The Pediatric Risk Evaluation for Predicting Anaphylaxis Recurrence in Emergency Department (PREPARED) Score: Derivation and Validation

Biphasic reactions (BR) affect 5-15% of children with anaphylaxis. Post-anaphylaxis monitoring guidelines vary and are based on limited evidence, with potentially negative impacts on patient safety and healthcare resources. We derived and internally validated a clinical prediction score for anaphylactic BR in children.

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Validation of the high-risk echocardiogram score for TIA and nondisabling stroke patients

Transient ischemic attack (TIA) is a medical emergency with a 10-18% risk of ischemic stroke within 90 days. Routine echocardiography is used to identify cardiogenic etiologies, but it is not readily available in many clinical settings. We derived a clinical score to identify TIA patients most likely to benefit from early  echocardiography. This study externally validated the rule in a new prospective cohort of TIA/minor stroke patients.

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Does dispensing medication from the emergency department reduce return visits and subsequent hospitalization? A systematic review 

Up to one-third of discharged emergency department (ED) patients do not fill their prescriptions. We systematically reviewed the evidence to evaluate the impact of directly dispensing medications in ED on return visits and hospitalizations.

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Réduction de dimension des antécédents médicaux par auto-encodeur neuronal pour des modèles prédictifs à l’urgence

L’informatisation des soins de santé génère de vastes volumes de données cliniques, offrant un fort potentiel de recherche, mais au prix de coûts computationnels élevés. La prise en compte des antécédents médicaux illustre ce défi: un encodage dichotomique classique produit des matrices de grande dimension, clairsemées et coûteuses à traiter. La réduction de dimensionnalité pourrait atténuer ce problème, mais demeure peu étudiée en médecine d’urgence. Cette étude visait à développer un auto-encodeur neuronal afin de compresser les antécédents médicaux dans un espace latent réduit, exploitable pour des modèles prédictifs.

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Development and implementation of a severe accidental hypothermia resuscitation pathway in an urban Canadian emergency department: A quality improvement initiative 

Severe accidental hypothermia (core temperature < 28°C) is an infrequent but resource‑intensive emergency department (ED) presentation that requires altered Advanced Cardiac Life Support (ACLS) management, aggressive re‑warming, and timely consideration of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Prior to this project, our inner‑city academic ED lacked a standardized approach, contributing to variability in care.

We aimed to design, implement, and achieve ≥ 95 % real‑time utilization of a bedside pathway for patients with severe accidental hypothermia.

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A clinical trial of AI-enhanced socially assistive robot distraction during intravenous insertion in the pediatric emergency department

Children experience significant pain and distress during medical procedures such as intravenous insertion (IVI). Socially assistive robots (SARs) are emerging distraction tools to reduce distress associated with painful medical procedures, however, previous iterations have lacked  the ability to adapt to a child’s emotional state. Our objective was to evaluate the effectiveness of an adaptive artificial intelligence-enhanced socially assistive robot (SAR) relative to standard of care (SOC) in reducing distress for children during IVI in the pediatric emergency department (PED).

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Non-pharmacological conservative spine care access including spinal manipulation for patients from an urban hospital emergency department, minor treatment, and spine surgery triage clinics: year one of a single-group pre-test post-test pilot study

Clinical practice guidelines recommend non-pharmacological pain management, including spinal manipulation (SM), for acute and chronic spine pain. Conservative spine care (CSC) access can be limited by financial barriers. The study objective was to describe characteristics and outcomes of referrals to a no-cost university-based CSC clinic over 1-year. We hypothesized pain, health-related quality of life (HRQoL) and disability improvements would temporally align with SM treatment.

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Safety and efficiency of Adjust-Unlikely pulmonary embolism testing in the emergency department 

When combined with D-dimer, the Wells score can help exclude pulmonary embolism (PE) without chest imaging. In emergency medicine everyday practice, the Wells score is complex to apply. Adjust-Unlikely is a simple PE decision rule which combines the physician’s opinion of whether PE is the most likely diagnosis with D-dimer testing. The aim of this study was to assess the safety and efficiency of Adjust-Unlikely PE testing.

