The Trauma Centre

The Montreal Children's Hospital (MCH) of the McGill University Health Centre is a provincially designated Pediatric and Adolescent Trauma Centre, a Neurotrauma Centre of Expertise, and an important player in the provincial trauma network. The hospital is dedicated to its trauma mandate with a well-developed Emergency Trauma Response system, a commitment to making the Pediatric Intensive Care Unit (PICU) accessible, and a variety of innovative inpatient and outpatient programs. Rapid access to expert medical, surgical, nursing, rehabilitation and psychosocial trauma care, state-of-the-art equipment, and a well-developed efficient and innovative trauma care system is paramount to increasing the chances of a positive outcome. 

Vertical Tabs

Who we are

The Montreal Children's Hospital (MCH) of the McGill University Health Centre is a provincially designated Pediatric and Adolescent Trauma Centre, a Neurotrauma Centre of Expertise, and an important player in the provincial trauma network. The hospital is dedicated to its trauma mandate with a well-developed Emergency Trauma Response system, a commitment to making the Pediatric Intensive Care Unit (PICU) accessible, and a variety of innovative inpatient and outpatient programs. Rapid access to expert medical, surgical, nursing, rehabilitation and psychosocial trauma care, state-of-the-art equipment, and a well-developed efficient and innovative trauma care system is paramount to increasing the chances of a positive outcome.

At the MCH, over 30 departments and services are involved in trauma care, providing coordinated medical, surgical, nursing, psychosocial and rehabilitation trauma expertise to children and adolescents who have sustained any one of a wide variety of injuries including skull fractures, diffuse axonal injuries, intra-cerebral hemorrhages, cerebral contusions, concussions, severely broken bones, spinal trauma, burns, severe chest, abdominal and pelvic injuries, eye traumas and dental traumas. Many of these injuries result from car collisions, sports accidents, falls, intentional trauma, fire, frostbite, drowning, caustic ingestions and poisonings. Patients and their families are cared for with an interprofessional approach (bringing professionals from different disciplines together to treat the patient).

We encourage physicians from regional centres and adult trauma centres to transfer patients with serious pediatric and adolescent trauma in need of a trauma centre level of expertise. As well, physicians can refer children and adolescents on an outpatient basis for consultation and intervention by our specialized programs.

Professionals from the following areas are involved in providing trauma care at the MCH:

Other specialties may be consulted as needed. 

Our mission

Mandate

Provide comprehensive, patient and family focused tertiary level interprofessional trauma care for all types and severities of trauma. Expertise spans from the acute, sub-acute and through the early rehabilitation phases. This includes excellence in trauma care; clinical and academic teaching; injury prevention and public awareness; education; research; community outreach; networking; and advocating for the needs of Quebec children and adolescents at a local, regional, provincial and Canada wide level.

Mission

  • To provide excellent trauma care
  • To maintain a high level of expertise
  • To ensure rapid accessibility for all patients to the MCH Trauma services
  • To assist patients and their families in understanding the impact of the injury and the expected course
  • To assist children and teens in achieving their maximum functional potential during the early stages of recovery
  • To provide coordinated patient-focused care in conjunction with other institutions in the healthcare consortium in order to assure timely continuum of care
  • To provide academic teaching and clinical training
  • To be leaders in pediatric and adolescent trauma research
  • To monitor trends and play a leadership role in the development of strategies for targeted injury prevention, public awareness, advocacy and lobbying
  • To be available as an expert community resource and develop strategic alliances with others sharing a common goal in advocating for the needs of the children and teens of Quebec

 

Our history

Over the years, the Montreal Children's Hospital Trauma Centre has continued to develop and expand in order to continue to meet the needs of the children and teens of Quebec:

  • 1989: Created First Pediatric Neurotrauma Program in Canada
  • 1993: Provincial (MSSS) designation as a Pediatric and Adolescent Trauma Centre (renewed in 1998, 2001, 2008)
  • 1997: Developed a comprehensive approach to the management of concussions/mild traumatic brain injuries
  • 2000: Reorganization and expansion of MCH Trauma mandate to include all types and severities of trauma
  • 2002: Expansion of Burn Trauma Program
  • 2006: Expansion of Injury Prevention mandate; development and implementation of Emergency Trauma Response System (1010 /2020 code)
  • 2007: Development of The Mild Traumatic Brain Injury and Return to Sports Program
  • 2007: Launch of the first edition of the MCH Concussion KiT
  • 2008: Development of the interprofessional MCH Concussion Clinic
  • 2009: Development of community partnerships, educational resources and outreach activities
  • 2010: Reorganization of MCH Trauma to include six interprofessional programs, including a Trauma Research section
  • 2011: The Canadian Hospital Injury Reporting Program officially joined the MCH Trauma Directorate
  • 2011: Publication of the second edition of the MCH Concussion KiT to be used by sports teams and schools across Quebec
  • 2012: New format and expansion of the MTBI Program/Concussion Clinic 

 

Where the care happens

Each year, more than 17,000 children and teens from all regions of Quebec are treated at the MCH Trauma Centre's Emergency Department for trauma-related injuries. Upward of 350 of these patients sustain injuries that are serious enough to require hospitalization.

On an annual basis, the MCH receives approximately 150 trauma patients from regional centres throughout the province who are in need of tertiary trauma expertise. The hospital's trauma specialists become involved with all these patients as well as hundreds more who are referred as outpatients by community physicians and regional centres for consultation and a variety of specialized interventions.

 The Mild Traumatic Brain Injury (MTBI) Program/Concussion Clinic specializes in the management of MTBI including assessment, intervention plan, recommendations for return to school, and individualized plan for return to sports and recreational activities. The interprofessional MTBI Program/Concussion clinic treats over 600 patients annually.

Our team

The management of a trauma patient can be quite challenging and complex as the patient’s needs are multi-faceted. MCH Trauma consists of many surgical, medical, nursing, rehabilitation and psychosocial specialists who provide highly specialized trauma expertise to children, teens and their families. Professionals from many different disciplines work closely together to ensure that the patient’s care is well coordinated and strongly evidence-based (using proven clinical results to make decisions about the child’s care). This interprofessional care is individualized to meet the specific needs of the patient, taking into consideration their age, stage of development and psychosocial and academic history. As part of the provincial trauma network, the programs work closely with the Société de l'assurance automobile du Québec (SAAQ), and assist families in opening claim dossiers if needed.

