Natalie Le Sage

• MD, PhD
• Professor (Associate) at Université Laval

Objectives: We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilita-tors and barriers for Canadian emergency medicine researchers , and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity.

Purpose/Objective: In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore t...

Background: Wide variations in emergency department (ED) syncope management exist. The Canadian Syncope Risk Score (CSRS) was developed to predict the probability of 30-day serious outcomes after ED disposition. Study objectives were to evaluate the acceptability of proposed CSRS practice recommendations among providers and patients, and identify...

Background: Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport...

Objectives To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation. Method The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderat...

Mild Traumatic Brain Injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multicentre study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were inc...

Objective: To evaluate the association between standard post-intubation hypotension (< 90 mmHg) and in-hospital mortality. Secondary objectives were to evaluate the association of post-intubation hypotension and length of stay and to assess the impact of increasing post-intubation hypotension threshold to 110 mmHg on hospital length of stay and 48...

Purpose: The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding. Methods: Secondary analyses of population-based cross-sectional data...

Purpose/objective: The goals of the present study were (a) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months postinjury in individuals with mild traumatic brain injury (mTBI) while considering preinjury history of anxiety disorders and (b) to verify whether the presence of anxiety in the first mont...

Background Published risk tools do not provide possible management options for syncope in the emergency department (ED). Using the 30-day observed risk estimates based on the Canadian Syncope Risk Score (CSRS), we developed personalised risk prediction to guide management decisions. Methods We pooled previously reported data from two large cohort...

Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. Participants and setting: patients with mTBI from 7 Canadian Emergency De...

Background: Older patients (age ≥ 65 yr) with trauma have increased morbidity and mortality compared to younger patients; this is partly explained by undertriage of older patients with trauma, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. The objective of this study was to identify modifiers to the prehos...

Objectives To compare post-concussion symptoms in patients who sustained a sports-related mild traumatic brain injury (TBI) to those with non-sports-related mild TBI at 7 and 90 days post-injury.Methods This prospective multicentre cohort study took place in seven Canadian Emergency Departments (ED). Non-hospitalized patients aged ≥ 14 years with a...

Background Clinical assessment of patients with mild traumatic brain injury (mTBI) is challenging and overuse of head CT in the ED is a major problem. Several studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. Higher levels of S100B protein have been associated wi...

Background Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans.Objective The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head CT...

Background Decision aids are patient-focused tools that have the potential to reduce the overuse of head computed tomography (CT) scans. Objective The objective of this study was to create a consensus among Canadian mild traumatic brain injury and emergency medicine experts on modifications required to adapt two American decision aids about head C...

Objective: To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI). Participants: Canadian healthcare professionals caring for patients with mTBI. Design: Online Delphi process. Main measures: A first Delphi round documented important dimensions or criteria to consider wh...

Introduction: Emergency department (ED) syncope management is extremely variable. We developed practice recommendations based on the validated Canadian Syncope Risk Score (CSRS) and outpatient cardiac monitoring strategy with physician input. Methods: We used a 2-step approach. Step-1: We pooled data from the derivation and validation prospective c...

Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI pat...

Introduction: Selecting appropriate patients for hospitalization following emergency department (ED) evaluation of syncope is critical for serious adverse event (SAE) identification. The primary objective of this study is to determine the association of hospitalization and SAE detection using propensity score (PS) matching. The secondary objective...

Introduction: Mild Traumatic Brain Injury (mTBI) is a common problem: each year in Canada, its incidence is estimated at 500-600 cases per 100 000. Between 10 and 56% of mTBI patients develop persistent post-concussion symptoms (PPCS) that can last for more than 90 days. It is therefore important for clinicians to identify patients who are at risk...

Introduction: The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial haemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence. Methods: This retrospective cohort study...

Introduction: Wide variability exists in emergency department (ED) syncope management. The Canadian Syncope Risk Score (CSRS) was derived and validated to predict the probability of 30-day serious outcomes after ED disposition. The objective was to identify barriers and facilitators among physicians for CSRS use to stratify risk and guide dispositi...

Introduction: Clinical assessment of patients with mTBI is challenging and overuse of head CT in the emergency department (ED) is a major problem. During the last decades, studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. S100B serum protein level might be helpfu...

