CJEM
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Randomized Controlled Trial
A randomized double-blind trial comparing the effect on pain of an oral sucrose solution versus placebo in children 1-3 months old needing bladder catheterization.
The efficacy of oral sweet solutions to decrease pain in infants during painful procedures remains uncertain. This study aimed to compare the efficacy of an oral sucrose solution versus placebo in reducing pain during bladder catheterization in infants in the Emergency Department (ED). ⋯ In infants undergoing bladder catheterization in the ED, administration of an oral sweet solution was not associated with lower pain as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying times did not change when sucrose was provided.
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Observational Study
The association between monthly social assistance disbursement days and emergency department visits for trauma, mental health, and substance use.
Social assistance helps fulfill the basic needs of low-income individuals. In British Columbia, social assistance is issued on the third or fourth Wednesday of every month. However, this sudden influx of resources may have negative health consequences. We investigated social assistance timing and emergency department (ED) visits related to trauma, mental health, and substance use. ⋯ Social assistance disbursement is followed by an increase in mental health and substance-related ED presentations and may be associated with an increase in trauma presentations on the day of cheque disbursement. These findings support calls for clinical and policy-level changes and support to reduce cheque day-associated harm.
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Randomized Controlled Trial Multicenter Study
Decision support for computed tomography in the emergency department: a multicenter cluster-randomized controlled trial.
Clinical decision support may facilitate evidence-based imaging, but most studies to date examining the impact of decision support have used non-randomized designs which limit the conclusions that can be drawn from them. This randomized trial examines if decision support can reduce computed tomography (CT) utilization for patients with mild traumatic brain injuries and suspected pulmonary embolism in the emergency department. This study was funded by a competitive public research grant and registered on ClinicalTrials.gov (NCT02410941). ⋯ Voluntary decision support addressing many commonly cited barriers to evidence-based imaging did not significantly reduce CT utilization or improve diagnostic yield but was limited by low rates of participation and high baseline rates of selective imaging. Demonstrating value to clinicians through interventions that improve workflow is likely necessary to meaningfully change imaging practices.