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Kulik D.M.,University of Toronto | Uleryk E.M.,Hospital for Sick Children | Maguire J.L.,St. Michaels Hospital | Maguire J.L.,Li Ka Shing Knowledge Institute | And 2 more authors.
Journal of Clinical Epidemiology | Year: 2013

Objectives: To systematically identify clinical prediction rules (CPRs) for children with suspected appendicitis and compare their methodological quality and performance. Study Design and Setting: Included studies involved children aged 0-18 years with suspected appendicitis identified through MEDLINE and EMBASE from 1950 to 2012. The quality was assessed using 17 previously published items. The performance was evaluated using the sensitivity, negative likelihood ratio, and predicted frequency of appendicitis diagnosis that would result if the rule was used. Results: Twelve studies fulfilled the inclusion criteria describing the derivation or validation of six unique CPRs involving 4,201 children with suspected appendicitis. Migratory pain, nausea or vomiting, and right lower quadrant tenderness were common predictors to all rules. Methodological quality varied widely. The most poorly addressed quality items were the predictor and outcome assessor blinding, predictor description, and reproducibility of predictor assessment. The most well-validated CPRs were the Pediatric Appendicitis Score (PAS) and MANTRELS (Migration, Anorexia, Nausea/vomiting, Tenderness in the right lower quadrant, Rebound pain, Elevation in temperature, Leukocytosis, Shift to the left)/Alvarado Score. Overall, the PAS validation studies outperformed the Alvarado validation studies. Conclusion: The PAS and Alvarado scores were the most well validated but neither met the current performance benchmarks. A high quality, well validated, and consistently high-performing CPR was not identified. Further research is needed before a CPR for children with suspected appendicitis can be used in routine practice. © 2013 Elsevier Inc. All rights reserved.


Persaud N.,University of Toronto | Persaud N.,Li Ka Shing Knowledge Institute | Maguire J.L.,University of Toronto | Maguire J.L.,Pediatric Outcomes Research Team PORT | And 11 more authors.
CMAJ | Year: 2013

Background: Modifiable behaviours during early childhood may provide opportunities to prevent disease processes before adverse outcomes occur. Our objective was to determine whether young children's eating behaviours were associated with increased risk of cardiovascular disease in later life. Methods: In this cross-sectional study involving children aged 3-5 years recruited from 7 pri mary care practices in Toronto, Ontario, we assessed the relation between eating behaviours as assessed by the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire (completed by parents) and serum levels of non-high-density lipoprotein (HDL) cholesterol, a surrogate marker of cardiovascular risk. We also as -sessed the relation between dietary intake and serum non-HDL cholesterol, and between eating behaviours and other laboratory indices of cardiovascular risk (low-density lipoprotein [LDL] cholesterol, apolipoprotein B, HDL cholesterol and apoliprotein A1). Results: A total of 1856 children were re -cruited from primary care practices in Toron -to. Of these children, we included 1076 in our study for whom complete data and blood samples were available for analysis. The eating behaviours subscore of the Nutri STEP tool was significantly associated with serum non-HDL cholesterol (p = 0.03); for each unit increase in the eating behaviours subscore suggesting greater nutritional risk, we saw an increase of 0.02 mmol/L (95% confidence interval [CI] 0.002 to 0.05) in serum non-HDL cholesterol. The eating behaviours subscore was also associated with LDL cholesterol and apolipoprotein B, but not with HDL cholesterol or apolipoprotein A1. The dietary intake subscore was not associated with non-HDL cholesterol. Interpretation: Eating behaviours in preschoolaged children are important potentially modifiable determinants of cardiovas cular risk and should be a focus for future studies of screening and behavioural interventions. © 2013 Canadian Medical Association or its licensors.


Maguire J.L.,Li Ka Shing Knowledge Institute | Maguire J.L.,Pediatric Outcomes Research Team PORT | Maguire J.L.,University of Toronto | Birken C.S.,Pediatric Outcomes Research Team PORT | And 17 more authors.
BMC Pediatrics | Year: 2014

Background: Vitamin D levels are alarmingly low (<75 nmol/L) in 65-70% of North American children older than 1 year. An increased risk of viral upper respiratory tract infections (URTI), asthma-related hospitalizations and use of anti-inflammatory medication have all been linked with low vitamin D. No study has determined whether wintertime vitamin D supplementation can reduce the risk of URTI and asthma exacerbations, two of the most common and costly illnesses of early childhood. The objectives of this study are: 1) to compare the effect of 'high dose' (2000 IU/day) vs. 'standard dose' (400 IU/day) vitamin D supplementation in achieving reductions in laboratory confirmed URTI and asthma exacerbations during the winter in preschool-aged Canadian children; and 2) to assess the effect of 'high dose' vitamin D supplementation on vitamin D serum levels and specific viruses that cause URTI.Methods/Design: This study is a pragmatic randomized controlled trial. Over 4 successive winters we will recruit 750 healthy children 1-5 years of age. Participating physicians are part of a primary healthcare research network called TARGet Kids!. Children will be randomized to the 'standard dose' or 'high dose' oral supplemental vitamin D for a minimum of 4 months (200 children per group). Parents will obtain a nasal swab from their child with each URTI, report the number of asthma exacerbations and complete symptom checklists. Unscheduled physician visits for URTIs and asthma exacerbations will be recorded. By May, a blood sample will be drawn to determine vitamin D serum levels. The primary analysis will be a comparison of URTI rate between study groups using a Poisson regression model. Secondary analyses will compare vitamin D serum levels, asthma exacerbations and the frequency of specific viral agents between groups.Discussion: Identifying whether vitamin D supplementation of preschoolers can reduce wintertime viral URTIs and asthma exacerbations and what dose is optimal may reduce population wide morbidity and associated health care and societal costs. This information will assist in determining practice and health policy recommendations related to vitamin D supplementation in healthy Canadian preschoolers. © 2014 Maguire et al.; licensee BioMed Central Ltd.


