Performance of Pediatric Mortality Prediction Models in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

OBJECTIVE: To describe the performance of prognostic models for mortality or clinical deterioration events among hospitalized children developed or validated in low- and middle-income countries. STUDY DESIGN: A medical librarian systematically searched EMBASE, Ovid Medline, Scopus, Cochrane Library, EBSCO Global Health, LILACS, African Index Medicus, African Journals Online, African Healthline, Med-Carib, and Global Index Medicus (from 2000 to October 2019). We included citations that described the development or validation of a pediatric prognostic model for hospital mortality or clinical deterioration events in low- and middle-income countries. In duplicate and independently, we extracted data on included populations and model prognostic performance and evaluated risk of bias using the Prediction model Risk Of Bias Assessment Tool. RESULTS: Of 41 279 unique citations, we included 15 studies describing 15 prognostic models for mortality and 3 models for clinical deterioration events. Six models were validated in >1 external cohort. The Lambarene Organ Dysfunction Score (0.85 [0.77-0.92]) and Signs of Inflammation in Children that Kill (0.85 [0.82-0.88]) had the highest summary C-statistics (95% CI) for discrimination. Calibration and classification measures were poorly reported. All models were at high risk of bias owing to inappropriate selection of predictor variables and handling of missing data and incomplete performance measure reporting. CONCLUSIONS: Several prognostic models for mortality and clinical deterioration events have been validated in single cohorts, with good discrimination. Rigorous validation that conforms to current standards for prediction model studies and updating of existing models are needed before clinical implementation.

Frequent users of the pediatric emergency department.

OBJECTIVES: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. METHODS: We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit. RESULTS: Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit. CONCLUSION: Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.

Tiered curriculum in global child health: A novel CanMEDs-based multidisciplinary educational program.

Despite the importance of Global Child Health to the practice of 21st century paediatricians, formal comprehensive outcomes-based curricula in this area are lacking. This article describes the development and implementation of a novel, tiered, CanMEDs-based and multidisciplinary curriculum in Global Child Health that was based on a thorough review of the literature. In addition to detailing the steps and results of our literature review, we discuss the three tiers of our curriculum (General Track, Advanced Curriculum and Elective Track) as well as the evidence-informed curricular topics and learning outcomes associated with each tier. Moreover, we highlight the importance of a multidisciplinary approach to Global Child Health education and the potential for this work to help transition Global Child Health training to competency-based models of teaching and learning. This review may help hospitals and residency programs across Canada looking to develop more formal curricula in this often overlooked area.

[Critical analysis of ADL measuring instruments in pediatrics: executive deficits and independence]. / Analyse critique d'instruments de mesure des AVQ en pédiatrie: déficits exécutifs et indépendance.

BACKGROUND: Although the assessment of the activities of daily living (ADL) through task analysis is central to the role of the occupational therapists working with children with traumatic brain injury (TBI), no review has revealed any study aimed at analyzing the instruments used to this effect, in regard to their potential to highlight the deficits associated with the executive functions (e.g., formulate a goal, planning). PURPOSE: To determine if any ADL assessment tools validated for children 10 to 15 years with a TBI consider executive functions. METHODS: Four tools, i.e., "Assessment of Motor and Process Skills' the "Children's Kitchen Task Assessment', the "Chocolate Cake Task" and the "ADL Profile' were analyzed according to the following criteria: 1) complexity of the tasks, 2) non-structured assessment method, and 3) psychometric properties appropriate for the target population. RESULTS: These tools are only partially consistent with the desired criteria. CONCLUSION: Further research on these tools will be necessary to meet the needs of this population.