accuracy. Greater numbers of interproximal lesions (P < .001) and the presence of noninterproximal caries (P < .001) predicted greater interpretation difficulty., Conclusions: Computer-assisted learning led to improved diagnosis of interproximal caries on bitewing radiographs among pre- and postdoctoral dental students., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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43. Competency Standard Derivation for Point-of-Care Ultrasound Image Interpretation for Emergency Physicians.
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Harel-Sterling M, Kwan C, Pirie J, Tessaro M, Cho DD, Coblentz A, Halabi M, Cohen E, Nield LE, Pusic M, and Boutis K
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- Humans, Child, Prospective Studies, Ultrasonography methods, Emergency Service, Hospital, Point-of-Care Systems, Physicians
- Abstract
Study Objective: Because number-based standards are increasingly controversial, the objective of this study was to derive a performance-based competency standard for the image interpretation task of point-of-care ultrasound (POCUS)., Methods: This was a prospective study. Operating on a clinically-relevant sample of POCUS images, we adapted the Ebel standard-setting method to derive a performance benchmark in 4 diverse pediatric POCUS applications: soft tissue, lung, cardiac and focused assessment with sonography in trauma (FAST). In Phase I (difficulty calibration), cases were categorized into interpretation difficulty terciles (easy, intermediate, hard) using emergency physician-derived data. In Phase II (significance), a 4-person expert panel categorized cases as low, medium, or high clinical significance. In Phase III (standard setting), a 3x3 matrix was created, categorizing cases by difficulty and significance, and a 6-member panel determined acceptable accuracy for each of the 9 cells. An overall competency standard was derived from the weighted sum., Results: We obtained data from 379 emergency physicians resulting in 67,093 interpretations and a median of 184 (interquartile range, 154, 190) interpretations per case. There were 78 (19.5%) easy, 272 (68.0%) medium, and 50 (12.5%) hard-to-interpret cases, and 237 (59.3%) low, 65 (16.3%) medium, and 98 (24.5%) cases of high clinical significance across the 4 POCUS applications. The panel determined an overall performance-based competency score of 85.0% for lung, 89.5% for cardiac, 90.5% for soft tissue, and 92.7% for FAST., Conclusion: This research provides a transparent chain of evidence that derived clinically relevant competency standards for POCUS image interpretation., (Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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44. Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury.
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Vaughan CG, Ledoux AA, Sady MD, Tang K, Yeates KO, Sangha G, Osmond MH, Freedman SB, Gravel J, Gagnon I, Craig W, Burns E, Boutis K, Beer D, Gioia G, and Zemek R
- Subjects
- Child, Adolescent, Humans, Female, Child, Preschool, Male, Cohort Studies, Prospective Studies, Canada epidemiology, Schools, Return to School, Brain Concussion diagnosis, Brain Concussion complications
- Abstract
Importance: Determining how the timing of return to school is related to later symptom burden is important for early postinjury management recommendations., Objective: To examine the typical time to return to school after a concussion and evaluate whether an earlier return to school is associated with symptom burden 14 days postinjury., Design, Setting, and Participants: Planned secondary analysis of a prospective, multicenter observational cohort study from August 2013 to September 2014. Participants aged 5 to 18 years with an acute (<48 hours) concussion were recruited from 9 Canadian pediatric emergency departments in the Pediatric Emergency Research Canada Network., Exposure: The independent variable was the number of days of school missed. Missing fewer than 3 days after concussion was defined as an early return to school., Main Outcomes and Measures: The primary outcome was symptom burden at 14 days, measured with the Post-Concussion Symptom Inventory (PCSI). Symptom burden was defined as symptoms status at 14 days minus preinjury symptoms. Propensity score analyses applying inverse probability of treatment weighting were performed to estimate the relationship between the timing of return to school and symptom burden., Results: This cohort study examined data for 1630 children (mean age [SD] 11.8 [3.4]; 624 [38%] female). Of these children, 875 (53.7%) were classified as having an early return to school. The mean (SD) number of days missed increased across age groups (5-7 years, 2.61 [5.2]; 8-12 years, 3.26 [4.9]; 13-18 years, 4.71 [6.1]). An early return to school was associated with a lower symptom burden 14 days postinjury in the 8 to 12-year and 13 to 18-year age groups, but not in the 5 to 7-year age group. The association between early return and lower symptom burden was stronger in individuals with a higher symptom burden at the time of injury, except those aged 5 to 7 years., Conclusions and Relevance: In this cohort study of youth aged 5 to 18 years, these results supported the growing belief that prolonged absences from school and other life activities after a concussion may be detrimental to recovery. An early return to school may be associated with a lower symptom burden and, ultimately, faster recovery.
