Sarah Curtis | University of Alberta (original) (raw)
Papers by Sarah Curtis
The Journal of pediatrics, Jan 17, 2015
To examine emergency department (ED) staff's knowledge of traumatic stress in children, attit... more To examine emergency department (ED) staff's knowledge of traumatic stress in children, attitudes toward providing psychosocial care, and confidence in doing so, and also to examine differences in these outcomes according to demographic, professional, and organizational characteristics, and training preferences. We conducted an online survey among staff in ED and equivalent hospital departments, based on the Psychological First Aid and Distress-Emotional Support-Family protocols. Main analyses involved descriptive statistics and multiple regressions. Respondents were 2648 ED staff from 87 countries (62.2% physicians and 37.8% nurses; mean years of experience in emergency care was 9.5 years with an SD of 7.5 years; 25.2% worked in a low- or middle-income country). Of the respondents, 1.2% correctly answered all 7 knowledge questions, with 24.7% providing at least 4 correct answers. Almost all respondents (90.1%) saw all 18 identified aspects of psychosocial care as part of their ...
CJEM, 2015
We explored caregiver perspectives on their children&... more We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction. This prospective survey examined a convenience sample of 97 caregivers (n=51 PED, n=46 GED) with children aged <17 years. A paper-based survey was distributed by research assistants, from 2009-2011. Most caregivers were female (n=77, 79%) and were the child's mother (n=69, 71%). Children were treated primarily for musculoskeletal pain (n=41, 42%), headache (n=16, 16%) and abdominal pain (n=7, 7%). Using a 100 mm Visual Analog Scale, the maximum mean reported pain score was 75 mm (95% CI: 70-80) and mean score at discharge was 39 mm (95% CI: 32-46). Ninety percent of caregiver respondents were satisfied (80/89, 90%); three (3/50, 6%) were dissatisfied in the PED and six (6/39, 15%) in the GED. Caregivers who rated their child's pain at ED discharge as severe were less likely to be satisfied than those who rated their child's pain as mild or moderate (p=0.034). Despite continued pain upon discharge, most caregivers report being satisfied with their child's pain management. Caregiver satisfaction is likely multifactorial, and physicians should be careful not to interpret satisfaction as equivalent to adequate provision of analgesia. The relationship between satisfaction and pain merits further exploration.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 20, 2015
Peripheral intravenous catheterization in children is challenging, and success rates vary greatly... more Peripheral intravenous catheterization in children is challenging, and success rates vary greatly. We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt. We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012. We stratified them by age (≤ 3 yr and > 3 yr) and randomly assigned them to undergo the procedure with the standard approach, or with the help of either ultrasound or near-infrared vascular imaging. The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt. The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach g...
JAMA Pediatrics, 2013
Many medical procedures aimed at helping children cause them pain and distress, which can have lo... more Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures. To compare music with standard care to manage pain and distress. Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included. Music (recordings selected by a music therapist via ambient speakers) vs standard care. The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress-Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety. With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P < .05). Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children's pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P = .03). Health care providers were more satisfied with the intravenous placement in the music group (86% very satisfied) compared with the standard care group (48%) (P = .02). Music may have a positive impact on pain and distress for children undergoing intravenous placement. Benefits were also observed for the parents and health care providers. clinicaltrials.gov Identifier: NCT00761033.
PEDIATRICS, 2010
Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence u... more Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence underscoring clinical features suggestive of meningitis is important. To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis. A review of Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed was conducted for all articles of relevance. Articles contained prospective data of clinical features in children with laboratory-confirmed bacterial meningitis and in comparison groups of those without it. Two authors independently assessed quality and extracted data to calculate accuracy data of clinical features. Of 14 145 references initially identified, 10 met our inclusion criteria. On history, a report of bulging fontanel (likelihood ratio [LR]: 8.00 [95% confidence interval (CI): 2.4-26]), neck stiffness (7.70 [3.2-19]), seizures (outside febrile-convulsion age range) (4.40 [3.0-6.4]), or reduced feeds (2.00 [1.2-3.4]) raised concern about the presence of meningitis. On examination, jaundice (LR: 5.90 [95% CI: 1.8-19]), being toxic or moribund (5.80 [3.0-11]), meningeal signs (4.50 [2.4-8.3]), neck stiffness (4.00 [2.6-6.3]), bulging fontanel (3.50 [2.0-6.0]), Kernig sign (3.50 [2.1-5.7]), tone up (3.20 [2.2-4.5]), fever of >40°C (2.90 [1.6-5.5]), and Brudzinski sign (2.50 [1.8-3.6]) independently raised the likelihood of meningitis. The absence of meningeal signs (LR: 0.41 [95% CI: 0.30-0.57]) and an abnormal cry (0.30 [0.16-0.57]) independently lowered the likelihood of meningitis. The absence of fever did not rule out meningitis (LR: 0.70 [95% CI: 0.53-0.92]). Evidence for several useful clinical features that influence the likelihood of pediatric meningitis exists. No isolated clinical feature is diagnostic, and the most accurate diagnostic combination is unclear.
