Prevalence of pain-related presentations in Canadian pediatric emergency departments.

OBJECTIVE: Pain is a common reason for attendance to the emergency department; however, pediatric specific data on the prevalence, location, and etiology of painful presentations are limited in the literature. Therefore, the objective of this study was to determine the prevalence of pain-related presentations to pediatric emergency departments during the triage process and characterize the anatomical locations and organ systems most affected by pain in a modern cohort. METHODS: A two-center health record review of triage documentation was conducted at Canadian pediatric emergency departments. All children (< 18 years) were eligible for inclusion. Data were extracted from administrative sources with one week of consecutive patients included every 3 months over a one-year timeframe. Regression analyses were completed to identify variables associated with painful presentations and analgesia provision during the triage process. RESULTS: A total of 7208 emergency department presentations were included. Median [IQR] child age was 5.2 [1.9, 11.8] years and 53.2% were male. 58.8% of children were found to have pain as a component of their triage presentation. Of those with pain (n = 4237), 24.1% had a pain score documented and 13.8% had analgesia provided at triage. Location of pain (n = 4523) was predominantly in the head (38.0%), extremities (27.8%), and abdomen (22.8%). Primary organ systems most affected (n = 4237) included the musculoskeletal (31.1%), gastrointestinal (18.3%), and cutaneous (including lacerations) (14.4%) systems. CONCLUSIONS: In this study, pain was identified in almost 60% of all pediatric emergency department presentations at the time of triage. Suboptimal documentation of pain scores and provision of analgesia at triage were found for children with pain. These results support early assessment and implementation of pain management strategies at triage. Results can also focus further research efforts to the management of the most commonly presenting types of pediatric pain.

RéSUMé: OBJECTIF: La douleur est un motif courant de présence à l'urgence, mais les données pédiatriques spécifiques sur la prévalence, l'emplacement et l'étiologie des présentations douloureuses sont limitées dans la littérature. Par conséquent, l'objectif de cette étude était de déterminer la prévalence des présentations liées à la douleur aux services d'urgence pédiatriques au cours du processus de triage et de caractériser les emplacements anatomiques et les systèmes d'organes les plus touchés par la douleur dans une cohorte moderne. MéTHODES: Un examen des dossiers médicaux de deux centres des documents de triage a été effectué aux services d'urgence pédiatriques du Canada. Tous les enfants (< 18 ans) étaient admissibles à l'inclusion. Les données ont été extraites de sources administratives avec une semaine de patients consécutifs inclus tous les 3 mois sur une période d'un an. Des analyses de régression ont été effectuées pour identifier les variables associées aux présentations douloureuses et à l'analgésie pendant le processus de triage. RéSULTATS: Un total de 7208 présentations à l'urgence ont été incluses. L'âge médian [IQR] des enfants était de 5,2 [1,9, 11,8] ans et 53,2 % étaient des hommes. 58,8 % des enfants présentaient de la douleur dans leur présentation de triage. Parmi les personnes souffrant de douleur (n = 4237), 24,1 % avaient un score de douleur documenté et 13,8 % avaient reçu une analgésie au triage. L'emplacement de la douleur (n = 4523) était principalement dans la tête (38,0 %), les extrémités (27,8 %) et l'abdomen (22,8 %). Les systèmes d'organes primaires les plus touchés (n = 4237) comprenaient les systèmes musculosquelettiques (31,1 %), gastro-intestinaux (18,3 %) et cutanés (y compris les lacérations) (14,4 %). CONCLUSIONS: Dans cette étude, la douleur a été identifiée dans près de 60 % de toutes les présentations aux urgences pédiatriques au moment du triage. La documentation sous-optimale des scores de douleur et la fourniture d'analgésie au triage ont été trouvées pour les enfants souffrant de douleur. Ces résultats appuient l'évaluation précoce et la mise en œuvre de stratégies de gestion de la douleur au triage. Les résultats peuvent également concentrer davantage les efforts de recherche sur la gestion des types de douleur pédiatrique les plus courants.

Impact of early surgical correction or palliation of congenital heart defects in infants with symptomatic viral respiratory tract infections in the current era.

