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178 results on '"Trottier, Evelyne D."'

6. Morphine versus hydromorphone in pediatrics: a narrative review of latest indications and optimal use in neonates and children

Author

SPÉNARD, Sarah, primary, METRAS, Marie-Elaine, additional, GÉLINAS, Charles, additional, SHAH, Vibhuti, additional, DORÉ-BERGERON, Marie-Joëlle, additional, DEKOVEN, Kathryn, additional, MARQUIS, Marc-Antoine, additional, TROTTIER, Evelyne D., additional, THIBAULT, Céline, additional, and KLEIBER, Niina, additional

Published
2023
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14. The Three W's of Acetaminophen In Children: Who, Why, and Which Administration Mode?

Author

Thibault, Céline, primary, Pelletier, Élaine, additional, Nguyen, Christina, additional, Trottier, Evelyne D., additional, Doré-Bergeron, Marie-Joëlle, additional, DeKoven, Kathryn, additional, Roy, Anne-Marie, additional, Piché, Nelson, additional, Delisle, Jean-Francois, additional, Morin, Caroline, additional, Paquette, Julie, additional, and Kleiber, Niina, additional

Published
2023
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15. Acute complications in children with sickle cell disease: Prevention and management

Author

Beck, Carolyn E, Trottier, Evelyne D, Kirby-Allen, Melanie, and Pastore, Yves

Subjects
hemic and lymphatic diseases, Pediatrics, Perinatology and Child Health, Position Statements / Document de Principes
Abstract

Sickle cell disease (SCD) is a chronic, multi-system disease that requires comprehensive care. The sickling of red blood cells leads to hemolysis and vascular occlusion. Complications include hemolytic anemia, pain syndromes, and organ damage. Patterns of immigration and an increase in newborn screening mean that paediatric health care providers across Canada, in small and large centres alike, need to be knowledgeable about SCD. This statement focuses on principles of prevention, advocacy, and the rapid treatment of common acute complications. Guidance includes the current status of newborn screening, recommendations for immunizations and antibiotic prophylaxis, and an introduction to hydroxyurea, a medication that reduces both morbidity and mortality in children with SCD. Case vignettes demonstrate principles of care for common acute complications of SCD: vaso-occlusive episodes (VOE), acute chest syndrome (ACS), fever, splenic sequestration, aplastic crises, and stroke. Finally, principles of blood transfusion are highlighted, along with indications for both straight and exchange blood transfusions.

Published
2022
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30. Nitrous oxide use in Canadian pediatric emergency departments: a survey of physician’s knowledge, attitudes, and practices

Author

Jain, Rini, Hudson, Summer, Osmond, Martin H., Trottier, Evelyne D., Poonai, Naveen, and Ali, Samina

Abstract

Objectives: Nitrous oxide (N2O) is an inhaled analgesic/ anxiolytic gas with evidence supporting its safety and efficacy for distressing procedures in children. Despite this, its use is not consistent across Canadian pediatric emergency departments (EDs). We aimed to characterize a) physicians’ knowledge and practices with N2O and b) site-specific N2O protocols in Canadian pediatric EDs to help optimize its use nationally. Methods: This cross-sectional survey was distributed to physician members of Pediatric Emergency Research Canada (PERC) in early 2021. Survey items addressed practice patterns, clinician comfort, and perceived barriers/ facilitators to use. Further, a representative from each ED completed a site-specific inventory of N2O policies and procedures. Results: N2O was available in 40.0% of 15 pediatric EDs, with 83.3% of these sites having written policies in place. Of 230 distributed surveys, 67.8% were completed with mean (SD) attending experience of 14.7 (8.6) years and 70.1% having pediatric emergency subspecialty training. Of the 156 respondents, 48.7% used N2O in their clinical practice. The most common indications for use were digit fracture/ dislocation reduction (69.7%), wound closure (60.5%), and incision & drainage (59.2%). Commonly perceived facilitators were N2O equipment availability (73.0% of 156) and previous clinical experience (71.7% of 156). Of the 51.3% of physicians who reported not using N2O, 93.7% did not have availability at their site; importantly, the majority indicated a desire to acquire access. They identified concerns about ventilation/ scavenging systems (71.2% of 80) and unfamiliarity with equipment (52.5% of 80) as the most common barriers to use. Conclusions: Despite evidence to support its use, only half of Canadian pediatric ED physicians surveyed use N2O in their clinical practice for treating procedure-related pain and distress. Increased availability of N2O equipment, protocols, and training may improve clinicians’ abilities to better manage pediatric acute pain and distress in the ED.

