Emergency
Improving emergency care for children through research and national and international collaboration.
Children visit Emergency Departments for acute medical care on average once every year per child, for the duration of their childhood. This represents a large interaction with our health system.
Emergency Department presentations are often critical, with the risk of death or substantial disability if children are not appropriately managed. Providing evidence-based care for emergency management is therefore essential. Our research focuses on areas where there is a lack of evidence, incomplete translation of existing evidence to practice, and limited policy development and dissemination:
- high-volume conditions that are of daily importance, including head and cervical spine injuries and medical conditions like bronchiolitis
- infrequent but life-threatening conditions in which optimum care is yet to be established, such as convulsive status epilepticus and severe asthma
- defining the most suitable methodology for disseminating and implementing practice change in both tertiary and non-tertiary EDs in Australia and New Zealand
We conducted single-site 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 and is a paediatric tertiary referral and trauma centre. Most of our multicentre projects are conducted through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) emergency research network.
The research group is also part of Pediatric Emergency Research Networks (PERN), 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've 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. Visiting researchers or research fellows have come from many countries, such as Australia, 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) are available through the Clinical Epidemiology and Biostatistics Unit (CEBU), the Clinical Research Development Office (CRDO), and other departments of Murdoch Children's Research Institute and the University of Melbourne. Some participants have completed research higher degrees while enrolled at the University of Melbourne or their home universities.
The main pathways to research exposure on campus
Clinical appointment as a junior trainee at the Emergency Department (ED) of the Royal Children’s Hospital
In this scenario, the major experience is clinical and research is a small part of the training experience. The clinical work as a full-time trainee is reasonably intense and can be difficult to conduct meaningful research. Trainees are exposed to and encouraged to take part 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.
Research appointment at Murdoch Children's Research Institute
This requires an appointment for at least six months and a well-developed 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
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 three, two, and one-year full-time equivalent respectively (or double part-time). On average we have about five PhD/MD students in the department. For non-resident students, higher degrees in Australia can be expensive.
PREDICT Algorithm: Imaging & observation decision-making for children with head injuries
PREDICT incorporates the core imaging and observation guideline recommendations for use by clinicians assessing a child with head injury in an acute care setting. This video provides an introduction to the algorithm and how it can be used during clinician decision-making.
More information
- Paediatric Emergency Medicine Centre for Research Excellence (PEM CRE)
- