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January 22, 2016

TREKK E-update: January 22nd, 2016

Happy New Year from TREKK!  In this week's issue, we highlight several new articles, including a landmark study by TREKK content advisors Drs. Kathy Boutis & Amy Plint on ankle injuries.  For those attending the Pediatric Emergency Research Canada annual meeting next week, looking forward to seeing you all there!

In This Issue...

Croup whiteboard video recieves 2nd place in the IHDCYH Talks video competition

Dr. Kathy Boutis and Dr. Amy Plint with landmark study on ankle injuries

January 2016 articles

Croup whiteboard video recieves 2nd place in the IHDCYH Talks video competition

Thank you to everyone for your participation and support throughout the Institute of Human Development, Child and Youth Health (IHDCYH) Talks Video Competition! We are pleased to announce that our submission, "A barky seal-like cough in children", came in second place.  Congratulations to ECHO and ARCHE - looking forward to the continued development of tools for parents and families. 

Watch the video here.

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Dr. Kathy Boutis and Dr. Amy Plint with landmark study on ankle injuries

Is it a fracture or a sprain?

Dr. Kathy Boutis and colleagues debunk the 50 year doctrine that "children fracture before sprain." The results of this latest study, published January 2016 in JAMA Pediatrics, demonstrated that the commonly made presumptive diagnosis of Salter-Harris type 1 fracture of the distal fibula (SH1DF) is rarely confirmed by MRI. Instead, children most often had sprains, occasionally associated with radiographically occult avulsion fractures. Additionally, they established that children with fractures detectable only by MRI had comparable recovery compared to those with sprains when treated with a removable ankle brace and self-regulated return to activities. 

These results have important implications, including the potential to simplify the care of these common injuries and reduce health care expenditures.  At a glance:

  1. Most children with suspected SH1DF were found to have an ankle sprain.
  2. The classic approach of 3 to 6 week casting is not necessary and is associated with delayed recovery time. The authors advocate instead for a less conservative approach of a removable splint, which reduces patient discomfort and allows for a speedier return to activities.
  3. Repeated radiography and referral to an orthopedic surgeon are also not routinely necessary and should be reserved for patients who are not recovering as expected. 

Congratulations to Dr. Kathy Boutis and colleagues on the publication of this landmark study.


Boutis K, Plint A, et al. (2016). Radiograph-negative lateral ankle injuries in children. Occult growth plate fracture or sprain? JAMA Pediatrics, 170(1):e154114.


Gill PJ & Klassen T. (2016). Revisiting radiograph-negative ankle injuries in children. Is it a fracture or a sprain? JAMA Pediatrics, 170(1):e154147.

Dr. Kathy Boutis is an Emergency Physician at the Hospital for Sick Children (Sick Kids) and is the TREKK content advisor for fractures.

Second author, Dr. Amy Plint is a an Emergency Physician at the Children's Hospital of Eastern Ontario (CHEO), a TREKK board member, the TREKK content advisor for bronchiolitis, and chair of Pediatric Emergency Research Canada (PERC).

For questions about the article, please contact Kathy Boutis: 


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January 2016 articles

Hamid M, Siddiqui S, Chandna A, Ariz A, & Scolnik D. (2016). Children are not young adults: a call for standardized guidelines for dealing with pediatric patients in the emergency department of Canadian community hospitals. CJEM, 18(1): 48-51.

Children represent 30% of the patient volume seen in emergency departments (EDs) across Canada, yet, the majority will access community EDs within community hospitals.  Currently, Canadian EDs are not required to meet standards that address the specific needs of their pediatric patients, and there are currently no Canadian specific guidelines, such as those found in the United States, the United Kingdom, and Australia. In this commentary piece in the Canadian Journal of Emergency Medicine (CJEM), Hamid and colleagues present their argument for the need to develop Canadian guidelines for community EDs that recognize the unique needs of our pediatric patients.  The implementation of standardized guidelines, they argue, would further improve the standard of care for pediatric emergency patients across the country. 

Freedman J & Ahmed S. (2016). A call for Canadian pediatric emergency guidelines - as certain as motherhood? CJEM, 18(1): 52-53.

In a follow-up editorial, A call for Canadian pediatric emergency guidelines - as certain as motherhood?, Freedman & Ahmed refer to TREKKs existing efforts to standardize and improve the care of children in EDs. Though they note that this call for guidelines is vital, they also pose several questions, including whether or not we need Canadian specific guidelines, what impact these would have on pediatric care, how to ensure the guidelines would be evidence based and free of influence, and if existing initiatives (such as TREKK) already exist to address this need. 

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