Pediatric Emergency Care, 2012
Pediatric Emergency Care, 2013
Establishing intravenous access in children is often challenging for health professionals. Multip... more Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC. We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, and Google.ca. We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool. Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41-1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74-1.33). Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.
Evidence-Based Child Health: A Cochrane Review Journal, 2008
Annals of Emergency Medicine, 2012
Prehospital and Disaster Medicine, 2014
Paediatrics & child health, 2014
Many children requiring acute care receive suboptimal analgesia. To describe paediatric pain mana... more Many children requiring acute care receive suboptimal analgesia. To describe paediatric pain management practices and policies in emergency departments (EDs) in Alberta. A descriptive survey was distributed to each of the EDs in Alberta. A response rate of 67% (72 of 108) was obtained. Seventy-one percent (42 of 59) of EDs reported the use of a pain tool, 29.3% (17 of 58) reported mandatory pain documentation and 16.7% (10 of 60) had nurse-initiated pain protocols. Topical anesthetics were reported to be used for intravenous line insertion by 70.4% of respondents (38 of 54) and for lumbar puncture (LP) by 30.8% (12 of 39). According to respondents, infiltrated anesthetic was used for LP by 69.2% (27 of 39) of respondents, and oral sucrose was used infrequently for urinary catheterization (one of 46 [2.2%]), intravenous line insertion (zero of 54 [0%]) and LP (one of 39 [2.6%]). Few Alberta EDs use policies and protocols to manage paediatric pain. Noninvasive methods to limit procedu...
The Journal of pediatrics, Jan 17, 2015
To examine emergency department (ED) staff's knowledge of traumatic stress in children, attit... more To examine emergency department (ED) staff's knowledge of traumatic stress in children, attitudes toward providing psychosocial care, and confidence in doing so, and also to examine differences in these outcomes according to demographic, professional, and organizational characteristics, and training preferences. We conducted an online survey among staff in ED and equivalent hospital departments, based on the Psychological First Aid and Distress-Emotional Support-Family protocols. Main analyses involved descriptive statistics and multiple regressions. Respondents were 2648 ED staff from 87 countries (62.2% physicians and 37.8% nurses; mean years of experience in emergency care was 9.5 years with an SD of 7.5 years; 25.2% worked in a low- or middle-income country). Of the respondents, 1.2% correctly answered all 7 knowledge questions, with 24.7% providing at least 4 correct answers. Almost all respondents (90.1%) saw all 18 identified aspects of psychosocial care as part of their ...
CJEM, 2015
We explored caregiver perspectives on their children&... more We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction. This prospective survey examined a convenience sample of 97 caregivers (n=51 PED, n=46 GED) with children aged <17 years. A paper-based survey was distributed by research assistants, from 2009-2011. Most caregivers were female (n=77, 79%) and were the child's mother (n=69, 71%). Children were treated primarily for musculoskeletal pain (n=41, 42%), headache (n=16, 16%) and abdominal pain (n=7, 7%). Using a 100 mm Visual Analog Scale, the maximum mean reported pain score was 75 mm (95% CI: 70-80) and mean score at discharge was 39 mm (95% CI: 32-46). Ninety percent of caregiver respondents were satisfied (80/89, 90%); three (3/50, 6%) were dissatisfied in the PED and six (6/39, 15%) in the GED. Caregivers who rated their child's pain at ED discharge as severe were less likely to be satisfied than those who rated their child's pain as mild or moderate (p=0.034). Despite continued pain upon discharge, most caregivers report being satisfied with their child's pain management. Caregiver satisfaction is likely multifactorial, and physicians should be careful not to interpret satisfaction as equivalent to adequate provision of analgesia. The relationship between satisfaction and pain merits further exploration.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 20, 2015
Peripheral intravenous catheterization in children is challenging, and success rates vary greatly... more Peripheral intravenous catheterization in children is challenging, and success rates vary greatly. We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt. We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012. We stratified them by age (≤ 3 yr and > 3 yr) and randomly assigned them to undergo the procedure with the standard approach, or with the help of either ultrasound or near-infrared vascular imaging. The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt. The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the standard approach g...
JAMA Pediatrics, 2013
Many medical procedures aimed at helping children cause them pain and distress, which can have lo... more Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures. To compare music with standard care to manage pain and distress. Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included. Music (recordings selected by a music therapist via ambient speakers) vs standard care. The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress-Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety. With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P < .05). Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children's pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P = .03). Health care providers were more satisfied with the intravenous placement in the music group (86% very satisfied) compared with the standard care group (48%) (P = .02). Music may have a positive impact on pain and distress for children undergoing intravenous placement. Benefits were also observed for the parents and health care providers. clinicaltrials.gov Identifier: NCT00761033.
PEDIATRICS, 2010
Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence u... more Clinical diagnosis of pediatric meningitis is fundamental; therefore, familiarity with evidence underscoring clinical features suggestive of meningitis is important. To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis. A review of Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed was conducted for all articles of relevance. Articles contained prospective data of clinical features in children with laboratory-confirmed bacterial meningitis and in comparison groups of those without it. Two authors independently assessed quality and extracted data to calculate accuracy data of clinical features. Of 14 145 references initially identified, 10 met our inclusion criteria. On history, a report of bulging fontanel (likelihood ratio [LR]: 8.00 [95% confidence interval (CI): 2.4-26]), neck stiffness (7.70 [3.2-19]), seizures (outside febrile-convulsion age range) (4.40 [3.0-6.4]), or reduced feeds (2.00 [1.2-3.4]) raised concern about the presence of meningitis. On examination, jaundice (LR: 5.90 [95% CI: 1.8-19]), being toxic or moribund (5.80 [3.0-11]), meningeal signs (4.50 [2.4-8.3]), neck stiffness (4.00 [2.6-6.3]), bulging fontanel (3.50 [2.0-6.0]), Kernig sign (3.50 [2.1-5.7]), tone up (3.20 [2.2-4.5]), fever of >40°C (2.90 [1.6-5.5]), and Brudzinski sign (2.50 [1.8-3.6]) independently raised the likelihood of meningitis. The absence of meningeal signs (LR: 0.41 [95% CI: 0.30-0.57]) and an abnormal cry (0.30 [0.16-0.57]) independently lowered the likelihood of meningitis. The absence of fever did not rule out meningitis (LR: 0.70 [95% CI: 0.53-0.92]). Evidence for several useful clinical features that influence the likelihood of pediatric meningitis exists. No isolated clinical feature is diagnostic, and the most accurate diagnostic combination is unclear.
Pediatric Emergency Care, 2012
Pediatric Emergency Care, 2013
Establishing intravenous access in children is often challenging for health professionals. Multip... more Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC. We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, and Google.ca. We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool. Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41-1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74-1.33). Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.
Evidence-Based Child Health: A Cochrane Review Journal, 2008
Annals of Emergency Medicine, 2012
Prehospital and Disaster Medicine, 2014
Paediatrics & child health, 2014
Many children requiring acute care receive suboptimal analgesia. To describe paediatric pain mana... more Many children requiring acute care receive suboptimal analgesia. To describe paediatric pain management practices and policies in emergency departments (EDs) in Alberta. A descriptive survey was distributed to each of the EDs in Alberta. A response rate of 67% (72 of 108) was obtained. Seventy-one percent (42 of 59) of EDs reported the use of a pain tool, 29.3% (17 of 58) reported mandatory pain documentation and 16.7% (10 of 60) had nurse-initiated pain protocols. Topical anesthetics were reported to be used for intravenous line insertion by 70.4% of respondents (38 of 54) and for lumbar puncture (LP) by 30.8% (12 of 39). According to respondents, infiltrated anesthetic was used for LP by 69.2% (27 of 39) of respondents, and oral sucrose was used infrequently for urinary catheterization (one of 46 [2.2%]), intravenous line insertion (zero of 54 [0%]) and LP (one of 39 [2.6%]). Few Alberta EDs use policies and protocols to manage paediatric pain. Noninvasive methods to limit procedu...