Introduction: Older (age >=65 years) trauma patients suffer increased morbidity and mortality. This is due to under-triage of older trauma victims, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. There are currently no Canadian guidelines for the management of older trauma patients. The objective of this stu...

Introduction: Choosing Wisely Canada has reported rates of unnecessary head computed tomography (CT) scans for low-risk mild traumatic brain injury (mTBI) patients in Ontario and Alberta ranging from 14% to 46%. Local data for Quebec is currently not available. We sought to estimate the overuse of CT scans among adults with mTBI in the emergency de...

Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post in...

Objectives: The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial hemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence. Methods: This retrospective cohort study ext...

Importance The management of patients with syncope in the emergency department (ED) is challenging because no robust risk tool available has been recommended for clinical use. Objective To validate the Canadian Syncope Risk Score (CSRS) in a new cohort of patients with syncope to determine its ability to predict 30-day serious outcomes not evident...

Objectives To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries. Methods Eighteen participants having recently sustained mTBI and 15 controls performe...

Objective With the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity. Methods We conducted a retrospective cohort...

This study assessed whether S-100β protein could be measured in urine when detectable in plasma after a mild traumatic brain injury (mTBI). Clinical data, plasma and urine samples were collected for the 46 adult patients prospectively enrolled in the emergency department (ED) of a Level 1 trauma center. S-100β protein concentrations were analysed u...

Introduction : Prompt defibrillation is critical during paediatric cardiac arrest. The main objective of this systematic review was to determine the initial defibrillation energy dose for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) that is associated with sustained return of spontaneous circulation (ROSC) during paediat...

Objective: To determine the initial defibrillation energy dose that is associated with sustained return of spontaneous circulation (ROSC) during paediatric cardiac arrest with ventricular fibrillation or pulseless ventricular tachycardia. Methods: A systematic review was performed using four databases (PROSPERO: CRD42016036734). Human studies an...

Background The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). Methods We conducted a retrospective chart...

Background: Despite their reported protective effect against the occurrence of head injuries, helmets are still used inconsistently in sports in which they are optional. We aimed to assess the impact of helmet use on the risk of hospitalization and intracranial haemorrhage for trauma occurring during sport activities. Methods: Retrospective coho...

Introduction: Prevalence and incidence of delirium in older patients admitted to acute and long-term care facilities ranges between 9.6% and 89% but little is known in the context of emergency department (ED) incident delirium. Literature regarding the incidence of delirium in the ED and its potential impacts on hospital length of stay (LOS), funct...

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, inc...

Introduction: Head injury is a common presentation to all emergency departments. Previous research has shown that such injuries may be complicated by delayed intracranial hemorrhage (D-ICH) after the initial scan is negative. Exposure to anticoagulant or anti-platelet medications (ACAP) may be a risk factor for D-ICH. We have conducted a systematic...

Introduction: It is documented that physicians and nurses fail to detect delirium in more than half of cases from various clinical settings, which could have serious consequences for seniors and for our health care system. The present study aimed to describe the rate of documented incident delirium in 5 Canadian Emergency departments (ED) by health...

Introduction: With a Canadian aging population, the prevalence of mild traumatic brain injury (mTBI) among elderly is increasing and the age criterion of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We evaluated if increasing the age criterion of the CCHR would maintain its validity. Methods: We conducted an historic...

Introduction: The Canadian Syncope Risk Score (CSRS) was developed to identify patients at risk for serious adverse events (SAE) within 30 days of an Emergency Department (ED) visit for syncope. We sought to validate the score in a new cohort of ED patients. Methods: We conducted a multicenter prospective cohort study at 8 large academic tertiary-c...

Objective We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. Design This is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two...

Study design: A nationwide cross-sectional study. Objectives: To measure the associations between cigarette smoking (defined as serum cotinine concentration > 15 ng/ml) and the 3-month prevalence of spinal pain (neck pain, low back pain, low back pain with pain below knee, and self-reported diagnosis of arthritis/rheumatism) and related limitati...

Background: This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following mild traumatic brain injury (TBI). Methods: Seven databases were searched for studies evaluating the association between NSE levels and post-concussion symptoms assessed ≥ 3 months (persistent)...

This systematic review and meta-analysis aimed to determine the prognostic value of S-100β protein to identify patients with post-concussion symptoms following a mild traumatic brain injury (mTBI). A search strategy was submitted to seven databases from their inception to October 2016. Individual patient data were requested. Cohort studies evaluati...

Purpose of the study: This study aims to describe all unsolicited electronic invitations received from potential predatory publishers or fraudulent conferences over a 12-month period following the first publication as a corresponding author of a junior academician. Study design: Unsolicited invitations received at an institutional email address...

Objective Mild traumatic brain injury (mTBI) has been insufficiently researched, and its definition remains elusive. Investigators are confronted by heterogeneity in patients, mechanism of injury and outcomes. Findings are thus often limited in generalisability and clinical application. Serum protein biomarkers are increasingly assessed to enhance...

Background: About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department. Methods: We conducted a 6-year prospect...

Introduction: Predatory publishing is a poorly studied emerging threat to scientists. Junior researchers are preferred targets as they are under academic pressure to publish but face high rejection rates by many medical journals. Methods: All electronic invitations received from predatory publishers and fraudulent conferences were collected over a...

Introduction: Mild traumatic brain injury (mTBI) is a major cause of morbidity but there are no validated tools to help clinicians predict post-concussion symptoms. This systematic review and meta-analysis aimed to determine the prognostic value of S-100B protein to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol...

Introduction: Mild traumatic brain injury (mTBI) is an understudied worldwide health problem and a socio-economic burden that remains a major cause of morbidity. However, there is no prognostication tool to help clinicians predict the occurrence of post-concussion symptoms. This systematic review aimed to determine the prognostic value of neuron-sp...

Canadian Journal of Emergency Medicine

Introduction: Mild traumatic brain injury (mTBI) is a common problem and until now, ED physicians don’t have any tool to predict when the patient will return to work. The purpose of this study is to develop and validate a clinical decision rule to identify the ED patients who are at risk of non-return to work or to school three months after a mTBI....

Background Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. Methods A historical cohort of patients who presented to a Canadian ED in 2009 and 2...

Objectives The main objective of this study was to evaluate the feasibility of emergency department (ED) point-of-care ultrasound (PoCUS) for rib fracture diagnosis in patients with minor thoracic injury (mTI). Secondary objectives were to 1) evaluate patients’ pain during the PoCUS procedure, 2) identify the limitations of the use of PoCUS techniq...

Objective: To compare gait parameters between children in early adolescence (EA) with and without a mild traumatic brain injury (mTBI) during dual-task walking (DTW). Methods: Children in EA with mTBI (n = 14; six girls) were compared to those without (n = 13; five girls) while walking in different combinations of obstacle avoidance and cognitive d...

Objectives: The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a head injury on the functional outcomes six months post-injury in older adults who sustained a minor trauma. Methods: This multicenter prospective cohort study in eight sites included pa...

Unlabelled: Objectif Notre objectif primaire est de mesurer l'incidence d'HPI selon quatre définitions différentes retrouvées dans la littérature. Notre principal objectif secondaire est d'évaluer l'impact de la présence d'instabilité hémodynamique avant l'intubation sur l'incidence d'HPI. Le deuxième objectif secondaire consiste à déterminer l'in...

Back pain brings about one of the heaviest burden of disease. Despite much research, this condition remains poorly understood and effective treatments are frustratingly elusive. Thus, researchers in the field need to consider new hypotheses. Vitamin C (ascorbic acid) is an essential co-factor for collagen crosslinks, a key determinant of ligament,...

Objective: The aim of this study was to determine the incidence of delayed complications, specifically hemothorax, and functional outcome in patients with isolated sternal fracture discharged from the emergency department (ED) compared to patients with other minor thoracic trauma. Methods: This prospective cohort study was conducted in four univ...

Introduction: Six Canadian provinces recently made bicycle helmet mandatory and subsequent data concerning hospitalization rates after head injuries in cyclists were controversial. Furthermore, there remains an important proportion of participants who don’t wear a helmet in sporting activity. We thus wanted to estimate the impact of helmet use in s...

