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About Sickkids
About SickKids

Kathy Boutis, B.Sc, M.Sc, MD, FRCPC

The Hospital for Sick Children
Staff Physician
Paediatric Emergency Medicine

Research Director
Paediatric Emergency Medicine

Research Assistant Program Director
Paediatric Emergency Medicine

Research Institute
Senior Associate Scientist, Child Health Evaluative Sciences
Research Institute

Phone: 416-813-8982
Fax: 416-813-5043
Email: kathy.boutis@sickkids.ca

Brief Biography

Dr. Kathy Boutis graduated from the University of Toronto medical school in 1991. She completed a residency in paediatrics in 1998 and a fellowship in pediatric emergency medicine in 2001 at the Children's Hospital in Boston, Harvard University. In 2008 she completed a Master’s degree in Health Research Methodology at McMaster University. Dr. Boutis is currently a staff physician in the emergency department at The Hospital for Sick Children (SickKids), a Senior Associate Scientist in the Child Health Evaluative Sciences Program at SickKids Research Institute, and an Associate Professor with the University of Toronto. In 2009, she developed and became director of the emergency department-based student volunteer program. In 2012, she was appointed Research Director in Pediatric Emergency Medicine and in 2015 she was appointed as Vice-Chair of the Research Ethics Board.

Clinical Care Activities

Dr. Boutis' clinical practice spans both patient care and educational responsibilities in paediatric emergency medicine. Although she practices and teaches on any problem that relates to paediatric emergency medicine, her area of specialty is in the emergency diagnosis and management of pediatric musculoskeletal injuries.

Academic Background

  • B.Sc, University of Toronto
  • M.Sc, McMaster University
  • MD, University of Toronto
  • FRCPC Pediatrics, Royal College of Physicians and Surgeons
  • Pediatric Residency, Children's Hospital Boston
  • Pediatric Emergency Medicine Fellowship, Children's Hospital of Boston

Research Interests


Dr. Boutis has become an internationally recognized thought leader in pediatric emergency medicine whose research on musculoskeletal injuries has challenged dogma and is transforming practice. She links her core research area to child abuse, radiation exposure, and how trainees learn. Of note, her established work on learning curves and the interpretation of diagnostic images combines scholarship in education theory, decision-making, and implementation science and results in innovative on-line learning platforms.

Research Activities

Emergency Management of Pediatric Injuries: This clinical research program focuses on the emergency management common minor pediatric fractures, abusive injuries, and pediatric concussion. Specifically, this program conducts research to answer important questions that derive innovative cost-effective diagnostic and management strategies for common minor fractures, improve detection of abusive fractures, and address diagnostic consistency for concussion.  

Deliberate Practice of Pediatric Medical Image Interpretation: This medical education research program combines the theoretical frameworks of cognitive simulation, decision-making, deliberate practice, and performance-based competency with screen-based on-line learning. This research defines the learning outcomes and mathematics of learning curves of varied expert levels and with different learning conditions during medical image interpretation. The team has also implemented learning analytics that could be applied to on-line learning platforms to better define where and how participants make mistakes, not just how often. Research in this area provides a validated framework for implementing competency-by-design for clinical skills amenable to cognitive simulation. The foundations derived from this research program were also successfully translated into a powerful fully automated on-line learning platform called ImageSim (www.imagesim.com) that is effectively teaching health care professionals in over 12 countries.

The Pediatric Research Academic Initiative at SickKids Emergency: This program is an innovative approach to the implementation of prospective research studies that include emergency department patients. The program includes 42 university student volunteers who facilitate the execution of prospective trials in the ED. The main research goal of this program is to improve the ability to conduct research in the ED, and enables eligible patients to be captured into studies while simultaneously decreasing the need for expensive full-time clinical research nurses. The key educational objective is to enhance participating students' understanding of medicine and research in a busy clinical environment. To date, this program has facilitated enrollment of 55 studies, culminated in publication of 33 manuscripts, and led to the creation of similar programs at seven other sites in Canada.     

Future Research Interests

In the future, Dr. Boutis will be undertaking knowledge translation studies of clinical and education research in paediatric injury management.