- Published
- 2023
- Full Text
- View/download PDF
45. Early analgesic administration and headache presence 7 days post-concussion in children.
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Ledoux A-, Tang K, Freedman SB, Gravel J, Boutis K, Yeates KO, Mannix RC, Richer LR, Bell MJ, and Zemek RL
- Subjects
- Adolescent, Child, Humans, Ibuprofen therapeutic use, Prospective Studies, Canada, Analgesics, Headache drug therapy, Acetaminophen therapeutic use, Brain Concussion complications
- Abstract
Objective: This study investigates whether acute treatment with ibuprofen, acetaminophen, or both is associated with resolution of headache or reduction of headache pain at 7 days post-concussion in children and youth., Methods: A secondary analysis of the Predicting and Preventing Post-concussive Problems in Pediatrics (5P) prospective cohort study was conducted. Individuals aged 5-18 years with acute concussion presenting to nine Canadian pediatric emergency departments (ED) were enrolled from August 2013 to June 2015. The primary outcome was the presence of headache at 7 days, measured using the Post-Concussion Symptom Inventory. The association between acute administration of ibuprofen, acetaminophen, or both and headache presence at 7 days was investigated with propensity scores and adjusted multivariate regression models., Results: 2277 (74.3%) of 3063 participants had headache upon ED presentation. Of these participants, 1543 (67.8%) received an analgesic medication before or during their ED visit [ibuprofen 754 (33.1%), acetaminophen 445 (19.5%), both 344 (15.1%); or no medication 734 (32.2%)]. Multivariate analysis pertained to 1707 participants with propensity scores based on personal characteristics and symptoms; 877 (51.4%) reported headache at 7 days post-concussion. No association emerged between treatment and presence of headache at 7 days [ibuprofen vs. untreated: (relative risk (RR) = 1.12 (95% CI 0.99,1.26); acetaminophen vs untreated RR = 1.02 (95% CI 0.87,1.22); both vs untreated RR = 1.02 (95% CI 0.86,1.18)]., Conclusions: Exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion. Non-opioid analgesics like ibuprofen or acetaminophen may be prescribed for short-term headache relief but clinicians need to be cautious with long-term medication overuse in those whose headache symptoms persist., (© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
- Published
- 2022
- Full Text
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46. How safe are paediatric emergency departments? A national prospective cohort study.
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, and Calder LA
- Subjects
- Child, Humans, Infant, Child, Preschool, Prospective Studies, Cohort Studies, Emergency Service, Hospital, Hospitalization, Patient Safety
- Abstract
Background: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department., Methods: Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred., Results: We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit., Conclusion: In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care., Competing Interests: Competing interests: LAC is the CEO of the Canadian Medical Protective Association and chair of the Saegis Board of Directors (paid positions). KC is the chair of Acute Care Committee, Canadian Paediatric Society, and the past president of the Section for Emergency Medicine, Canadian Paediatric Society (unpaid positions). GY is a voting member of the Royal College Committee for Pediatric Emergency Medicine (Canada) (unpaid). ASN is the secretary-treasurer for the Mental Health Executive, Canadian Paediatric Society (unpaid)., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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47. Torus fractures of the distal radius: time to focus on symptomatic management.
- Author
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Boutis K and Narayanan U
- Subjects
- Humans, Radius, Wrist Joint
- Abstract
Competing Interests: KB is a section editor and author for UpToDate and receives royalties for her contributions. KB has received fees for expert testimony in a legal case related to a paediatric musculoskeletal injury. UN declares no competing interests.
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- 2022
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48. Paediatric post-concussive symptoms: symptom clusters and clinical phenotypes.
