You are here

Emergency

The Emergency Research Group conducts its projects at The Royal Children's Hospital Emergency Department, which provides urgent medical care to children and adolescents. The department treats 90,000 children a year, ranging from newborns to teenagers. The hospital is a paediatric tertiary referral centre and provides the only paediatric trauma service in Victoria.

The research group has a strong commitment to clinical research across a broad range of topics. It provides research opportunities for medical and nursing students, paediatric and emergency trainees and higher degree students (Masters, MD, DMedSc, PhD) in emergency related topics.

The research group is a member of PREDICT (Paediatric Research in Emergency Departments International Collaborative) emergency research network. This network provides a research platform for achieving multicentre acute care research in Australia and New Zealand. PREDICT currently holds a prestigious National Health and Medical Research Council Centre for Research Excellence grant. The research group is also part of PERN (Pediatric Emergency Research Networks), which combines the efforts of research networks on several continents to investigate global acute care questions.

Information for clinicians and researchers wanting to conduct research within our group :
We have had research fellows and visiting researchers from many countries, either as trainee clinicians in paediatric emergency medicine who completed research projects alongside their clinical training at the emergency department of the Royal Children’s Hospital or by spending time on campus specifically to conduct emergency-related research projects. We have had visiting researchers or research fellows from many countries beyond Australia including from New Zealand, Canada, the United Kingdom, Ireland, Thailand, Switzerland, the United States, Costa Rica, Germany and Singapore. Short research education courses – ethics, biostatistics, epidemiology, health economics etc., can be attended through the Clinical Epidemiology and Biostatistics Unit (CEBU), the Clinical Research Development Office (CRDO) and other departments of MCRI and the University of Melbourne. Some have completed research higher degrees (e.g. PhDs) while enrolled at the University of Melbourne or their home universities.

For trainees and researchers the main pathways to research exposure on campus are the following:

• Clinical appointment as junior trainee at the ED of the Royal Children’s Hospital:
In this scenario the main experience is clinical and research is a small part of the training experience. The clinical work as a full time trainee is reasonably intense- it is therefore difficult to additionally conduct meaningful research; trainees are, however, exposed to and encouraged to participate in research projects conducted in the emergency department. Clinical appointments can also be part time when it is possible to have increased exposure to research and research education. Overseas fellows come self-funded (or funded by their home institution) or they apply for a paid hospital appointment via the emergency department of the Royal Children’s Hospital (see RCH emergency website for contacts).

• Research appointment at Murdoch Children’s Research Institute:
Here the main focus is research. It requires an appointment for at least 6 months and a well worked out plan for a project to complete – for shorter research appointments the visits need to be planned well ahead of time to ensure protocols and ethics applications are prepared and submitted prior to arrival.

• Higher degree appointment with the University of Melbourne:
Here the focus is on the completion of a PhD or MD degree (called DMedSc- Doctor of Medical Science at the University of Melbourne) or a masters degree (MPhil). This takes 3, 2 and 1 year full-time equivalent respectively (or double part time). On average we have about 5 PhD/MD students in the department at any one time. For non-resident students higher degrees in Australia can be expensive.

For further information, prospective overseas clinicians and researchers wanting to conduct research within our group should contact Marian Chandler, administrative assistant of the emergency research group, MCRI.


 
Group Leaders: 
Group Members: 
A/Prof Dianne Crellin
Role: 
Research Associate
Dr Elliot Long
Role: 
Research Associate
A/Prof Eva Alisic
Role: 
Honorary Fellow
A/Prof Peter Barnett
Role: 
Honorary Fellow
A/Prof Silvia Bressan
Role: 
Honorary Fellow
Dr John Cheek
Role: 
Research Associate
Dr Dominic Cincotta
Role: 
Research Associate
A/Prof Joanne Grindlay
Role: 
Research Associate
A/Prof Sandy Hopper
Role: 
Research Associate
A/Prof David Krieser
Role: 
Honorary Fellow
Dr Stuart Lewena
Role: 
Research Associate
Dr Adam O'Brien
Role: 
Research Associate
Dr Sonia Singh
Role: 
Student
Dr Amanda Stock
Role: 
Research Associate
Dr Michael Takagi
Role: 
Snr Research Officer
Ms Cathriona Clarke
Role: 
Research co-ordinator
Mr Nick Anderson
Role: 
Research Assistant
Mr Fabian Fabiano
Role: 
Research Assistant
Ms Georgia Parkin
Role: 
Research assistant
Ms Vanessa Rausa
Role: 
Research assistant
Ms Jessica Beamish
Role: 
Student
Ms Alice Gornall
Role: 
Student
Mr Blair Keys
Role: 
Student
Ms Jesse Shapiro
Role: 
Student
Ms Carla Wardlaw
Role: 
Student
Ms Joy Yumul
Role: 
Student