Published
2023
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31. Outpatient management of moderate cellulitis in children using high-dose oral cephalexin.

Author

Trottier, Evelyne D, St-Amand, Beatrice Farley, Vincent, Mélanie, Chevalier, Isabelle, Autmizguine, Julie, Tremblay, Stéphanie, and Gouin, Serge

Subjects
*CELLULITIS treatment, *CEPHRADINE, *HOSPITAL emergency services, *ORAL drug administration, *RETROSPECTIVE studies, *ACQUISITION of data, *TREATMENT effectiveness, *TREATMENT failure, *MEDICAL records, *HOSPITAL care, *DESCRIPTIVE statistics, *OUTPATIENT services in hospitals, *LONGITUDINAL method, *ANTIBIOTICS, *PHARMACODYNAMICS, *CHILDREN
Abstract

Objectives To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients. Methods In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution's HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up. Results A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0). Conclusions With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Distraction in the Emergency department using Virtual reality for INtravenous procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial

Author

Osmanlliu, Esli, primary, Trottier, Evelyne D., additional, Bailey, Benoit, additional, Lagacé, Maryse, additional, Certain, Mélanie, additional, Khadra, Christelle, additional, Sanchez, Marisol, additional, Thériault, Corinne, additional, Paquin, David, additional, Côtes-Turpin, Casey, additional, and Le May, Sylvie, additional

Published
2020
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36. 80 Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort -the DEVINCI project: A Pilot RCT

Author

Trottier, Evelyne D, primary, Osmanlliu, Esli, additional, Bailey, Benoit, additional, Lagacé, Maryse, additional, Sanchez, Marisol, additional, Certain, Melanie, additional, Khadra, Christelle, additional, Thériault, Corinne, additional, Paquin, David, additional, Cotes Turpin, Casey, additional, and Le May, Sylvie, additional

Published
2020
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44. A survey of Canadian emergency physicians’ experiences and perspectives during the COVID-19 pandemic

Author

Gaucher, Nathalie, Trottier, Evelyne D., Côté, Anne-Josee, Ali, Huma, Lavoie, Bertrand, Bourque, Claude-Julie, and Ali, Samina

Abstract

Background: The objective of this study was to explore Canadian emergency physicians’ experiences, concerns, and perspectives during the first wave of the coronavirus disease (COVID-19) pandemic. Methods: This cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses. Results: From June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85–100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada’s financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies. Conclusion: Canadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration.

Published
2021
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45. Evaluation of a clinical protocol using intranasal fentanyl for treatment of vaso-occlusive crisis in sickle cell patients in the emergency department.

Author

Paquin, Hugo, Trottier, Evelyne D, Pastore, Yves, Robitaille, Nancy, Bergeron, Marie-Joelle Dore, and Bailey, Benoit

Subjects
*INTRANASAL medication, *ANALGESICS, *ARTERIAL occlusions, *CLINICAL trials, *CONFIDENCE intervals, *DRUG prescribing, *FENTANYL, *HOSPITAL emergency services, *INTRAVENOUS therapy, *MEDICAL protocols, *NARCOTICS, *QUALITY assurance, *SICKLE cell anemia, *TIME, *PAIN management, *PHYSICIAN practice patterns, *PRE-tests & post-tests, *RETROSPECTIVE studies
Abstract