Trauma coordinators in the Neurotrauma Program, Trauma Program, Burn Trauma Program, and the Mild Traumatic Brain Injury (MTBI) Program work directly with patients and families daily. They play key roles linking all specialties involved in the child’s or adolescent’s care, thereby ensuring that:

  • a comprehensive, interprofessional and coordinated treatment plan is in place
  • evidence-based standardized protocols are followed in a timely and effective manner
  • parents receive consistent information from the moment that the child arrives through the critical, sub-acute, and early rehabilitation phases
  • transfer to an appropriate rehabilitation centre or other community resource taeks place. 

 

Our programs

Trauma program:

Specializes in emergency, acute care, early rehabilitation and outpatient follow-up for all types of trauma including: musculoskeletal; spinal; thoracic; abdominal; pelvic; ocular; dental; poisoning; and near drowning.

Neurotrauma Program:

Specializes in emergency, acute care, early rehabilitation, and outpatient management for all types and severities of brain, neck and spinal cord injuries.

Concussion Clinic/Mild Traumatic Brain Injury (MTBI) Program:

Specializes in the management of mild traumatic brain injuries (also known as concussions), including: assessment, intervention plan, recommendations for return to school, and individualized plan for return to sports and recreational activities.

Burn Trauma Program:

Specializes in emergency, critical care, early rehabilitation and ambulatory management for all types and severities of burns.

Injury Prevention Program:

Involves injury prevention recommendations, education, public awareness, community outreach, partnership development, networking, and research. The MCH Trauma approach to injury prevention balances activity and fun with promoting awareness of the risks involved and making informed choices.

Trauma Research Program:

Research is a key component of trauma activities. It is important in verifying the effectiveness of our interventions and evaluating our projects and programs. Trauma team members are involved in a variety of clinical research projects and many have been published in peer-reviewed journals such as The Journal of Trauma, Brain Injury and the Journal of Head Injury Rehabilitation.

Trauma Team Leader (TTL) Program:

This program ensures urgent accessibility of the trauma team leader in charge of severe, complex and critical trauma cases in a fast and efficient manner. The trauma team leader leads the inter-professional group and ensures the delivery of excellent care from the time the patient arrives at the trauma centre through the different areas of care until the patient's final disposition to the OR, PICU, or Trauma Unit. The TTL Program is well integrated in the already established Trauma Code System.

Affiliated Programs

CHIRPP:

The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is a Canada-wide program of the Injury and Child Maltreatment Section of the Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of the Federal Government.

Each centre involved in CHIRPP has a designated Director and Coordinator. In 2011, CHIRPP was integrated into the MCH Trauma System. In order to meet the government mandate it has been closely linked to the MCH Injury Prevention Program for research activities, development of educational materials and injury prevention awareness.

Trauma education

MCH Trauma offers year-round Interprofessional CME-approved Trauma Rounds, which take place on a monthly basis. Topics include a wide variety of trauma-related subjects. Staff from many departments and services, community physicians, residents, students and trauma network partners attend rounds. The MCH Telehealth Program makes the rounds available to regional centres.

 

MCH Trauma Partners

The MCH Trauma Programs work closely with trauma and neurotrauma network partners at a local, regional and provincial level to ensure continuity of care. This allows patients to benefit from our expertise in acute care and assures an effective progression across the trauma network.

The objective is to provide the best possible outcome.

Community out-reach

Throughout the history of the MCH Trauma Programs numerous partnerships have been developed with community resources in order to meet the needs of patients and families and to prevent injuries. Here are some examples:

Physicians from regional and adult trauma centres are encouraged to transfer serious trauma cases in need of a trauma centre level of expertise. As well, out patients can be referred to our programs for consultation and intervention of specialists.

Family physicians and pediatricians are encouraged to refer patients who have sustained a trauma. We provide a screening and an interdisciplinary evaluation to determine the patient's needs and direct the patient towards the appropriate resources within the trauma network. We share our expertise in the evaluation and treatment of trauma. We offer educational material for distribution to their patients.

Clinical Research

Research is a core component of trauma activities. Research is important in recognizing the needs of children and adolescents, verifying the effectiveness of our interventions and evaluating our projects and programs. Members are involved in a variety of clinical research projects and have had many publications in peer-reviewed journals, such as The Journal of Trauma, Brain Injury and the Journal of Head Injury Rehabilitation. In this section, you will find results from completed projects of the Montreal Children's Hospital Trauma Programs, as well as information and updates on our current studies. It also highlights our research initiatives and collaborative work.

Completed projects 2014

1. Visual perception deficits in children after mild traumatic brain injury: psychophysics, electrophysiology and impact on postural stability

Who were the researchers?

Robert Forget, Jocelyn Faubert, Michelle McKerral, Isabelle Gagnon. 
Collaborator: Debbie Friedman

What was the research question?

We want to know whether we can identify visual perception and balance problems in children and adolescents who have sustained a mild head injury or concussion.

What were we doing?

We are assessing children with mild head injuries and children without head injuries over a one year period to see whether they have problems and when these problems resolve. Children are seen 3 times over the 12 month-period and each time we evaluate them using various tests focusing on the perception of visual stimuli and in a virtual reality setting to better assess their balance.

How was this project funded?

This project is funded by a research grant from the Canadian Institutes of Health Research.

When will we have results?

We are currently analyzing data collected for this project and we expect to present results from this study sometime in 2015.

 

2. Relationship between Balance and Self-Efficacy Related to Physical Activities in Children with an MTBI

Who were the researchers?

Isabelle Gagnon, Lisa Grilli, Krithika Sambasiyan

What was the research question?

We wanted to know whether we can identify balance problems or lack of confidence upon return to sports in children who have fully recovered after sustaining a mild traumatic brain injury or concussion.

What were we doing?

