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About Sickkids
About SickKids

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

The Hospital for Sick Children
Staff Physician
Paediatric Emergency Medicine

Research Institute
Senior Associate Scientist
Child Health Evaluative Sciences

Research Ethics Board

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 2015, she was also 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 teach on any problem that relates to paediatric emergency medicine, her area of specialty is in musculoskeletal injuries.

Academic Background

  • B.Sc, University of Toronto
  • M.Sc, McMaster University
  • MD, University of Toronto
  • FRCPC (Pediatrics), Children's Hospital Boston and The Hospital for Sick Children
  • FAAP (Pediatric Emergency Medicine), Children's Hospital of Boston

Research Interests

Optimization of diagnosis and management of paediatric musculoskeletal injuries.

Research Activities 

Dr. Boutis has completed a study that validated a decision rule that could potentially reduce radiography rates in children with ankle injuries by about 25 per cent. Further, she has demonstrated that a convenient, effective, safe and removable immobilization device is useful in low risk paediatric ankle and wrist injuries. Dr. Boutis is currently working with child abuse teams to to improve the detection of abuse related fractures. She also recently launched ImageSim, which is an evidence based on-line learning system that improves physician learning of visually diagnosed tests (e.g. X-rays, ECGs, ultrasound).

Future Research Interests

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

External Funding

The Physicians' Services Incorporated Foundation.
Randomized control trial of casting vs Air-Stirrup ankle brace in children with acute low-risk ankle fractures. Boutis K, Schuh S, Babyn P, Alman B, Willan A, Narayanan U.

Canadian Institutes of Health Research
Controlled Radiography for Ankle Injury Cases in Kids in the Emergency Department (CRACKED): Implementation of Best Evidence for Imaging of Pediatric Ankle Injuries. Boutis K, Groodendorst P, Grimshaw J, Goeree R, Schuh S, Johnson D, Plint A, Babyn P, Naranyanan U, Sayal A, Butler N.

Royal College of Physicians and Surgeons Medical Education Research Grant
Climbing the Learning Curve: a new approach to teaching non-radiologists x-ray interpretation of ankle radiographs. Boutis K, Pusic M, Narayanan U, Pecaric M.

SickKids Foundation
A randomized controlled trial of casting versus wrist splint in children with minimally angulated distal radius fractures in children. Boutis K, Howard A, Babyn P, Willan A.


1.  Improving the Management of Low Risk Ankle Fractures  Boutis K (PI), 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 (PI)
, 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.  Abuse Related Fractures Commonly Missed at First Physician Visits Ravichandran N, Schuh S, Bejuk M, Shouldice M, Al-Harthy N, Au H, Boutis K (SRA).  Pediatrics 2010: 125: pp 60-6.
Significance:  Fractures represent the commonest injury in abused children, yet physicians may have difficulty distinguishing accidental fractures from those due to abuse.  This study is the first to report the frequency of delayed recognition of abusive fractures in children: in more than one fifth of the cases, the “abusive” aetiology of the fractures was missed at initial physician visits.  We also found that boys presenting to a non-paediatric ED or a primary care setting with an extremity fracture appear at the highest risk of the abusive aetiology of the fracture escaping detection by a physician.  This implies that appropriate targeted education, practice guidelines and future knowledge translational research may help us achieve better outcomes for this vulnerable population.  

4.  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.   

5.  A Clinical Decision Rule that Significantly Reduces Pediatric Ankle Radiographs  Boutis (PI) 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.