Introduction: The older adult population is growing. The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a MT-HI on the functional and cognitive outcomes six months post injury of older adults who sustained a minor trauma. Methods: This multicenter prosp...

The prevalence of hypovitaminosis C in the general population is high. Our study shows associations between vitamin C and spinal pain that warrant further investigation to determine the possible importance of vitamin C in the treatment of back pain patients.

Rib fractures represent a frequent condition associated with Minor Thoracic Injury (MTI). Since the last decade, ultrasound have become an important part of emergency physician’s (EP) daily practice, and its applications have become numerous. The main objective of this study was to evaluate the feasibility of Emergency Department Targeted Ultrasoun...

Delirium is a dreadful complication in seniors’ acute care. Many studies are available on the incidence of delirium, however ED-induced delirium is far less studied. We aim to evaluate the incidence and impact of ED-induced delirium among older non-delirious admitted ED patients who have prolonged ED stays (≥ 8 hours). Methods: This prospective IND...

Introduction: Injured seniors visits are on the rise in the emergency department (ED) and up to 30 % are traumatic brain injury (TBI). Many patients suffer from comorbidities that require the use of anticoagulant drugs. The use of these drugs usually modify the trajectory patients will undergo in the ED. In the last decade, some authors suggested a...

Introduction: Six Canadian provinces recently made bicycle helmet mandatory and subsequent data concerning hospitalization rates after head injuries in cyclists were controversial. Furthermore, there remains an important proportion of participants who don’t wear a helmet in sporting activity. We thus wanted to estimate the impact of helmet use in s...

Introduction : Les traumatismes crâniens mineurs (TCm) chez les personnes âgées sont fréquents et les conséquences fonctionnelles à long terme sont encore inconnues. Objectifs : Comparer le déclin fonctionnel et cognitif chez les patients de 65 ans et plus ayant subi un TCm à ceux ayant subi un traumatisme mineur sans TCm. Les effets sur le déclin...

We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a sys...

Introduction: Mild traumatic brain injuries (mTBI) are frequent and even if they sometimes may seem minor, their consequences can be worrisome. Among potential new tools to help a better identification of patients at risk of persistent symptoms after a mTBI, a number of biomarkers have been described to be elevated after a mTBI of which the S100B p...

Background: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, o...

Context: Calcium channel blocker poisoning is a common and sometimes life-threatening ingestion. Objective: To evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in...

Background: Little is known about factors influencing professionals' use of wikis. Objective: We developed and validated two questionnaires to assess health care professionals' intention to use wiki-based reminders for the management of trauma patients. Methods: We developed questionnaires for emergency physicians (EPs) and allied health profe...

Objective:: To investigate whether minor thoracic injuries (MTIs) relate to subsequent functional limitations. Background:: Approximately 75% of patients with an MTI are discharged after an emergency department (ED) visit, whereas significant functional limitations can occur in the weeks that follow. Methods:: A 19 months' prospective cohort s...

Background: Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. Th...

Objectives: The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma. Method: A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hou...

Objectives:The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma.Method:A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for...

Background The optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently. Methods This quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart...

Process performance indicators that evaluate trauma centers in clinical case management provide information essential to the improvement of trauma care. However, multiple indicators are needed to adequately evaluate process performance, which renders comparisons cumbersome. Several methods are available for generating composite indicators that meas...

Objective: This study aimed to (i) describe unplanned readmission rates after injury according to time, reason, and place; (ii) compare observed rates with general population rates, and (iii) identify determinants of 30-day readmission. Background: Hospital readmissions represent an important burden in terms of mortality, morbidity, and resource...

Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop an...

OBJECTIVES: The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma. METHOD: A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours...

Study objective: Patients admitted to emergency departments (EDs) for minor thoracic injuries are possibly at risk of delayed pneumonia. We aimed to evaluate the incidence of delayed pneumonia post-minor thoracic injury and the associated risk factors. Methods: A prospective, multicenter cohort study was conducted in 4 Canadian EDs, from Novembe...

Mortality is widely used as a performance indicator to evaluate the quality of trauma care, but there is no consensus on the most appropriate definition. Our objective was to evaluate the influence of the definition of mortality in terms of the place (in-hospital or postdischarge) and time (30 days and 3, 6, and 12 months) of death on the results o...