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Automated external defibrillators for in-hospital cardiac arrest: A systematic review

Automated external defibrillators (AEDs) improve survival after out-of-hospital cardiac arrest (OHCA), but their role in in-hospital cardiac arrest (IHCA) remains uncertain.   This systematic review aims to assess whether AED use prior to the arrival of a code blue team improves survival or favourable neurologic outcomes in IHCA patients compared with the use of standard manual defibrillators.

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One-year outcomes and cardiac device insertion among emergency department syncope patients with and without bifascicular block

Syncope is a common emergency department (ED) presentation, yet management of patients with bifascicular block (BfB) on electrocardiogram (ECG) remains variable. Given the risk of progression to high-grade atrioventricular block, we compared 1-year outcomes among ED syncope patients with BfB versus propensity-matched controls without BfB.

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Point-of-care ultrasound in the emergency department for identification of pediatric hip effusion: a systematic review and meta-analysis

The identification of a hip effusion through point-of-care ultrasound (PoCUS) in the emergency department (ED) may assist in the workup of a child presenting with an acute limp or hip pain. This systematic review and meta-analyses aimed to explore the accuracy of PoCUS in identifying hip effusions in pediatric patients presenting with an acute limp or hip pain.

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Assessment of paediatric care in Saskatchewan’s general emergency departments with a validated paediatric readiness score

The weighted Paediatric Readiness Score is a 100-point score that assesses six paediatric-specific domains of systemic care provided to critically ill and injured children presenting to general emergency departments (GED) The six domains include (1) coordination of care, (2) staffing and training, (3) availability of required equipment / supplies, (4) policies and procedures, (5) patient safety, and (6) quality improvement processes. Existing literature suggests that GEDs with higher wPRS have decreased morbidity and mortality for the children they treat. The wPRS for Saskatchewan’s GEDs has not been previously assessed.

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Clinical outcomes and characteristics of patients transported by helicopter emergency medical services to a comprehensive stroke centre

Helicopter emergency medical services (HEMS) provide rapid access to comprehensive care for patients with ischemic stroke. Expansion of the endovascular thrombectomy (EVT) treatment time window has enabled more ischemic stroke patients to be considered for intervention, but also presents challenges for triage and transport decisions in strained healthcare systems. This study aimed to describe the clinical outcomes of HEMS transports for confirmed or suspected ischemic stroke patients, compare intervention rates between early (<6h from last seen normal to HEMS consult) and late (≥6h) presenters, and identify pre-transport factors associated with neuro-intervention.

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Trends in Hospital Presentations and Management of Patients with Kratom, Phenibut and Tianeptine Use: A ToxIC Core Registry Study

Increasing interest in cognitive performance and wellness has contributed to the widespread accessibility of unregulated psychotropic “supplements” across Canada and the United States. These supplements – including kratom, phenibut and tianeptine – are easily purchased online and in gas stations, carrying risk of overdose and dependence due to their opioid and GABA-receptor effects. Despite rising concern of harms related to these substances, clinical burden associated with their use is unknown. The purpose of our study was to describe hospital presentations and management of patients with kratom, phenibut and tianeptine use.

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“There’s no other option”: Patient and referring provider perspectives on feedback and referral pathways to the emergency department in a Learning Health System

Canadian hospitals face persistent challenges providing timely emergency care. Patients frequently encounter overcrowding, prolonged triage and wait times that exceed Canadian Triage and Acuity Scale (CTAS) targets. Limited access to outpatient care, specialty consultations, and timely follow-up further strain the system and contribute to potentially avoidable emergency department (ED) use. Optimal outcomes are achieved when care is delivered by the right provider in the most appropriate setting. Feedback can influence clinician practice; however, poorly designed feedback may worsen performance. Within Learning Health System (LHS) frameworks, feedback is central to continuous improvement; however, little is known about what feedback referring providers need to evaluate ED referral decisions or how patients experience referral pathways. The study explored patient and referring provider perspectives on ED referrals and feedback to inform development of an ED-based LHS intervention.

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