Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury.

Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI.

Subjective and objective burden and psychological distress in care partners of older adults with traumatic brain injury.

Purpose/objective: In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore the predictors of subjective burden and psychological distress.

Research Method/design: This is an observational study of care partners of older adults with TBI ( = 46; = 65.2 years, = 11.

The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury.

Objective: To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.

Design: Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus.

Participants: The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists.

Development of practice recommendations based on the Canadian Syncope Risk Score and identification of barriers and facilitators for implementation.

Background: Wide variations in emergency department (ED) syncope management exist. The Canadian Syncope Risk Score (CSRS) was developed to predict the probability of 30-day serious outcomes after ED disposition. Study objectives were to evaluate the acceptability of proposed CSRS practice recommendations among providers and patients, and identify barriers and facilitators for CSRS use to guide disposition decisions.

Bioelectrocatalysis with a palladium membrane reactor.

Enzyme catalysis is used to generate approximately 50,000 tons of value-added chemical products per year. Nearly a quarter of this production requires a stoichiometric cofactor such as NAD/NADH. Given that NADH is expensive, it would be beneficial to regenerate it in a way that does not interfere with the enzymatic reaction.

A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study.

Background: Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area.

Methods: Based on a list of potential participants we obtained using data on training, experience, geographic location, affiliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey.

Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life.

Objectives: To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation.

Method: The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective).

The Association Between Self-Reported Cigarette Smoking and Spinal Pain is Not Explained by Serum Cotinine Levels.

Purpose: The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding.

Methods: Secondary analyses of population-based cross-sectional data pertaining to 4470 adults were conducted. In multivariate analyses examining the associations of self-reported smoking with several spinal pain outcomes (neck pain, low back pain, low back pain with pain below knee, self-reported diagnosis of arthritis/rheumatism, and related limitations), further adjustment for serum cotinine concentrations was made.

Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury.

Purpose/objective: The goals of the present study were (a) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months postinjury in individuals with mild traumatic brain injury (mTBI) while considering preinjury history of anxiety disorders and (b) to verify whether the presence of anxiety in the first months after mTBI was associated with more symptoms present 1 year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months postaccident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain.

Results: At 4 months, 23.

Personalised risk prediction following emergency department assessment for syncope.

Background: Published risk tools do not provide possible management options for syncope in the emergency department (ED). Using the 30-day observed risk estimates based on the Canadian Syncope Risk Score (CSRS), we developed personalised risk prediction to guide management decisions.

Methods: We pooled previously reported data from two large cohort studies, the CSRS derivation and validation cohorts, that prospectively enrolled adults (≥16 years) with syncope at 11 Canadian EDs between 2010 and 2018.

A Delphi study to identify prehospital and emergency department trauma care modifiers for older adults.

Background: Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehospital and emergency department phases of major trauma care for older adults based on expert consensus.

Methods: We conducted a modified Delphi study between May and September 2019 to identify major trauma care modifiers for older adults based on national expert consensus.

Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments.

Background: The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs).

Methods: We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre.

S100B protein level for the detection of clinically significant intracranial haemorrhage in patients with mild traumatic brain injury: a subanalysis of a prospective cohort study.

Background: Clinical assessment of patients with mild traumatic brain injury (mTBI) is challenging and overuse of head CT in the ED is a major problem. Several studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. Higher levels of S100B protein have been associated with intracranial haemorrhage following a mTBI in previous literature.

Adapting two American Decision Aids for Mild Traumatic Brain Injury to the Canadian Context Using the Nominal Group Technique.

Background: Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans.

Objective: The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head CT use for adult and paediatric mild traumatic brain injury to the Canadian context.

Methods: We invited 21 Canadian stakeholders and the two authors of the American decision aids to a Nominal Group Technique consensus meeting to generate suggestions for adapting the decision aids.

Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score-matched analysis of a multicentre prospective cohort.

Background: The benefit of hospital admission after emergency department evaluation for syncope is unclear. We sought to determine the association between hospital admission and detection of serious adverse events, and whether this varied according to the Canadian Syncope Risk Score (CSRS).

Methods: We conducted a secondary analysis of a multicentre prospective cohort of patients assessed in the emergency department for syncope.

Persistent Postconcussion Symptoms: An Expert Consensus-Based Definition Using the Delphi Method.

Objective: To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI).

Participants: Canadian healthcare professionals caring for patients with mTBI.

Design: Online Delphi process.

An environmental scan of emergency medicine research support, training, and infrastructure across Canada.

Objective: Our study objective was to describe the Canadian emergency medicine (EM) research community landscape prior to the initiation of a nationwide network.

Methods: A two-phase electronic survey was sent to 17 Canadian medical schools. The Phase 1 Environmental Scan was administered to department chairs/hospital EM chiefs, to identify EM physicians conducting clinical or educational research.

Clinically significant traumatic intracranial hemorrhage following minor head trauma in older adults: a retrospective cohort study.

Objectives: The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial hemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence.

Methods: This retrospective cohort study extracted data from electronic patient records.

Multicenter Emergency Department Validation of the Canadian Syncope Risk Score.

Importance: The management of patients with syncope in the emergency department (ED) is challenging because no robust risk tool available has been recommended for clinical use.

Objective: To validate the Canadian Syncope Risk Score (CSRS) in a new cohort of patients with syncope to determine its ability to predict 30-day serious outcomes not evident during index ED evaluation.

Design, Setting, And Participants: This prospective multicenter cohort study conducted at 9 EDs across Canada included patients 16 years and older who presented to EDs within 24 hours of syncope.

Adapting the Canadian CT head rule age criteria for mild traumatic brain injury.

Objective: With the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.

Methods: We conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014.