Paediatric Emergency Medicine Centre for Research Excellence (PEM CRE): Our research group is part of the PREDICT Centre for Research Excellence into common and important paediatric emergency conditions including head and neck injuries, epilepsy, stroke, acute infections and pain. The centre brings together researchers across Australian and New Zealand emergency departments in the PREDICT network, to collaborate in the conduct of high-quality multi-centre clinical studies. From 2015 onwards the PEM CRE has been funded by two NHMRC Centre of Research Excellence grants. In addition to generating new evidence a key focus of the centre is to translate new findings into clinical practice and determine how best to achieve this. The PEM CRE aims to build capacity for future research by supporting research higher degree students (MPhil, MD/DMedSc, PhD) from PREDICT affiliated universities while embedded in multicentre acute care studies. Research students generally have supervisors from more than one institution within PREDICT, routinely have input from biostatisticians (Centre for Epidemiology and Biostatistics at MCRI) and health economists and are usually mentored by content experts from relevant sub-specialties such as neurology, neurosurgery, anaesthesia & pain medicine (led by Ms Amanda Williams (research coordinator, Melbourne Children's Campus), Ms Catherine Wilson (network coordinator), Dr Emma Tavender (knowledge translation coordinator), A/Prof Ed Oakley, Professor Franz Babl).