We were assessing children once fully recovered from a mild traumatic brain injury and children without head injury to see how their balance skills and self-confidence may impact their return to physical activities. Children with a mTBI were evaluated at time of discharge from physiotherapy and then interviewed 2 weeks later. Testing focused on their balance and confidence level when particpating in physical activities.

How was the project funded?

This project was funded by REPAR/FRSQ - OPPQ/REPAR program

What are the results?

Some balance difficulties tend to outlast post-concussive symptoms and can be detected using various measures of balance in children after a mild traumatic brain injury.

 

3. Relationship between oculomotor deficits, vestibular deficits and functional mobility in children following a mild traumatic brain injury (mTBI)/concussion.

Who were the researchers?     

Isabelle Gagnon, Vishwa Buch

What was the research question?

The extent to which eye movements (oculomotor) and inner ear (vestibular) deficits affect functional mobility following mTBI in children and adolescents.

 

What were we doing?

We examined eye movements, inner ear, and functional mobility in children and adolescents presenting to the MCH concussion clinic with an mTBI. It helped us understand how each of the two systems relate to functional mobility. We targetted three eye movements, such as saccades, smooth pursuits and vergence and we also examined visual acuity.

How was the project funded?

This project was funded through internal funds at the MUHC.

What are the results?

Twenty-nine children with mTBI participated in our study. The results indicated that vergence (eye movement) was significantly related to functional mobility; however none of the vestibular deficits were related to functional mobility.

 

 

4. Post-concussion symptoms as a marker of delayed recovery in children and youth who recently suffered a mild traumatic brain injury (MTBI)

Who were the researchers?

Isabelle Gagnon and Laurie-Ann Corbin-Berrigan

What were we doing?

Through a retrospective cohort study design, based on the Montreal Children's Hospital Concussion Clinic databse, a predictive model of delayed recovery was established for patients seen at 10 days post-concussion.Variables such as, post-concussion symptoms, medical history, gender, age, history of concussion, sleep disturbances, anxiety, learning disabilities, attention problems and depression were used in order to find the best predictive model of delayed recovery.

How was this project funded?

This project was funded through internal funds

What were the results?

The project started in 2013 and the results have been presented at various conferences. A scientific article is currently under review.

Projects completed in 2011-2012 

Projects completed in 2010-2011

Projects completed in 2008-2009

Ongoing Projects

1. Generating innovation through the use of common data: Improving the diagnosis and treatment of youth mild traumatic brain injury in Canada

Who are the researchers?

Isabelle Gagnon and Debbie Friedman lead a team of over 25 researchers working together to improve the care provided to kids and teens with concussions.

What are we doing?

We are developing and implementing a list of common data elements that should be collected both clinically and for research with the pediatric concussion population. We have agreed on domains and measures to be included in our projects.  We are now implementing it in a pilot project across Canada.

How is this project funded?

The project is funded through a research partnership grant from the Canadian Institutes of Health Research and the Fonds de recherche du Québec-Santé.

When will we have results?

The project started in 2013 and will last until 2018.

2. Exploring the impact of a physiotherapy intervention on the risk of re-injury and recovery in children and adolescents with acute ankle sprains: a randomized controlled trial

Who are the researchers?

Isabelle Gagnon, Guy Grimard, Carolyn Emery, David Johnson, Debbie Friedman

What is the research question?

We want to know if there is a difference between two different types of physiotherapy interventions when we look at how children recover and at the rate of re-injury after an ankle sprain.

What are we doing?

We are assessing the rate of re-injury in children who were seen at the MCH emergency department with the diagnosis of an ankle sprain. The children are randomized to one of two different types of physiotherapy interventions. The children are assessed by a blinded physiotherapist 1 week and 12 weeks following their initial injury. The children also receive a monthly phone call for 1 year following the initial injury to determine whether they have sprained their ankle or re-injured themselves again.

How is this project funded?

This project was initially funded through MCH Clinical Projects Competition and then went on to be funded by the Fonds de Recherche du Québec-Santé (FRQS).

When will we have results?

We are currently collecting data for this study and are expecting to present results from this study sometime in 2015.

3. Structural and functional neuroimaging, cognitive testing and postural stability assessment in children with mild traumatic brain injury

Who are the researchers?

Alain Ptito, Isabelle Gagnon, Michael Petrides, Miriam Beauchamp, Jen Kai Chen, Rajeet Singh Saluja, Debbie Friedman

What is the research question?

Can we identify structural and functional changes in the brain using imaging, as well as cognitive and balance difficulties using clinical tests after a mild traumatic brain injury in children and adolescents?

What are we doing?

We are assessing children with mild head injuries and children with orthopedic injuries over a 3 month period to see whether they have structural or functional changes in their brain, as well as cognitive or balance problems, and when these problems resolve. Children are seen 2 to 3 times over a 3-month period after the injury and every time we evaluate them using various tests. Testing will focus on cognitive and balance measures as well as by use of imaging technology to document actual changes in the brain.

How is this project funded?

This project is funded by a research grant from Canadian Institutes of Health Research (CIHR).

When will we have results?

We will begin recruitment for this study in the fall of 2011 and are expecting to present results from this study in June 2015.

4.Impact of a rehabilitation intervention for children and adolescents with atypical recovery following a mild traumatic brain injury or concussion

Who are the researchers?

Isabelle Gagnon, Debbie Friedman, Lisa Grilli, Grant Iverson

What is the research question? 

To what extent does providing children and youth with atypical recovery following concussion with an active rehabilitation intervention, improve outcome when compared to children receiving standard care?  

What are we doing?

We are following a group of children in Montreal and a group of children in Hamilton to examine their pattern of recovery with or without the intervention. We will also follow them over the following year to see whether they are at risk of sustaining more injuries.

How is this project funded?

This project is funded by a research grant from the Fonds de la Recherche du Québec-Santé.

When will we have results?

We are currently collecting data for this study and are expecting to present results from this study in June 2015.

5. Perceptual-Cognitive training in children and adolescents after sustaining a mild Traumatic Brain Injury (mTBI): Towards a sensitive marker on recovery

Who are the researchers?

Isabelle Gagnon, Jocelyn Faubert and Laurie-Ann Corbin-Berrigan (PhD student)

What are we doing?