- Author
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Lyons TW, Mannix R, Tang K, Yeates KO, Sangha G, Burns EC, Beer D, Dubrovsky AS, Gagnon I, Gravel J, Freedman SB, Craig W, Boutis K, Osmond MH, Gioia G, and Zemek R
- Subjects
- Child, Cohort Studies, Fatigue complications, Female, Headache complications, Humans, Male, Phenotype, Prospective Studies, Brain Concussion complications, Brain Concussion diagnosis, Pediatrics, Post-Concussion Syndrome epidemiology
- Abstract
Objective: To assess the co-occurrence and clustering of post-concussive symptoms in children, and to identify distinct patient phenotypes based on symptom type and severity., Methods: We performed a secondary analysis of the prospective, multicentre Predicting and Preventing Post-concussive Problems in Pediatrics (5P) cohort study, evaluating children 5-17 years of age presenting within 48 hours of an acute concussion. Our primary outcome was the simultaneous occurrence of two or more persistent post-concussive symptoms on the Post-Concussion Symptom Inventory at 28 days post-injury. Analyses of symptom and patient clusters were performed using hierarchical cluster analyses of symptom severity ratings., Results: 3063 patients from the parent 5P study were included. Median age was 12.1 years (IQR: 9.2-14.6 years), and 1857 (60.6%) were male. Fatigue was the most common persistent symptom (21.7%), with headache the most commonly reported co-occurring symptom among patients with fatigue (55%; 363/662). Headache was common in children reporting any of the 12 other symptoms (range: 54%-72%). Physical symptoms occurred in two distinct clusters: vestibular-ocular and headache. Emotional and cognitive symptoms occurred together more frequently and with higher severity than physical symptoms. Fatigue was more strongly associated with cognitive and emotional symptoms than physical symptoms. We identified five patient groups (resolved/minimal, mild, moderate, severe and profound) based on symptom type and severity., Conclusion: Post-concussive symptoms in children occur in distinct clusters, facilitating the identification of distinct patient phenotypes based on symptom type and severity. Care of children post-concussion must be comprehensive, with systems designed to identify and treat distinct post-concussion phenotypes., Competing Interests: Competing interests: GG is an author of the Post-Concussion Symptom Inventory (PCSI) used in this study. The PCSI is freely available and he receives no financial benefit from its use., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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49. Pediatric Musculoskeletal Radiographs: Anatomy and Fractures Prone to Diagnostic Error Among Emergency Physicians.
- Author
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Li W, Stimec J, Camp M, Pusic M, Herman J, and Boutis K
- Subjects
- Child, Diagnostic Errors, Humans, Radiography, Elbow Joint, Humeral Fractures, Physicians
- Abstract
Background: Pediatric musculoskeletal (pMSK) radiograph interpretations are common, but the specific radiograph features at risk of incorrect diagnosis are relatively unknown., Objective: We determined the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians (EPs) reviewing pMSK radiographs., Methods: EPs interpreted 1850 pMSK radiographs via a web-based platform and we derived interpretation difficulty scores for each radiograph in 13 body regions using one-parameter item response theory. We compared the difficulty scores by presence or absence of a fracture and, where applicable, by fracture location and morphology; significance was adjusted for multiple comparisons. An expert panel reviewed the 65 most commonly misdiagnosed fracture-negative radiographs to identify imaging features mistaken for fractures., Results: We included data from 244 EPs, which resulted in 185,653 unique interpretations. For elbow, forearm, wrist, femur, knee, and tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0.004 for all comparisons). The descriptive review demonstrated that specific normal anatomy, overlapping bones, and external artefact from muscle or skin folds were often mistaken for fractures. There was a significant difference in difficulty score by anatomic locations of the fracture in the elbow, pelvis, and ankle (p < 0.004 for all comparisons). Ankle and elbow growth plate, fibular avulsion, and humerus condylar fractures were more difficult to diagnose than other fracture patterns (p < 0.004 for all comparisons)., Conclusions: We identified actionable learning opportunities in pMSK radiograph interpretation for EPs., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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50. A Target Population Derived Method for Developing a Competency Standard in Radiograph Interpretation.
- Author
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Lee MS, Pusic MV, Camp M, Stimec J, Dixon A, Carrière B, Herman JE, and Boutis K
- Subjects
- Child, Diagnostic Errors, Humans, Radiography, Emergency Service, Hospital, Physicians
- Abstract
Construct: 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., Background: 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., Approach: 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., Findings: 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., Conclusion(s): 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.
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- 2022
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