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Paediatric Emergency Medicine Centre of Research Excellence
Paediatric Emergency Medicine Centre of Research Excellence
The Paediatric Emergency Medicine Centre of Research Excellence (PEM CRE) brings together leading researchers and clinicians in Australia and New Zealand, with the aim of providing leadership and infrastructure for multicentre research and collaboration. The multicentre projects undertaken by the PEM CRE are implemented via the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. There are currently over 100 members from over 50 sites involved in PREDICT who undertake multicentre paediatric emergency research projects throughout Australia and New Zealand.
Children visit Emergency Departments (EDs) for acute medical care on average of once every year per child, for the duration of their childhood. This represents a large interaction with our health system and an important opportunity to address paediatric health issues. Emergency Department presentations are often of a critical nature, with the risk of death or substantial disability if the children are not managed appropriately. Providing evidence-based care for emergency management is essential and research is directed to address areas where there is a lack of evidence, incomplete translation of existing evidence to practice, and limited policy development and dissemination.
Research undertaken by the PEM CRE focuses on:
- high volume conditions that are of daily importance including head injuries and cervical spine injuries.
- infrequent but life-threatening conditions in which optimum care is yet to be established (convulsive status epilepticus and severe asthma;
- defining the most suitable methodology for disseminating and implementing practice change in Australasian EDs.
PREDICT funders both past and present:
- National Health and Medical Research Council (NHMRC)
- Medical Research Futures Fund (MRFF)
- Health Research Council of New Zealand
- 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
- Ontario Neurotrauma Foundation
- Perpetual Trustees
- Perth Children's Foundation
- Practice Research and Education Trust Fund
- Princess Margaret Hospital Foundation
- Thrasher Foundation
- Townsville Hospital and Health Service
- University of Queensland
- Victor Smorgon Charitable Fund
- Victorian Neurotrauma Initiative
- Victorian Managed Insurance Authority
- WA Health Targeted Research Fund
Paediatric Research in Emergency Departments International Collaborative (PREDICT)
- Canberra Hospital (ACT)
- Children’s Hospital Westmead (NSW)
- Gold Coast University Hospital (QLD)
- John Hunter Hospital (NSW)
- Kidzfirst Hospital (NZ)
- Queensland Children’s Hospital (QLD)
- Monash Medical Centre (VIC)
- Perth Children's Hospital (WA)
- Royal Children’s Hospital (VIC)
- Starship Children's Hospital (NZ)
- Sunshine Hospital (VIC)
- Sydney Children’s Hospital (NSW)
- Townsville Hospital (QLD)
- Women’s and Children’s Hospital (SA)
- Advanced Paediatric Life Support
- Australasian College for Emergency Medicine
- Australian Clinical Trials Alliance
- Children's Health Care Australasia
- Don't Forget the Bubbles
- Emergency Care Institute
- Murdoch Children's Research Institute
- Neurosurgery, Austin Health|
- Emergency Medicine Foundation
- Pediatric Emergency Research Networks (PERN)
- Pediatric Emergency Research Canada (PERC)
- Pediatric Emergency Care Applied Research Network (PECARN)
- Paediatric Emergency Research United Kingdom & Ireland (PERUKI)
- Research in European Paediatric Emergency Medicine (REPEM)
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, (Melbourne Children's Campus research coordinator), 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 we 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. An 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, 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. 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 acute 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 acute severe behavioural disturbance. This body of work is funded by a MRFF Million Minds call (led by Prof Simon Craig and Prof Franz Babl).
- Study of Neck Injury Imaging in Children (SONIC): Improving the Diagnosis of Spinal Cord, Bone and Ligament Injuries: Many children sustain head and neck trauma during their lifetime. Significant neck injuries - to spinal cord, neck bones and connecting ligaments - can be identified by performing neck imaging with x-rays, or, if needed, computed tomography or magnetic resonance imaging. Yet, it is unclear when children should receive neck imaging in the emergency department (ED), especially in the context of increasing concerns about radiation-induced cancer in children and the discomfort and delays of immobilisation prior to imaging. This study aims to: (i) investigate the accuracy of existing CDRs to detect neck injuries in children (external validation) of adult focussed CDRs and the newly developed paediatric PECARN CDR and (ii) derive and validate a new CDR for neck imaging in children (the SONIC CDR). The study will be conducted at PREDICT sites in Australia and New Zealand. We will collaborate with the PECARN team led by Dr Julie Leonard from the Research Institute at Nationwide Children's Hospital, Ohio, USA, who is leading the validation of the PECARN neck injury rule in the USA. Funded by an MRFF grant (led by Dr Natalie Phillips and Prof Franz Babl).
- PRagMatic Pediatric Trial of Balanced versus NOrmaL Saline FlUid in Sepsis (PRoMPT-BOLUS): Sepsis is one of the most common causes of multiple organ dysfunction and death in children and is recognised as an urgent global public health problem. One of the key research questions is the optimal type of fluid to use in paediatric sepsis. We know that all crystalloid fluids help to reverse shock and children admitted with suspected sepsis routinely receive fluid resuscitation in the emergency department, on wards and in the intensive care unit.l Unfortunately, the most effective and safest crystalloid fluid to use for initial resuscitation of septic shock has not yet been established. PRoMPT BOLUS (PRagMatic Pediatric Trial of Balanced versus NOrmaL Saline FlUid in Sepsis) is a large pragmatic randomised trial comparing Normal Saline and Balanced Fluids e.g. Lactated Ringer's or PlasmaLyte in children with suspected sepsis. The trial is embedded within everyday clinical practice and provides a cost-efficient and generalisable method of informing best practice. This is an international study led by the PECARN network in the United States that also involves the Australian & New Zealand PREDICT network. The study has been endorsed by the Australian College of Emergency Medicine Clinical Trials Network (AC EMCTN0005) and the Australian and New Zealand Intensive Care Society Paediatric Study Group (PSG1920-02). Funded by an MRFF grant (led by A/Prof Elliot Long and Prof Franz Babl).
PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children: Children frequently present with head injuries to acute care settings. Led by PREDICT (Paediatric Research in Emergency Departments International Collaborative), a multidisciplinary working group has developed the first Australian and New Zealand guideline for mild to moderate head injuries in children. Addressing 33 key clinical questions, it contains 71 recommendations, and an imaging/observation algorithm. The Guideline provides evidence-based, locally applicable, practical clinical guidance for the care of children with mild to moderate head injuries presenting to acute care settings. The guideline was published in Emergency Medicine Australasia and is available at PREDICT.org.au.
Research Higher Degrees
A key objective of the PEM CRE is to build a sustainable research environment and consequently we are seeking candidates to undertake research higher degrees (PhD, MD/DMedSci and masters degrees) in multicentre acute care studies to develop research capacity in emergency medicine.
Potential projects are able to be undertaken in a range of research areas and locations. The details of candidature are open to discussion and some stipends will be awarded on a competitive basis.
To apply, or for further information, please contact:
Research Network Coordinator
Phone: +613 9936 6081