Single Centre Studies

  • Fentanyl, Nitrous Oxide and Ondansetron Trial (FON): Sedation with nitrous oxide and intranasal fentanyl is useful for mild to moderately painful procedures in the emergency department, such as fracture reductions. However, the combination has a higher emesis rate compared to nitrous oxide alone. As part of a suite of sedation related studies over the past decade, we are conducting an MCRI funded double blind, placebo controlled randomised clinical trial to investigate whether ondansetron is better than placebo in reducing the emesis rate in fentanyl and nitrous oxide sedations (led by Dr Emmanuelle Fauteux-Lamarre, A/Prof Sandy Hopper, A/Prof Greta Palmer, Prof Andrew Davidson, Prof Franz Babl). The study protocol has been published in BMC Paediatrics.
  • Cellulitis treatment at Home Or Inpatient in Children presenting to ED (CHOICE): Many conditions could be treated at home with visiting nurses and doctors, rather than in hospital. As part of a PhD thesis and in collaboration with Hospital-In-The-Home (HITH) and the infectious diseases group at Royal Children's Hospital we are conducting a series of studies to investigate if children with cellulitis can be safely treated with intravenous antibiotics at home. The studies were funded by the Royal Children’s Hospital Foundation. The core paper was published in The Lancet Infectious Diseases. Further papers include the development of a cellulitis scoring system (ASSET score) published in Pediatrics (led by Dr Laila Ibrahim, A/Prof Penelope Bryant, Prof Franz Babl).
  • Urinary tract infection (UTI CHOICE): Our understanding of UTIs in children is limited and it is not clear which children require intravenous antibiotics or need to be treated in hospital. As part of a DMedSc thesis and in collaboration with HITH and the infectious diseases group at Royal Children's Hospital we are conducting a series of studies to determine which children with UTI are at increased risk of adverse outcomes (led by Dr Barry Scanlon, A/Prof Penelope Bryant, Prof Franz Babl).
  • The Take CARe Concussion Assessment and Recovery Research) Study: It is unclear which children with concussion are at increased risk of prolonged post-concussive symptoms. The Take CARe study funded by the Royal Children’s Hospital Foundation is a joint clinical and research project with neuropsychology, neurosurgery sports medicine and rehabilitation medicine to improve the care of children who sustain a concussion and to identify predictors of delayed recovery. Protocol paper and initial results papers were published in the Journal of Neurotrauma and Pediatrics (led by Prof Vicki Anderson, Prof Gavin Davis, A/Prof Peter Barnett, Ms Cathriona Clarke, Dr Michael Takagi, Prof Franz Babl).
  • Biomarkers Study: Biomarkers in blood and sophisticated neuroimaging may help predict outcomes after traumatic brain injuries. Funded by the Victorian Neurotrauma Initiative/Ontario Neurotrauma Foundation and in collaboration with the Hospital for Sick Kids in Canada, this study attempts to correlate child and family function pre and post head injury and brain specific proteins in peripheral blood and neuroimaging findings. Initial papers have been published in The Lancet Child and Adolescent Health (led by Prof Jamie Hutchison, Prof Vicki Anderson, Prof Franz Babl).
  • SCAT (Sport Concussion Assessment Tool) Study: Diagnostic tools are important to assess concussion in children. In conjunction with a member of the international Concussion in Sports Group we validated the SCAT3 and ChildSCAT 3 test (published in Pediatrics). We are currently validating the updated version of SCAT (SCAT5 and ChildSCAT3) in children (led by Ms Cathriona Clarke, Mr Nicholas Anderson, Prof Gavin Davis, Prof Vicki Anderson, Prof Franz Babl). Prof Gavin Davis, Prof Vicki Anderson and Prof Franz Babl have collaborated on a systematic review on concussion in children published in the British Journal of Sports Medicine as part of the Berlin consensus work of the Concussion in Sports Group.
  • Procedural pain and distress: Children undergo many procedures which can cause pain and distress, yet we do not have a good way of measuring this. As part of a PhD thesis we are investigating how to better measure procedural pain and distress in pre-verbal and early verbal children. This work has led to publications in Pain and the Journal of Pain (led by A/Prof Dianne Crellin, Prof Franz Babl).
  • Brain Attacks: Stroke in children can cause long term disabilities and can be fatal, yet is often only diagnosed after lengthy delays. Together with the Department of Neurology and funded by the Royal Children’s Hospital Foundation we aim to better define and identify brain attacks - acute neurological changes, including strokes. Multiple papers have been published by the group in Stroke, Neurology and Annals of Emergency Medicine (led by A/Prof Mark Mackay, Prof Franz Babl).
  • Sepsis research: Sepsis is a major cause of disability and mortality in children. Yet, we do not understand the efficacy of basic interventions, such as fluid bolus therapy. As part of a PhD thesis we have investigated the use of echocardiography and ultrasound to determine fluid responsiveness in sepsis in children. Resulting papers have been published in Shock, Pediatric Critical Care Medicine and Emergency Medicine Australasia. In addition we have initiated an improvement processes in sepsis in the emergency department (led by Dr Elliot Long, A/Prof Ed Oakley, Prof Franz Babl).

Large multi-centre randomised controlled trials and observational studies:

  • Australian Paediatric Head Injury Rules Study (APHIRST): Computed tomography (CT) scans of the head provide rapid identification of intracranial injuries but have radiation-related risks and may require sedation in young or uncooperative children. The NHMRC funded APHIRST study aimed to determine whether children are at high or low risk of intracranial injury after mild head trauma and therefore should or should not undergo a CT scan. 20,000 children presenting to 10 PREDICT EDs with head injury were enrolled and first papers were published in Lancet, Pediatrics and Annals of Emergency Medicine. In collaboration with investigators from other countries we have also been able to use to use the data set to assess the accuracy of overseas head injury management guidelines (led by Prof F Babl, Dr J Cheek, A/Prof E Oakley).
  • APHIRST Gap-Study: APHIRST focussed on children with head injuries seen at hospitals with paediatric emergency departments. Yet the majority of head injured children in Australia and New Zealand are seen outside tertiary centres. In this study funded by an NHMRC Centre of Research Excellence grant we are investigating management practice for head injuries at non-tertiary hospitals. Results of APHIRST and APHIRST-Gap, together with an ongoing systematic review of the literature, will form the basis for a planned bi-national head injury guideline under the aegis of PREDICT (led by Ms Catherine Wilson, Dr Emma Tavender, A/Prof Ed Oakley, Prof Franz Babl).
  • Bronchiolitis Knowledge Translation Study (BronchKT): Based on a series of PREDICT studies in bronchiolitis funded by three NHMRC project grants and a detailed literature review PREDICT has developed a bi-national guideline for bronchiolitis management endorsed by many relevant professional bodies and published in the Journal of Paediatrics and Child Health. A key recommendation was to reduce interventions proven to be of no benefit. In a subsequent cluster randomised trial at 26 PREDICT sites funded by an NHMRC Centre of Research Excellence grant explored two different strategies to reduce such care of no benefit (led by Ms Libby Haskell, Dr Emma Tavender, Ms Catherine Wilson, Prof Stuart Dalziel, A/Prof Ed Oakley, Prof Franz Babl).
  • Convulsive Status Epilepticus Paediatric Trial (ConSEPT) and seizure studies: If seizures in children do not stop after benzodiazepines it is unknown what drugs should be used to stop ongoing seizures or status epilepticus. In an open label randomised clinical trial of >200 patients at 10 PREDICT sites we have investigated whether levetiracetam or phenytoin is better at stopping status epilepticus in children. The core paper of this Health Research Council New Zealand funded study was published in The Lancet in 2019 (led by Prof Stuart Dalziel, A/Prof Ed Oakley and Prof Franz Babl). As part of a PhD thesis we have also conducted a series of studies to explore research priorities and consent in seizure research with papers published in BMC Medical Ethics and Seizure (led by A/Prof Jeremy Furyk, Prof Franz Babl).
  • Bell’s Palsy in Children (BellPIC): In contrast to adults, where steroids have been shown to improve outcome in idiopathic facial palsy or Bell’s palsy, it is unclear if steroids should be used in children. We are conducting an NHMRC funded double blind, placebo controlled randomised clinical trial at 11 PREDICT sites to investigate whether prednisolone is better than placebo in improving facial nerve function at 1 month. The protocol paper has been published in BMC Pediatrics (led by A/Prof Sandy Hopper, A/Prof Ed Oakley, Dr John Cheek and Prof Franz Babl).
  • Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC): Children with cancer often present with fever while they are neutropaenic. While they are traditionally admitted to hospital on intravenous antibiotics, children at low risk of serious bacterial infection could be treated at home. In collaboration with the oncology and infectious disease service and the Peter MacCallum Cancer Centre/Victorian Comprehensive Cancer Centre we are conducting a series of studies at PREDICT hospitals to risk stratify >800 neutropaenic febrile children and develop low risk pathways for home care (funded by NHMRC). Initial papers investigating existing clinical decision rules for risk stratification have been published in the British Journal of Cancer, Journal of Paediatric Child Health and Pediatric Infectious Diseases Journal. A NHMRC funded implementation study will be conducted across multiple PREDICT sites (led by Dr Gabrielle Haeusler, Prof Karin Thursky, Prof Franz Babl).
  • High-Flow studies (Pediatric Acute Respiratory Intervention Study (PARIS)): The role of nasal cannula high flow therapy in children with respiratory failure is evolving. In a collaboration with the Paediatric Critical Care Research Group, University of Queensland, and the PREDICT network we are conducting a series of multicentre randomised controlled trials to clarify the role of high flow nasal cannula therapy. A first randomised controlled trial of >1400 children into the use high flow in bronchiolitis funded by NHMRC has been published in the New England Journal of Medicine in 2018. A second multi-centre randomised controlled trial of its use in asthma and pneumonia funded by NHMRC is ongoing (led by Dr Donna Franklin, Prof Andreas Schibler, A/Prof Ed Oakley, Prof Franz Babl).
  • Pediatric Emergency Research Networks (PERN) Bronchiolitis Study: Bronchiolitis is the most frequent reason for admission in infants. In a collaboration of 38 hospitals within the PERN network we are investigating variability in bronchiolitis care across countries and determine factors that place infants at increased risk of severe outcomes. Initial results of >3000 patients with bronchiolitis have been published in Pediatrics and Lancet Child and Adolescent Health (led by Dr Susanne Schuh and Prof Franz Babl).
  • Pediatric Emergency Research Networks (PERN) Pneumonia Study: Pneumonia is a frequent reason for emergency department presentations and is associated with high mortality in developing countries. In a collaboration of >100 hospitals worldwide within the PERN network we are investigating which children are at increased risk of severe outcomes (led by Dr Todd Florin, Prof Nate Kuppermann; local lead Prof Franz Babl).
  • Asthma outcomes study: It is unclear how to best treat acute severe asthma in children and care varies widely. Led by Monash University in a collaboration between PREDICT and PERN we will explore what the key outcomes in studies in acute severe asthma should be. This project is part of a PhD thesis and will likely set the global standard for future interventional studies (led by Prof Simon Craig, Prof Franz Babl).
  • Million Minds: There has been an alarming increase in the number of children and adolescents presenting to emergency departments with concerns relating to mental health such as self-harm, depression and behavioural disturbance.  The Million Minds project provides an opportunity to work out why this is happening and how we can improve care for children and adolescents presenting with actue mental health problems.  The research, to be conducted with multiple hospitals across the PREDICT network will include an exploration of factors which influence how staff care for these patients, a Delphi prioritisation study, a multicentre retrospective of current practice and clinical outcomes and multicentre randomised medication trials for oral and intramuscular sedative agents to determine the optimal drugs for actue severe behavioural disturbance,  This body of work is funded by a MRFF Million Minds call (led by Prof Simon Craig and Prof Franz Babl).
Funding: 