We are implementing a newly designed research methodology in the pediatric concussion population, which consists of visual cognitive training. Through this methodolgy, we aim to establish if brains of children and adolescents post-mTBI respond the same way to perceptual-cognitive training than brains of uninjured individuals. In addition, the feasbilitiy of this research paradigm will be evaluated when it comes to enhancing recovery of children and adolescents with persistent symptoms.

How is this project funded?

This project is funded through internal funds.

When will we have results?

The project started in 2014 and will last until 2016.

 

Media

Injury Prevention Education

Community involvement

As a trauma centre, we feel strongly about our role in injury prevention, public awareness, education and being available for community outreach initiatives. For 15 years, the programs' experts have been involved in hundreds of media alerts, press conferences, and interviews aimed at educating the public, making them aware of the risks and providing sound recommendations for safety and injury prevention. The MCH Trauma Programs monitor injury trends in order to alert parents and caregivers of potential dangers, develop community outreach projects and implement research initiatives. A close working relationship exists with the Canadian Hospitals Injury Reporting & Prevention Program (CHIRPP) coordinator and the Medical Archivist.

In 1997 following the death of a teen from injuries sustained in gym class while using a trampoline, the MCH Trauma Programs, in conjunction with the Department of Community Paediatrics of the MCH, called for the ban of trampolines in schools, leading to a resolution to ban them, passed by the Federation of Quebec Home and School Associations. Also in 1997, the Trauma Programs alerted municipalities about the importance of securing soccer nets in parks and schools after several children sustained severe brain injuries from falling nets. In 2002, the trauma team noticed a significant increase in minor hockey injuries and went public to urge parents and coaches to take simple precautions to prevent players from being injured. In 2003, the MCH, as a partner with Safe Kids Canada, held a joint press conference calling for the ban of baby walkers. In 2005, the team exposed the potential danger, especially to young children, of playing paintball after a 10-year-old boy nearly lost an eye at an indoor paintball facility. Later that same year, the team appealed to municipal officials to develop standards for recreational diving boards. In 2007, the MCH embarked upon a province-wide water safety campaign. In the fall of 2008, the MCH launched a road safety campaign. In 2011, an urgent media advisory was issued in response to a large Quebec furniture and appliance retailer featuring a radio and television advertisement emphasizing the benefits of placing a colicky baby on clothes dryer. Minutes following the advisory the Quebec retailer pulled the ad. In 2012, MCH Trauma advocated for a multi-faceted approach to prevention of drowning through various media outlets. In 2013, MCH Trauma director reviewed Canada-wide injury statistics using CHIRPP database and concluded that there were no reported injuries involving turbans while playing soccer, following Quebec’s ban on turbans in soccer. That same year, MCH Trauma joined forces with other local trauma centres to advocate the provincial government to pass bicycle helmet legislation for those under 18 years of age.

Some other examples of press conferences and media alerts include:

  • Preventing drowning (July 2012)
  • Car seat verification clinic in partnership with SAAQ and SPVM (June 2012)
  • Falls from windows (June 2011)
  • Car seat verification clinic in partnership with SAAQ and SPVM (June 2011)
  • Dangers of ingesting button batteries media alert (March 2011)
  • Dangers of placing babies of clothes dryer advisory (March 2011)
  • Skulls and Crosschecks?: Special report on concussions (February 2011)
  • Tougher driving laws needed to save lives? (December 2010)
  • Concussions in minor hockey (November 2010)
  • Spinal cord trauma in hockey special report (September 2010)
  • Legislating Bicycle Helmets ( June 2010)
  • Teens & Risk taking behavior (June 2010)
  • All terrain vehicles (June 2010)
  • A graduation message for teens (May 2010)
  • Playing Smart Hockey (December 2009)
  • Water safety (June – August 2009)
  • Road safety in collaboration with Safekids Canada (May 2008)
  • Bunk bed safety (April 2008)
  • Preventing concussions and the Launch of the MCH Concussion KiT (December 2007)
  • Falls from windows through screens (July 2007)
  • Injuries from paintball (June 2007)
  • Holiday and toy safety (December 2006)
  • Diving board safety (August 2006)
  • Pedestrian safety (May 2006)
  • Blind cord strangulations (March 2006)
  • Icy school yards alert (March 2006)
  • Holiday safety (December 2005)
  • Wheel sports safety (seasonal)
  • Winter sports safety (seasonal)
  • Back to school tips (seasonal)
  • Backpack injury prevention alert (September 2005)
  • Public service announcements (assorted topics) (2005-2006)
  • Backyard trampoline press conference (July 2004)
  • Car seat safety and the results of our car seat verification clinic (May 2004)
  • Rise in minor hockey injuries alert (November 2002)

The Trauma Programs have also developed a series of trauma and injury prevention pamphlets that are readily available to the public and are currently widely used in schools, paediatricians' offices, community centres and CSSSs.

Topics include:

Coroner reports

2012-08-20: Swim to Survive Program

Following the drowning deaths of a 16 year old teenager in 2008, and 2 children aged 5 and 8 years in 2011 in Quebec Rivers, the 2012 coroner's report recommends mandatory swimming lessons. The joint recommendation of the coroners involved in these cases strongly recommends that a "swim to survive" program be included in elementary school curriculums. Children will be trained to have the basic capacity to face emergency situations in water.

2011-06-22: St-Sauveur Water Park Incident Leads Coroner to Recommend Additional Safety Measures

Following the drowning death of a 9 year-old boy at a St-Sauveur water park in June 2010, the Quebec Coroner’s recommends several changes to the park’s procedures and policies to prevent a similar incident from happening again. These include updating the park’s safety procedures to include clear instructions on how to deal with a missing child, posting additional lifeguards around the wave pool, implementing specialized training for staff guarding the wave pool, training school staff to monitor children on trips involving aquatic activities, and ensuring that school staff are aware of the possible dangers at any facility they visit with students.

2008-09-05: Seated position is dangerous for babies

After investigation into the death of a two-month old baby, the Quebec Coroner's office is advising that babies should never be left to sleep in their car seats because of the dangers of asphyxiation. Babies should ALWAYS sleep in their beds.

