Canadian Journal of Emergency Medicine

Rouge Elton, Paola Andrea; Lucas, Nathalie; D. Trottier, Evelyne; Mousseau, Sarah; Tourigny-Ruel, Geneviève; Métras, Marie-Elaine; Gravel, Jocelyn

doi: 10.1007/s43678-026-01169-4pmid: 42047987

ObjectivesMigraine is a common presentation in pediatric emergency departments (ED), and non-invasive treatment options are desirable. This study evaluated what proportion of children treated with oral metoclopramide would not need a rescue medication for the treatment of migraine in the ED.MethodsWe conducted a retrospective cohort study at a tertiary pediatric ED in Montréal, Canada, over a one-year period. Patients aged 8–18 years diagnosed with migraine and treated with either oral or intravenous metoclopramide were included. The primary outcome was headache relief, defined as no need for rescue medication. Secondary outcomes included ED length of stay, adverse events, return visits within 7 days, and reduction in pain scores measured by the 10-point verbal numeric rating scale. The primary analysis was the proportion of children who did not need a rescue medication restricted to children treated with oral metoclopramide. Secondary exploratory analyses compared oral to intravenous administrations on primary and secondary outcomes.ResultsOf the 225 patients included, 78 received oral and 147 received intravenous metoclopramide. Headache relief was achieved in 83% (95% CI 73–91%) of the oral group. This compared favorably to the intravenous group (difference: 4%; 95% CI –7 to 14%). ED length of stay was shorter in the oral group (median 314 vs 500 min). Adverse events occurred only in the intravenous group (4%) and return visit proportions were similar between groups (difference 2%; 95% CI − 6 to 12%).ConclusionsOral metoclopramide is an effective and well-tolerated treatment for 80% of children with migraine in the ED. On exploratory evaluation, it offered comparable outcomes to intravenous administration with the added benefits of shorter ED stays and reduced procedural pain. Oral metoclopramide should be considered as a first-line treatment option for pediatric migraine in the emergency department.

Tataru, Elena; Mercuri, Mathew; Shoamanesh, Ashkan; Clayton, Natasha; Mercier, Éric; Morris, Judy; Jeanmonod, Rebecca; Eagles, Debra; Varner, Catherine; Barbic, David; Buchanan, Ian; Ali, Mariyam; Kagoma, Yoan; Engels, Paul; Sharma, Sunjay;

Eastwood, Kyle W.; Brousseau, Marc; Matheson, Kara; Bystrzycki, Alexia; May, Ronald; Clarke, Matthew; Loubani, Osama M.

doi: 10.1007/s43678-026-01158-7pmid: 41920514

ObjectivesEmergency Department Information Systems (EDIS) are essential digital technology used in Emergency Departments (ED). Modern EDIS provide electronic patient tracking, documentation, order entry and decision support, and are crucial for enabling data analytics and Artificial-Intelligence (AI)-based tools to improve patient care. However, Canada’s adoption of digital-health technology is slow, and the digital functions of current Canadian EDIS are unknown.This study presents an inventory of current Canadian EDIS functions. The primary outcome is a categorization of ED-centers as either ‘mostly-digital’, ‘hybrid-digital & handwritten’ or ‘mostly-handwritten.’ We hypothesized that < 50% of Canadian ED-centers are mostly-digital.MethodsA national electronic survey aiming to sample the 739 total Canadian ED-centers was conducted from Jan-Sept 2024. One response representing each center was recorded. The primary outcome was EDIS functions based on an adapted version of the electronic health record system functional model (EHR-S FM). Secondary outcomes include respondent and hospital demographics, and the ED-centers’ current and future-planned EDIS use.ResultsData from 99 individuals representing 545 (74%) of the target ED-centers was obtained. The most used EDIS brands include MEDITECH (31%), EPIC Systems (21%) and Allscripts (15%). Overall, 52.4% ED-centers are mostly-digital, 47.4% are hybrid-digital & handwritten, and 0.2% are mostly handwritten. Paper-based health provider ED documentation and order entry were reported in 19.7% and 46.2% of responses. Tracking medication administration and patient vitals are paper-based in 45.6% and 21.8% of responses.ConclusionsDespite national expansion in digital-health technology, there is widespread use of paper-based processes for Canadian ED patient care. These findings affect strategic planning for use of electronic care supports and AI. Further infrastructure changes are needed in order for Canadian patients to equitably and practically benefit from AI and data analytics innovations in the ED. Large portions of the information these technologies use are in difficult to access formats.