Objective: This study investigates the influence of timing of surgery among infants with congenital heart disease and active respiratory tract infections in a contemporary Western Canadian cohort. Methods: This was a retrospective matched cohort study of infants aged 1 week to 6 months undergoing surgical repair of congenital heart disease between 2014 and 2017. Case patients had active respiratory tract infections preoperatively and were matched to control patients based on primary heart lesion. The primary outcome was time to extubation. Results: We identified 20 cases (median age, 3.4 months [range, 2.4-4.3 months]) that were matched to 40 controls (1:2 ratio). In case patients, surgery occurred at a median of 1 day after the positive viral testing. There were no statistically significant differences between cases and controls in time to extubation (59 vs 34 hours [P = .12]), postoperative vasoactive scores at 24 hours (0 vs 0 [P = .53]), 48 hours (0 vs 0 [P = .23]), maximum vasoactive score in postoperative period (5 vs 5.5 [P = .54]), or time to hospital discharge (13 vs 12 days [P = .39]). Case patients had increased duration of total respiratory support (including noninvasive ventilation, 3.5 vs 2 days [P = .02]) and postoperative intensive care unit length of stay (5.5 vs 3 days [P = .01]). Conclusions: Cardiac surgery on infants with congenital heart disease during an acute viral respiratory tract infection may yield a clinically relevant prolongation in time to extubation.

Reactions of a persistent phosphinyl radical/diphosphine with heteroallenes.

The persistent phosphinyl radical, (H2C)2(NDipp)2P˙, formed upon dissolution from the homolytic cleavage of the P-P bond in the diphosphane [(H2C)2(NDipp)2P]2, was reacted with carbon disulfide, phenyl isocyanate, and phenyl isothiocyanate. The phosphinyl fragments add across the C[double bond, length as m-dash]S or C[double bond, length as m-dash]O double bond to give neutral, diamagnetic species.

Probing the effect of OSCE checklist length on inter-observer reliability and observer accuracy.

PURPOSE: The Objective Structured Clinical Examination (OSCE) is a widely employed tool for measuring clinical competence. In the drive toward comprehensive assessment, OSCE stations and checklists may become increasingly complex. The objective of this study was to probe inter-observer reliability and observer accuracy as a function of OSCE checklist length. METHOD: Study participants included emergency physicians and senior residents in Emergency Medicine at Dalhousie University. Participants watched an identical series of four, scripted, standardized videos enacting 10-min OSCE stations and completed corresponding assessment checklists. Each participating observer was provided with a random combination of two 40-item and two 20-item checklists. A panel of physicians scored the scenarios through repeated video review to determine the 'gold standard' checklist scores. RESULTS: Fifty-seven observers completed 228 assessment checklists. Mean observer accuracy ranged from 73 to 93% (14.6-18.7/20), with an overall accuracy of 86% (17.2/20), and inter-rater reliability range of 58-78%. After controlling for station and individual variation, no effect was observed regarding the number of checklist items on overall accuracy (p=0.2305). Consistency in ratings was calculated using intraclass correlation coefficient and demonstrated no significant difference in consistency between the 20- and 40-item checklists (ranged from 0.432 to 0.781, p-values from 0.56 to 0.73). CONCLUSIONS: The addition of 20 checklist items to a core list of 20 items in an OSCE assessment checklist does not appear to impact observer accuracy or inter-rater reliability.

Preparation of a diphosphine with persistent phosphinyl radical character in solution: characterization, reactivity with O2, S8, Se, Te, and P4, and electronic structure calculations.

A new, easily synthesized diphosphine based on a heterocyclic 1,3,2-diazaphospholidine framework has been prepared. Due to the large, sterically encumbering Dipp groups (Dipp = 2,6-diisopropylphenyl) on the heterocyclic ring, the diphosphine undergoes homolytic cleavage of the P-P bond in solution to form two phosphinyl radicals. The diphosphine has been reacted with O(2), S(8), Se, Te, and P(4), giving products that involve insertion of elements between the P-P bond to yield the related phosphinic acid anhydride, sulfide/disulfide, selenide, telluride, and a butterfly-type perphospha-bicyclobutadiene structure with a trans,trans-geometry. All molecules have been characterized by multinuclear NMR spectroscopy, elemental analysis, and single-crystal X-ray crystallography. Variable-temperature EPR spectroscopy was utilized to study the nature of the phosphinyl radical in solution. Electronic structure calculations were performed on a number of systems from the parent diphosphine [H(2)P](2) to amino-substituted [(H(2)N)(2)P](2) and cyclic amino-substituted [(H(2)C)(2)(NH)(2)P](2); then, bulky substituents (Ph or Dipp) were attached to the cyclic amino systems. Calculations on the isolated diphosphine at the B3LYP/6-31+G* level show that the homolytic cleavage of the P-P bond to form two phosphinyl radicals is favored over the diphosphine by ~11 kJ/mol. Furthermore, there is a significant amount of relaxation energy stored in the ligands (52.3 kJ/mol), providing a major driving force behind the homolytic cleavage of the central P-P bond.

Varsity athletes have lower 2D:4D ratios than other university students.