2008-02-01 : Coroner's diving board report

Conclusions: It is an accidental death which could have been avoided. It is a highly worrisome death, since it can reoccur if the status quo remains.

Trauma Rounds

2014-2015 Trauma Rounds Presentations Schedule

2014-2015 presentations

The MCH Trauma Code Response System: Integrating the Trauma Team Leader Program

2013-2014 Trauma Rounds Presentations Schedule

2013-2014 presentations

What’s new in clinical toxicology?

 

2012-2013 presentations

Drowning update

Pediatric Concussions: latest approach to management

Pancreas Trauma Rounds

Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) at the Montreal Children’s Hospital Trauma Centre

MCH Trauma Injury Prevention Program

Abusive Head Trauma

2011-2012 presentations

Emergency Sports Equipment Removal Workshop

Trauma CT: What's the risk?

Bier Block for Fracture Reduction in the Pediatric Emergency Department

Inhalation Injury

2010-2011 presentations

Blunt Torso Trauma: A Pediatric Perspective

The Role of Laparoscopy in the Diagnosis and Management of Pediatric Trauma

Changing Trends in Pediatric Femoral Fracture

Pediatric Dental Trauma: The Old and the New

Global Disparities in Trauma Care: How you Can Help

Treating Traumatized Children: When and How

2009-2010 presentations

City mouse, country mouse: The trauma experience in a rural African environment

Wii-Hab: Using commercial videogames in rehabilitation after a pediatric trauma

Pain management in polytrauma

ER pitfalls in orthopedic trauma

Crush Syndrome

Les jouets bruyants pour bambins: Une cacophonie à risque?

Use of Oral Contrast in CT Evaluation of Pediatric Blunt Abdominal Trauma

Acute Management of Burns in Children

MCH Trauma protocols
How to refer a patient

Criteria for referral to the Montreal Children's Hospital Neurotrauma Program

The Montreal Children's Hospital Neurotrauma Program provides several services: emergency, acute care, early rehabilitation and out-patient management for all types and severities of brain, neck and spinal cord injuries.

Children and adolescents who have sustained a mild traumatic brain injury have various needs provided by our comprehensive services of expertise within the program.

The Criteria for Referral to Neurotrauma Program are:

  • Patients given Miami-J collar to rule out neck injuries
  • Delayed emergency department visit with a confirmed skull fracture
  • Multiple concussions ( > 2 in the same year) or occurring with less impact forces
  • Persistent symptoms with no improvement lasting greater than two weeks
  • Concussive convulsions
  • Athletes (practice > 8 hours/week competitive sport)

What you need:

A referral to neurotrauma program which can be faxed at 514-412-4254 or mailed to:

The Montreal Children's Hospital:
The Trauma Programs
2300 Tupper, Room C-831,
Montreal, Quebec, H3H 1P3.

For additional information, please call 514-412-4400 extension 23310.

How to transfer a patient

The target clientele

Trauma categories determining if a child/adolescent (0 to 18 years of age) needs to be transferred to a tertiary pediatric trauma centre:

  • Child/adolescent who is intubated
  • Child/adolescent with a head injury: signs of lateralization, Glasgow Coma scale < 14
  • Child/adolescent with a mild head injury requiring observation
  • Child/adolescent with a spinal cord injury
  • Child/adolescent with a depressed or open skull fracture
  • Child/adolescent with a burn (more than 15% TBSA, 2nd degree)
  • Baby with a burn over 10% TBSA (nutritional needs)
  • Child/adolescent with a burn on the face, hands or feet
  • Child/adolescent with a burn on the perineum
  • Child/adolescent with a major trauma who is hemodynamically stable
  • Baby/infant (< 4 years old)
  • Child/adolescent requiring complex and extensive reconstruction
  • Child/adolescent with a Salter fracture or another serious type of fracture
  • Child/adolescent with a major trauma requiring cardiovascular, renal or nutritional support
  • Child/adolescent whose trauma is evaluated as non-accidental

Stabilization criteria before the transfer

Even in the case of an urgent transfer, the referring hospital must ensure that the child/adolescent is hemodynamically stable before transferring.

The following are signs of instability of vital signs in patients under 18 yeas of age:

  • Respiratory rate under 10 or over 60 per minute;
  • Systolic arterial tension under 70, over twice the patient's age in years;
  • Heart rhythm:
    If < 2 years, < 100 and > 160/min.
    If between 2 and 10 years, < 80 and > 150/min. 
    If > 10 years, < 60 and > 140/min.

In the presence of an urgent medico-surgical condition where the trauma threatens the child/adolescent's organs or life, the transfer is to be done after stabilization.

The stabilization includes an adequate evaluation and the beginning of the treatment so that, with reasonable probability, the transfer does not result in death or serious damage to the vital functioning of one of the organs.

The stabilization of the patient must include, when required:

  • Maintaining the permeability of the airways.
  • Control of any haemorrhaging.
  • Adequate immobilization of the patient or of a limb.
  • Setting up intravenous access for the administration of a solution or blood product.
  • Administering the necessary medication.
  • Necessary measures to ensure optimal stability during transfer.
  • Adequate accompaniment of the child by professionals deemed necessary to safeguard the life or corporal integrity of the patient during the transfer between the two hospital centres.

Modalities concerning the process for transferring to the MCH

Axis of communication to ensure transfer:

The emergentologist of the referring centre must communicate the request to the MCH ER Department, using the direct transfer line at (514) 412-4499.

Pertinent documents to submit with the transfer:

Initial pre-transfer information must be sent by fax to (514) 412-4399. In an ideal situation, this information should be sent before the patient's arrival at the MCH, using the polytrauma form and/or ER medical and nursing notes.

Documents to accompany the transfer:

  • Pre-hospital information (ambulance, police), forms AS 803, AS 810, and others if necessary
  • The standard trauma form or a legible copy of the physical exam of the patient by the physician, of the clinical evolution and any interventions carried out.
  • Paraclinical exams: haematology, biochemistry, blood gas, medical imaging, ECG
  • The identification of the referring hospital and the name and contact information of the emergentologist must clearly appear on the first page of the transfer documents.

