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, which includes researchers from 14 hospital emergency departments.
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 injury identification, imaging and management of post-concussion syndrome;
- infrequent but life-threatening conditions in which optimum care is yet to be established (convulsive status epilepticus (CSE), sepsis management, stroke recognition and diagnosis);
- defining the most suitable methodology for disseminating and implementing practice change in Australasian EDs.
Current Project specific funding bodies include:
- National Health and Medical Research Council
- The Health Research Council in New Zealand
- A+ Trust, Auckland District Health Board, Auckland, New Zealand
- Queensland Emergency Medicine Research Fund (QEMRF)
- Princess Margaret Hospital Foundation
- Eric Ormond Baker Charitable Fund
- Townsville Hospital and Health Service Private Practice Research and Education Trust fund
- Perpetual Trustees
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)
- Lady Cilento Children’s Hospital (QLD)
- Monash Medical Centre (VIC)
- Princess Margaret 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
- Childrens Health Care Australasia
- National Trauma Research Institute
- Queensland Emergency Medicine Research Foundation
- Paediatric Emergency Medicine Society
- Pediatric Emergency Research Networks
- Royal Australasian College of Physicians
- Australian College for Emergency Medicine
- Australian Research Alliance for Children and Youth
- Neurosurgery, Austin Health
- Pediatric Emergency Research Canada
- Pediatric Emergency Care Applied Research Network
- Paediatric Emergency Research United Kingdom & Ireland
- Research in European Paediatric Emergency Medicine
APHIRST – Australian Paediatric Head Injury Rules Study
This study aims to determine which of three existing clinical decision rules for the management of paediatric head injuries (CATCH, CHALICE & PECARN), can best be applied to the Australasian population. It aims to improve current emergency department patient care through more accurately identifying those children who have clinically significant intracranial injuries and reducing the number of unnecessary brain CT scans.
BELLS PALSY – Retrospective
The Bells Palsy Retrospective study aims to determine the rate of steroid use and the steroid regimen used in children less than 18 years of age presenting to Emergency Departments (ED) with Bell’s palsy within the PREDICT network. This data will inform the future design and conduct of a randomised controlled trial (RCT) of steroid use in children with Bell’s palsy. In addition, the data will provide a baseline for a subsequent knowledge translation study once RCT data are available.
BELLS PALSY – Multicentre Randomised Controlled Trial
It is unclear if children with Bell’s palsy should be treated with corticosteroids or not and consequently guidelines are vague and practice is variable regarding steroid use. The Bells Palsy Randomised Controlled Trial aims to determine the efficacy of prednisolone as a treatment for Bell’s palsy in children less than 18 years of age, presenting to Emergency Departments within the PREDICT network. The multicentre randomised and placebo controlled trial will be conducted over a four year period. As the first appropriately powered trial of steroid use in children with Bell’s palsy the study will likely have a worldwide impact on the management of this important yet treatable condition in this vulnerable population.
Bronchiolitis Management Knowledge Translation Study
Prior research conducted by the PREDICT network has identified that there is substantial variation in practice patterns in Australasia in relation to the management of bronchiolitis, despite treatment being well defined. In order to improve emergency department practice, the PREDICT network wish to develop Australasian wide guidelines for the management of bronchiolitis and test how this is translated into practice. Once the guideline is developed a cluster randomised controlled trial of three knowledge translation (KT) implementation strategies for the bronchiolitis guideline will be undertaken. There are a number of ongoing trials assessing the effectiveness of various strategies for KT in emergency medicine and Paediatric Emergency Medicine, however, different environments and countries have unique structure and inherent barriers to implementing practice change. Thus KT strategies used in one country should be reassessed before implementation in another to ensure optimal KT practices are found for the local environment.
CONSEPT – Convulsive Status Epilepticus Paediatric Trial
This study aims to determine whether intravenous (IV) levetiracetam or IV phenytoin is the better second line treatment for the emergency management of convulsive status epilepticus (CSE) in children. We hypothesise that children treated with IV levetiracetam for CSE will do better than children treated with IV phenytoin in terms of time to clinical cessation of seizure activity, need for intubation for ongoing seizure management, need for intensive care unit (ICU) admission, serious adverse events, length of hospital stay, health care costs, and long term outcome.
Changing incidence of CT for head injury
This research pools data from the past 10 years from Emergency Department (ED) and Medical Imaging databases at PREDICT sites and a number of other mixed EDs. It will determine the changing incidence of presentation with head injury to EDs and the changing rate of use of CT for head injury across Australasia. This study will allow accurate long-term follow up of change implemented following the Australian Paediatric Head Injury Rules Study (APHIRST) outcomes.
PARIS High Flow Study
Bronchiolitis, a viral lung disease in infants, is the most common reason worldwide for infants <1 year of age to be admitted into hospital, with approximately 9000 admissions occurring annually in Australia alone. Over the last decade a new method to provide respiratory support to infants <1 year of age with bronchiolitis has emerged, high flow nasal cannula (HFNC). Non-experimental evidence, from our group, has shown that HFNC in bronchiolitis can be applied very early in the disease process, can be provided on paediatric wards (both regional and tertiary centres), reduces the need for PICU admission, and reduces the need for non-invasive and invasive ventilation once in PICU. However, the majority of this evidence has focused on critically ill infants with bronchiolitis, the role of HFNC in moderately unwell hospitalised infants with bronchiolitis, the majority of infants hospitalised with bronchiolitis, has yet to be defined. We will perform a large multi-centre randomised trial comparing respiratory support and oxygen delivery via HFNC with respiratory support and oxygen delivery via standard nasal cannula in infants admitted to hospitals with bronchiolitis, in Australia and New Zealand, to determine which treatment strategy results in less clinical deterioration. In addition, we will assess the health care cost of the two treatment strategies.
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.
If you are a health professional interested in emergency research and undertaking a higher degree, please review the Students area of the website. Potential projects are able to be undertaken in a range of research areas and locations. The details of candidature are open to discussion and stipends will be awarded on a competitive basis.
To apply, or for further information, please contact:
Research Network Coordinator
Phone: +613 9936 6081