Additional funding:

  • Royal Children's Hospital Foundation
  • Murdoch Children's Research Institute
  • A+ Trust Research Grant
  • Auckland Medical Research Foundation
  • Perpetual Philanthropic Services
  • Queensland Emergency Medicine Research Foundation
  • Victorian Managed Insurance Authority
  • Foundation for Children
  • National Stroke Foundation
  • Collier Charitable Fund
  • Victorian Neurotrauma Initiative
  • Angior Foundation
  • Shepherd Foundation
Collaborations: 
  • Campus
  • Neuropsychology: Prof V Anderson
  • Neurology: A/Prof M Mackay; A/Prof S Harvey
  • General Medicine/Hospital in the Home: Dr Laila Ibrahim, Dr S McNab, A/Prof P Bryant
  • Intensive Care: Prof T Duke, Dr B Gelbart
  • Anaesthesia/Pain Service: Prof A Davidson, Dr S Sabato, A/Prof G Palmer
  • Health Economics Group, Centre for Health Policy, University of Melbourne: A/Prof K Dalziel
  • Community Health Services Research: Prof H HIscock, Dr A Rhodes

State

  • Neurosurgery, Austin Hospital: Prof G Davis
  • Florey Institute & National Stroke Institute: Prof L Churilov
  • Emergency Department, Monash University: Prof S Craig, Dr A West
  • Infectious Diseases, Victorian Comprehensive Cancer Centre: Dr G Haeusler, Prof K Thursky

National

  • Paediatric Critical Care Research Group, University of Queensland: Dr D Franklin, Prof A Schibler, Prof L Schlapbach
  • Paediatric Research in Emergency Departments International Collaborative (PREDICT)

International

  • Pediatric Emergency Research Networks (PERN)
  • International Committee for the Advancement of Procedural Sedation: Dr Steve Green, Loma Linda, CA; Dr K Mason, Boston, MA, USA
  • Pediatric Emergency Medicine special Interest Group, International Federation for Emergency Medicine (IFEM)
  • Starship Children's Hospital, New Zealand: Prof S Dalziel
  • Royal Bristol Hospital for Children, United Kingdom: A/Prof M Lyttle
  • Hospital for Sick Children, Canada; Dr S Schuh, Dr K Boutris
  • Cork University Hospital, Ireland; Prof R O'Sullivan
  • University of Padua, Italy: A/Prof S Bressan
  • University of California Davis, USA: Prof Nate Kupperman, Prof J Holmes, Prof J Hoch, Dr S Singh
  • University of Cardiff, Wales: Dr L Cowley, Prof A Kemp
  • St Justine Children's Hospital, Montreal, Canada: Dr E Trottier
  • Hospital Nacional de Ninos: Dr A Yock
  • Ruth Rappaport Children's Hospital, Haifa, Israel: Prof Itay Shavit