If the referring centre encounters a problem and needs to quickly contact the responsible parties:

  • Dr Harley Eisman, Medical Director of the Emergency Department
    (514) 412-4400 ext. 23039
  • Anne Boisvert, Interim Nurse Manager of the Emergency Department, 
    (514) 412-4400 ext. 22650
  • Dr. Kenneth S. Shaw, Medical Director of the Trauma Program, 
    (514) 412-4388 between 9 am and 4 pm, 
    or by pager at (514) 406-4773
  • Debbie Friedman, Director of the Trauma Programs, 
    (514) 412-4400 ext. 23310
How to contact us

To transfer a patient from regional centre, call the Emergency Department:         514 412-4499

Trauma (Room C-831)

  • 2300 Tupper, Montreal
  • Quebec, H3H 1P3
  • Tel #: 514-412-4400 ext. 23310
  • Fax #: 514-412-4254

Debbie Friedman, BSc pht, M.Mgmt

  • Director, Trauma Programs
  • Director, Canadian Hospitals Injury Prevention and Reporting Program (CHIRPP)
  • Director Trauma Research

Diane Richard, BScN Trauma Coordinator

  • Neurotrauma Program
  • Trauma Program
  • Burn Trauma Program

Helen Kocilowicz, BScN Trauma Coordinator

  • Mild Traumatic Brain Injury Program
  • Concussion Clinic

Liane Fransblow, BSc. pht, MPH Trauma Coordinator

  • Injury Prevention Program

Lisa Grilli, BSc. pht, MSc Trauma Coordinator

  • Injury Prevention Program
  • Research Program
  • Head physiotherapist Concussion Clinic

Dr. Isabelle Gagnon, PT PhD Clinician Scientist

  • Research Program

Glenn Keays, MSc CHIRPP Coordinator

  • Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
Trauma Stories

Lucas Romano

Lucas Romano was a midget level hockey player. He suffered a concussion and lost consciousness during a hockey tournament after an opposing player hit him in the head. Lucas was followed by the Montreal Children’s Hospital Concussion Clinic. Here is his story.

Laura Rea

Philipe-Alex

(video available in French only)

Injury Prevention
Treating Trauma
Important resources to manage trauma
Brochures / Pamphlets
Publications

People are at the heart of the outstanding contributions to patient care, research, education and health technology assessment at the Montreal Children's Hospital. Every day our health care professionals work to improve the health and well being of children.

The efforts and the vision of the experts of the MCH Trauma Programs are highlighted in the following various publications.

Chapters in books

Gagnon, I. Mild Traumatic Brain Injury in Children and Adolescents From Basic Science to Clinical Management. Pediatric Neuropsychology, Second Edition Research, Theory, and Practice. Guilford Publications, Inc. New York, NY, 2012.

Friedman D, Atkinson J, Saltaris C, Daignault S, Gagnon I. L'approche utilisée dans le programme de traumatologie de l'Hôpital de Montréal pour enfants dans le traitement du traumatisme craniocérébral léger, dansÉpidémie Silencieuse : le traumatisme craniocérébral léger symptômes et traitement. Presses de l'Université du Québec, Québec. 2008

Gagnon I, Swaine B, Friedman D, Forget R. L'identification de séquelles suite à un traumatisme crânio-cérébral léger chez l'enfant. Publications du CRIR. 2005; 2: 119-134.

Books

Friedman D, Schopflocher C. Understanding Pediatric and Adolescent Neurotrauma. Montreal Children's Hospital, 1999.

Peer-reviewed scientific journals

Alexander Sasha Dubrovsky, Elise Mok,Suk Yee Lau, Mohammad Al Humaidan. Point tenderness at 1 of 5 locations and limited elbow extension identify significant injury in children with acutre elbow trauma: a study of diagnostic accuracy. Am J Emerg Med, 2014: Nov 29

Rajeet Singh Saluja, Jen-Kai Chen, Isabelle Gagnon, Michelle Keightley, Alain Ptito. Navigational memory fMRI: A test for concussion in children. J Neurotrauma, 2014: Oct 1.

Elana Pinchefsky, Alexander Sasha Dubrovsky, Debbie Friedman, Michael Shevell. Part II- Management of Pediatric Posttraumatic Headaches. Pediatr Neurolo, 2014: Oct 16

Alexander Sasha Dubrovsky, Anna Kempinska, Ilana Bank, Elise Mok. Accuracy of Ultrasonography for Determining Successful Realignment of Pediataric Forearm Fractures. Ann Emerg Med, 2014: Oct 16

Glenn Keays, Alex Dumas. Longboard and skateboard injuries. Injury, 2014: Aug 3:45(8):1215-9

Glenn Keays, Isabelle Gagnon, Debbie Friedman. Ringette-related injuries in young female players. Clin J Sport Med, 2014: Jul;24(4)326-30

Alexander Sasha Dubrovsky, Debbie Friedman, Helen Kocilowicz. Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey. Headache, 2014: May 2:54(5):878-87

Michelle L Keightley, Rajeet Singh Saluja, Jen-Kai Chen, Isabelle Gagnon, Gabriel Leonard, Michael Petrides, Alain Ptito. A functional magnetic resonance imaging study of working memory in youth after sports-related concussions: is it still working? J Neurotrauma, 2014: Mar11:31(5):437-51

Glenn Keays, Robin Skinner. Playground equipment injuries at home versus those in public settings: differences in severity. Injury Prevention, 2012; Apr16:18(2):138-41

Pomerleau G, Hurteau A-M, Parent L, Doucet K, Corbin-Berrigan L-A, Gagnon I. Developmental trajectories of infants and toddlers with good initial presentation following moderate or severe traumatic brain injury: a pilot clinical assessment project. Journal of Pediatric Rehabilitation Medicine, 2012; Jan.1; 5(2):89-97

Keays G, Pless I.B. Impact of a Celebrity Death on Children's Injury-related Emergency Room Visits. Canadian Journal of Public Health, 2010; 101 (2): 115-18.