Background Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visits and admission in children with sickle cell disease (SCD). Objectives This study aims to evaluate whether the use of a new pain management pathway using intranasal (IN) fentanyl from triage leads to improved care, translated by a decrease in time to first opiate dose. Methods We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) with VOC, in the period pre- (52 patients) and post- (44 patients) implementation period of the protocol. Time to first opiate was the primary outcome and was evaluated pre- and postimplementation. Patients received a first opiate dose within 52.3 minutes of registration (interquantile range [IQR] 30.6, 74.6), corresponding to a 41.4-minute reduction in the opiate administration time (95% confidence interval [CI] −56.1, −27.9). There was also a 43% increase in the number of patients treated with a nonintravenous (IV) opiate as first opiate dose (95% CI 26, 57). In patients who were discharged from the ED, there was a 49% decrease in the number of IV line insertions (95% CI −67, −22). There was no difference in the hospitalization rates (difference of 6 [95% CI −13, 25]). Conclusions This study validates the use of our protocol using IN fentanyl as first treatment of VOC in the ED by significantly reducing the time to first opiate dose and the number of IVs. [ABSTRACT FROM AUTHOR]

Published
2020
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47. Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review

Author

Le May, Sylvie, Ali, Samina, Khadra, Christelle, Drendel, Amy L., Trottier, Evelyne D., Gouin, Serge, and Poonai, Naveen

Subjects
Article Subject
Abstract

Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0–18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.

Published
2016
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48. Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients.

Author

Paquin, Hugo, Trottier, Evelyne D., Bailey, Benoit, Robitaille, Nancy, Pastore, Yves, and Bergeron, Marie-Joelle Dore

Subjects
*DRUG therapy for sickle cell anemia, *THERAPEUTIC use of narcotics, *CLINICS, *CONFIDENCE intervals, *HEMATOLOGY, *HOSPITAL care, *LENGTH of stay in hospitals, *HOSPITAL admission & discharge, *HOSPITAL emergency services, *MEDICAL protocols, *MORPHINE, *ORAL drug administration, *PATIENTS, *PEDIATRICS, *PAIN measurement, *MEDICAL records, *RETROSPECTIVE studies
Abstract

Background Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visit and admission in children with sickle cell disease (SCD). Objectives This study aimed to evaluate whether the implementation of a protocol promoting the use of oral morphine as a primary intervention has led to improved care of SCD. Methods We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) and hematology outpatient clinic (HOC) with VOC, in the year pre and postimplementation of the protocol. The primary outcome was the hospitalization rate. Results The protocol resulted in a significant 43% reduction of hospitalization rate (95% confidence interval [CI] −53.0, 26.5). Results also showed a 35% increase in the use of oral morphine as first-line opiate treatment (95% CI 17.9, 45.2), a 28% increase in the use of pain scales (95% CI 17.3, 43.2) and a 30% net increase in patients eventually not requiring intravenous (IV) line placement (95% CI 16.0, 39.9). While we did observe an overall decrease in length of stay in ED of -55 min (95% CI −100.6, −12.0), there was a nonsignificant decrease of 7 minutes (95% CI −26, 3) in the opiate administration time. Conclusions This study validates the use of our oral morphine protocol for the treatment of VOC by significantly reducing the admission rate and decreasing the number of IVs. [ABSTRACT FROM AUTHOR]

Published
2019
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49. External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol.

Author

Ballard, Ariane, Khadra, Christelle, Adler, Samara, Trottier, Evelyne D., Bailey, Benoit, Poonai, Naveen, Théroux, Jean, and Le May, Sylvie

Abstract

Introduction Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. Methods and analysis This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A noninferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. Ethics and dissemination This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peerreviewed publications and conference presentations. [ABSTRACT FROM AUTHOR]

Published
2019
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