Cohen E.,Pediatric Outcomes Research Team PORT | Cohen E.,University of Toronto | Mahant S.,Pediatric Outcomes Research Team PORT | Dell S.D.,Hospital for Sick Children | And 6 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2012

Objective: To describe the long-term outcomes of pediatric pleural empyema. Design: Prospective observational study from October 2008 to October 2011. Setting: Tertiary care children's hospital. Participants: Children with pleural empyema (loculations and/or septations identified on radiologic imaging or frank pus on thoracentesis). Main Outcome Measures: Children were seen 1, 6, and 12 months postdischarge. Outcome measures included symptoms and signs of respiratory disease, child and parental impact, radiographic resolution, spirometry, and health-related quality of life (Pediatric Quality of Life Inventory score). Analysis was based on the last observation carried forward for missing data. Results: Eighty-two of 88 patients (93%) eligible were recruited. Fifty-four percent were male and mean (SD) age was 4.5 (3.4) years. Outcome data was obtained in 100% at 1 month, 90% at 6 months, and 72% at 1 year. Seventyone percent had effusions occupying a quarter or more of the hemithorax and 62% of effusions were drained. Fever, cough, parental work loss, child school loss, radiographic abnormalities, and abnormal spirometry results were common in the first month and then declined. By the last observation, 2% of patients had abnormal radiographs (aside from pleural thickening), 6% had mild obstruction on spirometry, and Pediatric Quality of Life Inventory scores were better than for children with asthma (P < .001). Patients with abnormal outcomes in 1 measure had normal outcomes in all other clinical measures. Conclusions: Clinically important phenomena persist in the short-term, but virtually all children with pleural empyema have no long-term sequelae. ©2012 American Medical Association. All rights reserved.


Sarker H.,McGill University | Anderson L.N.,Pediatric Outcomes Research Team PORT | Anderson L.N.,Li Ka Shing Knowledge Institute | Borkhoff C.M.,Pediatric Outcomes Research Team PORT | And 12 more authors.
BMC Research Notes | Year: 2015

Background: It is unknown if young children's parent-reported physical activity and sedentary time are correlated with direct measures. The study objectives were to compare parent-reported physical and sedentary activity versus directly measured accelerometer data in early childhood. Methods: From 2013 to 2014, 117 healthy children less than 6 years of age were recruited to wear Actical accelerometers for 7 days. Accelerometer data and questionnaires were available on 87 children (74 %). Average daily physical activity was defined as the sum of activity ≥100 counts per minute, and sedentary time as the sum of activity <100 counts per minute during waking hours. Parents reported daily physical activity (unstructured free play in and out of school, and organized activities) and selected sedentary behaviors (screen time, stroller time, time in motor vehicle). Spearman correlation coefficients and Bland-Altman plots were used to assess the validity of parent-reported measures compared to accelerometer data. Results: Total physical activity was significantly greater when measured by accelerometer than parent-report; the median difference was 131 min/day (p < 0.001). Parent-reported child physical activity was weak to moderately correlated with directly measured total physical activity (r = 0.39, 95 % CI 0.19, 0.56). The correlations between types of physical activity (unstructured free play in and outside of school/daycare, and organized structured activity) and accelerometer were r = 0.30 (95 % CI 0.09, 0.49); r = 0.42 (95 % CI 0.23, 0.58); r = 0.26 (95 % CI 0.05, 0.46), respectively. There was no correlation between parent-reported and accelerometer-measured total sedentary time in children (r = 0.10, 95 % CI -0.12, 0.33). When the results were stratified by age group (<18, 18-47, and 48-70 months of age) no statistically significant correlations were observed and some inverse associations were observed. Conclusions: The correlation between parent-report of young children's physical activity and accelerometer-measured activity was weak to moderate depending on type of activity and age group. Parent-report of children's sedentary time was not correlated with accelerometer-measured sedentary time. Additional validation studies are needed to determine if parent-reported measures of physical activity and sedentary time are valid among children less than 6 years of age and across these young age groups. © 2015 Sarker et al.

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