Osmond, M. H., Klassen, T.P., Wells, G. A., Correll, R. , Jarvis, A., Joubert, G., Bailey, B., Chauvin-Kimoff, L., Pusic, M., McConnell, D., Nijssen-Jordan, C., Silver, N., Taylor, B., Stiell, I.G., for the Pediatric Emergency Research Canada (PERC) Head Injury Study Group. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. Canadian Medical Association Journal, 2010; 182 (4): 341-348.

Gagnon I, Galli C, Friedman D, Grilli L, Iverson G.L. Active rehabilitation for children who are slow to recover following sport-related concussion, Brain Injury, 2009; 23: 12, 956-964.

Gagnon I, Swaine B, Forget R. Do they actually listen? Using activity diaries to measure children and adolescents' compliance with activity restrictions after a mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 2009; 22: 355-362.

Brosseau-Lachaine O, Gagnon I, Froget R, Faubert J. Complex visual information processing in children after Mild Traumatic Brain Injury. Brain Injury, 2008, 22: 657-668.

Gagnon I, Swaine B, Champagne F, Lefebvre H. Perspectives of adolescents and their parents regarding service needs following a mild traumatic brain injury. Brain Injury 2008; 22: 161-173.

Swaine B, Gagnon I, Champagne F, Lefebvre H, Friedman D, Atkinson J, Feldman D. Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective. Brain Injury 2008; 22: 581-588.

Borsuk DE, Gallant M, Richard D, Williams HB. Silver-coated nylon dressings for pediatric burn victims. Can J Plast Surg; 2007; 15 (1): 29-31.

Pless, I.B., Hagel, B., Patel, H., Leduc, D., & Magdalinos, H. Preventing product-related injuries: a randomized controlled trial of poster alerts. Canadian Journal of Public Health. Revue Canadienne de Santé Publique. 98(4):271-5, 2007 Jul-Aug.

Su W, Hui T, Shaw K. All-terrain vehicle injury patterns: are current regulations effective? Journal of Pediatric Surgery, 2006; 41 (5) 931-934.

Gagnon I, Swaine B, Friedman D, Forget R. Comparing the Sensory Organization Test and the Pediatric Clinical Test of Sensory Interaction for Balance in children. Physical and Occupational Therapy in Pediatric 2006; 26: 23-41.

Pless, I.B., Magdalinos, H., & Hagel, B. Risk-compensation behavior in children: myth or reality? Archives of Pediatrics & Adolescent Medicine. 160(6):610-4, 2006 Jun.

Gagnon I, Swaine B, Friedman D, Forget R. Exploring children's self-efficacy related to physical activity performance after a Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation 2005; 20: 436-449.

Gagnon I, Swaine B, Friedman D, Forget R. Children demonstrate decreased dynamic balance following a mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation 2004; 85: 444-452.

Gagnon I, Swaine B, Friedman D, Forget R. Visuomotor response time in children with a mild traumatic brain injury.Journal of Head Trauma Rehabilitation 2004; 19: 391-404.

Bienkowski P, Harvey EJ, Reindl R, Berry GK, Benaroch TE, Ouellet JA. The locked flexible intramedullary humerus nail in pediatric femur and tibia shaft fractures: a feasibility study. J Pediatr Orthop 2004; 24 (6): 634-637.

Pickle A, Benaroch TE, Guy P Harvey EJ. Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation. J Pediatr Orthop 2004; 24 (2): 178-180.

Swaine B.R., Friedman D, Activity Restrictions as part of Discharge management for Children with a Traumatic Head Injury. Journal of Head Trauma Rehabilitation; 2001; 16 (3): 292-301.

Gagnon I, Friedman D, Swaine B, Forget R. Balance findings in a child before and after a mild head injury. Journal of Head Trauma Rehabilitation; 2001; 16(6): 595-602.

Swaine BR, Pless IB, Friedman D, Montes J. Using the Measure of Processes of Care with parents of children hospitalized for head injury. American Journal of Physical Medicine & Rehabilitation, 1999; 78 (4): 323-329.

Gagnon I, Forget R, Sullivan SJ, Friedman D. Motor performance following a mild traumatic brain injury in children: an exploratory study. Brain Injury; 1998; 12 (10): 843-853.

Swaine BR, Pless IB, Friedman D, Montes J. Parental perceptions of care provided to children hospitalized for head injury. Canadian Journal of Rehabilitation, 1998:11(4)

Research reports

Swaine B, Champagne F, Lefebvre H, Atkinson J, Feldman D, Gagnon I, Friedman D. Identification des besoins spécifiques des adolescents ayant subi un traumatisme craniocérébral léger. Rapport de recherche déposé en juillet 2006 au Programme de Recherche en Réadaptation et Intégration Sociale en Traumatologie. 101 pages.

Non peer-reviewed publications

Friedman, D. Health Promotion through Injury Prevention: The Perspective of a Paediatric and Adolescent Trauma Centre. Orthopaedic Division Review. 2011

Gagnon I, Swaine B, Friedman D, Forget R. Capacités motrices et retour aux activités physiques après un traumatisme crânio-cérébral léger chez l'enfant. Physio-Québec 28: 14-15, 2003.

Gagnon I, Forget R, Sullivan SJ, Friedman D: La performance motrice des enfants ayant subi un traumatisme crânio-encéphalique léger: une étude exploratoire. Physio-Québec 23: 18-19, 1998.