External Funding

Dr. Boutis has successfully sustained funding of her research programs for the duration of her career as a scientist. Specific agencies that have granted Dr. Boutis funds include Physicians’ Services Incorporated, Canadian Institutes of Health Research, Royal College of Physicians and Surgeons, SicKKids Foundation,and the University of Toronto.


Five Most Significant Publications

  1. Improving the Management of Low Risk Ankle Fractures
    Boutis K (PA), Willan A, Babyn P, Narayanan U, Alman B, Schuh S: Pediatrics 2007: 119(6): pp e1256-63.  
    Significance:  The findings from this research have the potential to change practice of the most common paediatric lower leg fractures.  Traditionally, low risk paediatric ankle fractures, such as Salter-Harris I fractures of the distal fibula, have been managed with casting which may be associated with risks and inconveniences.  This study demonstrates that a removable ankle brace is not only at least as effective as casting with respect to recovery of physical function but is also less costly and without any reported adverse outcomes.
  2. A More Convenient Treatment Option for Minimally Angulated Paediatric Wrist Fractures
    Boutis K (PA), Willan A, Babyn P, Goeree R, Howard A:  CMAJ 2010: 182: pp 1507-12.
    Significance:  The findings from this research have the potential to change practice of the most common paediatric wrist fractures.  Traditionally, minimally angulated distal radius fractures have been managed with casting which may be associated with risks and inconveniences. This study demonstrates that a prefabricated wrist splint is not only at least as effective as casting with respect to recovery of physical function, but is also less costly, without any reported adverse outcomes, and favoured by parents and children.
  3. Using Deliberate Practice and Learning Curves to Determine How Much Practice Is Enough to Perfect Radiograph Interpretation Skills of Pediatric Ankle Radiographs
    Pusic M, Pecaric M, Boutis K (SRA): Acad Med. 2011 Jun;86(6):731-6
    Significance:  The main objective of this study was to demonstrate how proficiency improvements associated with deliberate practice of radiograph interpretation can be described using learning curves.  The results demonstrated that learning curves can be a useful representation of how trainees acquire the skill of radiograph interpretation.  In our sample, a qualitative inspection of the learning curves allowed us to determine the most efficient amount of practice, and how much practice was required to achieve a given level of competence for a given learner and/or a learner group.   
  4. A Clinical Decision Rule that Significantly Reduces Pediatric Ankle Radiographs
    Boutis (PA) et al: CMAJ.  2013;185(15):E731-8.  
    Significance:  The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule that has the potential to safely reduce ankle radiographs in children with ankle injuries.  We performed a phased implementation of the LRAR and evaluated its effectiveness on reducing the frequency of ankle radiographs among children. We enrolled 2,151 children with ankle injuries, 1,055 of these at intervention and 1,096 at control hospitals.  Implementation of the LRAR reduced the frequency of ankle radiographs was reduced by 21.9%.  Further, the sensitivity of the LRAR was 100%, while the specificity was 53.1%. Thus, implementation of the LRAR in several different emergency department settings reduced the rate of pediatric ankle radiographs significantly and safely, without an accompanying change in physician or patient satisfaction.
  5. Lateral ankle injuries in cchildren are more likely to be sprains than growth plate fractures
    Boutis (PA) et al. JAMA Pediatrics. 2016;170:e154114
    Significance:  For over 50 years, physicians have thought that growing children "do not get sprains" since it is the growth plate is assumed to be weaker than the relatively stronger adjoining ligaments. As a result, when a child presents with an ankle injury and x-rays that do not show a fracture, the traditional teaching is to place these children in a cast and refer to an orthopedic surgeon since they may have a growth plate fracture we can't see on radiographs. Our research changed this dogma. We enrolled 135 children who received MRI to identify the precise pathology and we demonstrated that in fact growth plate injuries in this clinical scenario are rare but ankle sprains are in fact very common.  Importantly, regardless of what the specific MRI injury was, children recovered well when treated with support and return to activities as directed by the children's symptoms.

Click here for a more complete list of publications.