Evidence map›Paper›PMID 37351798›Full record

Trial reportCJEM2023

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

Keith Owen Yeates, Karen M Barlow, Bruce Wright, Ken Tang, Olesya Barrett, Edward Berdusco, Amanda M Black, Brenda Clark, Alf Conradi, Heather Godfrey and 9 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in CJEM, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05095012 (Implementation of a Clinical Pathway for Paediatric Concussion in Acute Care Settings), which is not on this map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
3.8field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05095012 nacompletednot on this map

Implementation of a Clinical Pathway for Paediatric Concussion in Acute Care Settings: Measuring Health Outcomes of the RECOVER Intervention Project

TypeinterventionalSponsorUniversity of CalgaryRan2018 to 2019Enrolled2,878ConditionsConcussion, Brain, Pediatric Disorder, Mild Traumatic Brain InjuryArmsPediatric Acute Care Concussion Clinical Pathway
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Evaluation of injury prevention interventions using the stepped wedge cluster randomised trial design: key considerations.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2026
    Article
  5. Article
  6. Article
  7. Review
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 7 institutions in 2 countries.

Keith Owen YeatesDepartment of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada. kyeates@ucalgary.ca.ORCID http://orcid.org/0000-0001-7680-2892
Karen M BarlowChild Health Research Centre, Queensland Children's Hospital, University of Queensland, South Brisbane, Australia.
Bruce WrightDepartment of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Ken TangIndependent Statistical Consulting, Vancouver, BC, Canada.
Olesya BarrettAlberta Health Services, Calgary, AB, Canada.
Edward BerduscoDepartments of Emergency Medicine and Family Medicine, University of Alberta, Edmonton, AB, Canada.
Amanda M BlackAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Brenda ClarkDepartment of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Alf ConradiDepartment of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Heather GodfreyAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Ashley T KolstadAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Anh LyDepartment of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada.
Angelo MikrogianakisDepartment of Pediatrics, McMaster University, Hamilton, ON, Canada.
Ross PurserDepartment of Emergency Medicine, Grey Nuns Hospital, Edmonton, AB, Canada.
Kathryn SchneiderAlberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Antonia S StangDepartment of Pediatrics, University of Calgary, Calgary, AB, Canada.
Roger ZemekDepartments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada.
Jennifer D ZwickerSchool of Public Policy, University of Calgary, Calgary, AB, Canada.
David W JohnsonDepartment of Pediatrics, University of Calgary, Calgary, AB, Canada.
University of Calgary · CAUniversity of Alberta · CAAlberta Health Services · CAGrey Nuns Community Hospital · CAMcMaster University · CAThe University of Queensland · AUUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.

methodsStepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.

resultsA total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites.

conclusionsImplementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.

trial registrationClinicalTrials.gov NCT05095012.

Indexed as

Critical PathwaysEmergency Service, HospitalAlbertaChildFemaleHumansMalePatient Acceptance of Health CareTriageClinical pathwayPediatricTraumatic brain injuryUtilization

Identifiers

PMID37351798
PMCPMC10333406
OpenAlexW4381715309

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.