Published abstracts

Grilli L, Gagnon I, Friedman D. Duration of symptom-free period and impact on clinical outcome in children after concussion. Physiotherapy. 2011. 97: suppl 1 eS385

Gagnon I, Friedman D. Management of mild traumatic brain injury or concussion in children: is there a role for the Physical Therapist? Physiotherapy 2011. 97: suppl 1 eS1487

Isabelle Gagnon, Robert Forget, Lisa Grilli Exploring Post-concussion Symptoms in Children After an Injury: Can musculoskeletal injury bring them on? Ninth World Congress on Brain Injury; Edinburgh, Scotland; March 21-25, 2012

Grilli L, Fransblow L, Friedman D, Auclair N, Levis NP, Belluci L, Jubinville H, Galli C, Gagnon I. Collaboration amongst trauma and injury prevention experts: Addressing risky teen road behaviours. CPHA Conference: “Public Health in Canada: Innovative Partnerships for Action”; Montreal; June 19, 2011

Fransblow L, Grilli L, Friedman D, Dion D, Lauzon F, Robert JL, Ibrahim M, Gagnon I; Car seat verification clinic at a suburban community open house. CPHA Conference: “Public Health in Canada: Innovative Partnerships for Action”; Montreal; June 19, 2011

Livernoche F, Pépin K, Berry M, Friedman D, Morel J. Traumatismes par véhicule motorisé chez les enfants du Nunavik: CPHA Conference: “Public Health in Canada: Innovative Partnerships for Action”. Montreal, June 19, 2011

Friedman D, Gagnon I, Le TCC léger pédiatrique et adolescent en contexte sportif. 17e colloque Défis traumatologie ; Québec, February 24-25, 2011

Gagnon I, Galli L, Grilli L, Simard J. Assessing balance in children after a mild traumatic brain injury: Choosing the right tools. Eighth World Congress on Brain Injury, Washington March 10-14, 2010. Brain Injury. 24: 147, 2010.

Friedman D, Gagnon I, Kocilowicz H, Galli C, Grilli, L. Concussion care model Eighth World Congress on Brain Injury, Washington March 10-14, 2010. Brain Injury. 24: 333, 2010.

Hurteau A-M, Doucet K, Parent L, Gagnon I. Developmental outcome of infants with moderate and severe head injury. Eighth World Congress on Brain Injury, Washington March 10-14, 2010. Brain Injury. 24: 179, 2010.

Gagnon I, Grilli L, Galli C, Friedman D. Managing acute ankle sprains in a pediatrics emergency department: Implementing an interdisciplinary approach. Canadian Association of Sport Medicine Annual Meeting, Vancouver May 2009. Clinical Journal of Sports Medicine. 19: 249. 2009

Gagnon I, Galli C, Friedman D, Iverson G. Active rehabilitation for children and adolescents with atypical recovery following a concussion. 3rd International Conference on Concussion in Sports, Zurich, October 2008. British Journal of Sport Medicine. 43 (suppl. 1) i97, 2009

Gagnon I, Galli C, Friedman D, Simard J, Kocilowicz H, Grilli L. Returning to sports after a concussion - The Montreal Children's Hospital Return to Sports Program. 3rd International Conference on Concussion in Sports, Zurich, October 2008. British Journal of Sport Medicine. 43 (suppl. 1) i97, 2009

Gagnon I, Swaine B. Exploring the impact of Knowledge-Transfer and Exchange tools with clinicians working with teenagers who sustain mild traumatic brain injuries. ACRM-ASNR Annual Educational Conference, Toronto October 2008, Archives of Physical Medicine and Rehabilitation, 2008, 89: e31.

Gagnon I, Champagne F, Friedman D, Swaine B. Evaluating the implementation and impact of an innovative, integrated approach to identify and orient children and adolescent with MTBI in a pediatric trauma center emergency room. Seventh World Congress on Brain Injury, Lisbonne, April 8-12 2008. Brain Injury. 22: supplement 1, 190.

Gagnon I, Galli C, Friedman D. Taking care of the "miserable minority": Rehabilitation strategies for children and adolescents presenting with atypical recovery following a mild traumatic brain injury. Seventh World Congress on Brain Injury, Lisbonne, April 8-12 2008. Brain Injury. 22: supplement 1, 194.

Gagnon I, Swaine B, Champagne F, Lefebvre H, Atkinson J, Feldman D. Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective. American Congress of Rehabilitation Medicine Annual Conference, Washington, October 2-7, 2007 Volume 88 , Issue 10 , Pages e18 - e19

Brosseau-Lachaine O, Gagnon I, Froget R, Faubert J. Complex visual information processing in children after Mild Traumatic Brain Injury. Vision Sciences Society Annual Meeting, 5-10 mai 2006. Journal of Vision. 2006

Gagnon I, Swaine B, Friedman D, Forget R. Diaries as an indirect measure of compliance with return to activity; guidelines given to children who sustain a mild head injury. ACRM-ASNR Annual Educational Conference, Chicago, 28 septembre-2 octobre 2005. Archives of Physical Medicine and Rehabilitation. 2005; 86: e19.

Gagnon I, Forget R, Swaine B, Friedman D. Balance findings after a mild head injury in children. 3rd World congress of Neurorehabilitation, Venise, Italie, 2-6 avril 2002, Neurorehabilitation and Neural Repair. 2002; 16: 22-3.

Gagnon I, Forget R, Swaine B, Friedman D. Transient increase in response time after a mild head injury in children, 79th Annual Meeting of the American Congress of Rehabilitation Medicine, Philadelphia, 2-6 octobre 2002.Archives of Physical Medicine and Rehabilitation. 2002; 83: 1481.

Swaine B, Gagnon I, Forget R, Friedman D. Mild traumatic brain injury affects children's confidence in their physical activity performance, 7th annual conference of the Euroacademia Multidisciplinaria Neurotrumatologica, Newcastle-upon-Tyne, UK, June 26-29 2002, Acta Neurochirurgica, 2002; 144(7): A35.

Gagnon I, Forget R, Sullivan SJ, Friedman D. Motor performance following a mild traumatic brain injury in children: an exploratory study. Annual Meeting of the American Physical Therapy Association, Orlando, Floride 4-8 juin 1998,Physical Therapy. 78: s81, 1998.

Contact info 

Phone : 514-412-4400 ext. 23310

Fax : 514-412-4254

514-412-4499, Emergency Department (for patient transfer) / 514-412-4399 (fax)

Safety and wellness

The Montreal Children’s Hospital Concussion KiT was developed through the work of the Neurotraum

The discharge package following an ankle sprain is available on-line.

Annually at The Montreal Children’s Hospital, we see over 2,500 children and adolescents with he

Traumatic brain injuries continue to be an important cause of death and disability among childre

Pedestrians, motorists, passengers and cyclists must know and respect all safety rules of the ro

Why Shaking a Baby Is So Dangerous