In order to help us all keep up to date the DFTB team and friends scour a great many journals to fill the monthly edition of Bubble Wrap. Given the large volume of research already out there that has not made it from the journal to the bedside, the major research agencies have been trying to determine what we really want to know.
The Paediatric Emergency Research in the United Kingdom and Ireland network was formed in 2012 to help passionate clinicians work together. What do this esteemed group of doctors think we need to be looking at?
Hartshorn S, O’sullivan R, Maconochie IK, Bevan C, Cleugh F, Lyttle MD. Establishing the research priorities of paediatric emergency medicine clinicians in the UK and Ireland. Emerg Med J. 2015 Feb 12:emermed-2014.
Here are their top 10…
1. Are there any useful biomarkers to help determine the presence of a serious bacterial infection in a child with a fever?
2. Which injured children need to go to a major trauma centre?
3. In children with septic shock should we use aggressive or judicial fluid management? In other words, how can FEAST be studied in a UK population?
4. What is the best IV treatment for acute severe asthma?
5. Does tranexamic acid (TXA) work in kids?
6. Do C-spine injury guidelines for children work?
7. What is the best decision tool for children with atraumatic limp?
8. What is the best decision tool for a child with petechiae?
9. Are ED observation units for children cost effective?
10. Is the NICE head injury guideline better than any other head injury decision rule?
Next, we’ll take a look at the Paediatric Research in Emergency Departments International Collaborative which was founded in 2004 as a means of creating a research powerhouse combining the best that Australia and New Zealand have to offer. You can listen to Franz Babl talk about their role in determining which head injury tool rules them all here.
Deane HC, Wilson CL, Babl FE, Dalziel SR, Cheek JA, Craig SS, Oakley E, Borland M, Cheng NG, Zhang M, Cotterell E. PREDICT prioritisation study: establishing the research priorities of paediatric emergency medicine physicians in Australia and New Zealand. Emerg Med J. 2018 Jan 1;35(1):39-45.
Here are their top 10…
1. What is the best IV treatment for acute severe asthma?
2. In a well-looking 3-6 month old infant with a UTI should we use oral or IV antibiotics?
3. In children with severe asthma does early use of NIV shorten length of stay?
4. Do C-spine injury guidelines for children work?
5. Does a paediatric intubation checklist improve outcomes?
6. What is the best decision tool for children with atraumatic limp?
7. Can we create a decision instrument that predicts which children with abdominal pain need surgical intervention?
8. In children presenting with presumed sepsis is a balanced isotonic solution better than normal saline?
9. In children with septic shock should we use aggressive or judicial fluid management? In other words, how can FEAST be studied in an ANZ population?
10. Does HFNCO2 use during intubation improve outcomes?
The Pediatric Emergency Care Applied Research Network is a federally funded multi-institutional research network in the US.
Miller SZ, Rincón H, Kuppermann N, Pediatric Emergency Care Applied Research Network (PECARN). Revisiting the emergency medicine services for children research agenda: priorities for multicenter research in pediatric emergency care. Academic emergency medicine. 2008 Apr;15(4):377-83.
Here are their top 10 ranked research priorities…
1. Respiratory illness/asthma
2. Prediction rules around high stakes/low likelihood illnesses
3. Medication error reduction
4. Injury prevention
5. Urgency and acuity scaling
6. Race, ethnic and class disparities in health
7. Mental health
8. Treatment of infectious diseases
9. Best practices in patient care
10. Pain and anxiety management
Finally we’ll take a look at PERC. Pediatric Emergency Research Canada was formed in 1995 and is a network of over 200 healthcare professionals. This crafty group decided to do things a little different and involved children and their parents in the decision making process.
Bialy L, Plint AC, Freedman SB, Johnson DW, Curran JA, Stang AS, Pediatric Emergency Research Canada (PERC). Pediatric Emergency Research Canada (PERC): Patient/Family‐Informed Research Priorities for Pediatric Emergency Medicine. Academic Emergency Medicine.
Here are their top 10 research priorities. They are much broader brushstrokes than those from PERUKI and PREDICT.
1. Dealing with mental health presentations
2. Guidelines around pain relief and sedation
3. Development of clinical practice guidelines in general
4. Determining the quality of care delivered
5. Resource utilisation or the appropriateness of the tests we order
6. A framework for the management of multi-system injury/trauma
7. Development of clinical prediction rules for high stakes, low frequency presentations
8. Improved methods of healthcare communication between practitioners
9. Better antibiotic stewardship
10. Management of bronchiolitis/pre-school wheeze
What should we make of these research agendas (other than Australians are overburdened with asthma)? There are commonalities between the four groups that reflect a paucity of evidence around a number of key topics. Whilst it is wonderful that the Canadians are involving the people at the receiving end – the patients – in assessing their research priorities it is hard to see how these objectives could be achieved without breaking them down further. Both the UK and Australia/New Zealand groups have already come up with some very specific research questions. What this space to see what will be at the forefront of the paediatric emergency medicine agenda over the next five years.
To find out a little more of what PREDICT are up to then come along to their session at DFTB18. Otherwise why not listen to Sarah McNab and Kelly Foster explain how to get started with your first RCT or how to set up your own departmental research program.
*The header image show the first recorded prednisolone versus dexamethasone trial