The second to fourth digit ratio (2D:4D) is a sexually dimorphic trait with lower finger ratios considered more masculine. These digit ratios are believed to reflect the prenatal hormonal environment with higher exposure to androgens in utero leading to more masculine digit ratios. The 2D:4D ratio has been negatively correlated with many factors, including aggression, physical fitness, and athleticism. We compared 2D:4D finger ratios of (1) male and female varsity athletes (n = 99) versus male and female student non-athletes (n = 122), and (2) males (n = 104) versus females (n = 117). Our results confirmed that both male (mean ± s(x) : 0.97 ± 0.004) and female (0.98 ± 0.005) varsity athletes had significantly lower ratios than their non-varsity peers (males: 0.99 ± 0.004; females: 1.00 ± 0.006), and that male athletes had significantly lower 2D:4D ratios than female athletes. Overall, males had significantly lower 2D:4D ratios than females (0.98 ± 0.003 vs. 0.99 ± 0.004). A smaller 2D:4D ratio appears to be consistent with participation in varsity sports among both males and females.

A new polymorph of 2,6-bis-(trifluoro-meth-yl)benzoic acid.

The asymmetric unit of a second polymorph of the title compound, C(9)H(4)F(6)O(2), contains five independent mol-ecules, which form hydrogen-bonded O-H⋯O dimers about inversion centers. The most significant structural difference between this structure and that of the first polymorph [Tobin & Masuda (2009 ▶). Acta Cryst. E65, o1217] is the hydrogen-bonded, dimeric orientation of the carb-oxy-lic acid functionalities.

Anhydrous TEMPO-H: reactions of a good hydrogen atom donor with low-valent carbon centres.

In this paper, we report a novel synthesis of anhydrous 1-hydroxy-2,2,6,6-tetramethyl-piperidine (TEMPO-H). An X-ray crystal structure and full characterization of the compound are included. Compared to hydrated TEMPO-H, its anhydrous form exhibits improved stability and a differing chemical reactivity. The reactions of anhydrous TEMPO-H with a variety of low-valent carbon centres are described. For example, anhydrous TEMPO-H was reacted with 1,3-bis(2,4,6-trimethylphenyl)imidazol-2-ylidene (IMes), an unsaturated NHC. Crystals of [CHNC(6)H(2)(CH(3))(3)](2)C···HO(NC(5)H(6)(CH(3))(4)), IMes···TEMPO-H, were isolated and a crystal structure determined. The experimental structure is compared to the results of theoretical calculations on the hydrogen-bonded dimer. Anhydrous TEMPO-H was also reacted with the saturated NHC, 1,3-bis(2,6-diisopropylphenyl)imidazolidin-2-ylidene (SIPr), giving the product [CH(2)Ni-Pr(2)C(6)H(3)](2)CH···O(NC(5)H(6)(CH(3))(4)). In contrast, the reaction of hydrated TEMPO-H with 1,3-bis(2,6-diisopropylphenyl)imidazolidin-2-ylidene gave small amounts of the hydrolysis product, N-(2,6-diisopropylphenyl)-N-[2-(2,6-diisopropylphenylamino)ethyl]formamide. Finally, anhydrous TEMPO-H was reacted with (triphenylphosphoranylidene)ketene to generate Ph(3)PC(H)C(=O)O(NC(5)H(6)(CH(3))(4)). A full characterization of the product, including an X-ray crystal structure, is described.

1,3-Bis(2,6-diisopropyl-phen-yl)imidazolidinium tetra-phenyl-borate dichloro-methane disolvate.

The title compound, C(27)H(39)N(2) (+)·C(24)H(20)B(-)·2CH(2)Cl(2), is the first reported imidazolidinium cation with the sterically demanding 2,6-diisopropyl-phenyl groups in the 1,3-positions. The crystal structure is stabilized by weak inter-molecular C-H⋯π(arene) inter-actions. Due to the bulky nature of both the flanking 2,6-diisopropyl-phenyl substituents and the tetra-phenyl-borate counter-ion, anion inter-actions with the imidazolidinium H atom in the 2-position are not observed, also a first for this class of ortho-alkyl-substituted Arduengo-type carbene precursors.

1,3-Bis(2,6-diisopropyl-phen-yl)imidazolidin-2-yl-idene.

The title compound, C(27)H(38)N(2), is the first reported free imidazolidin-2-yl-idene carbene with 2,6-diisopropyl-phenyl groups in the 1,3-positions. The five-membered ring adopts a twisted conformation and the dihedral angle between the aromatic rings is 48.81 (6)°. Both isopropyl groups attached to one of the benzene rings are disordered over two sets of sites in 0.74 (2):0.26 (2) and 0.599 (8):0.401 (8) ratios.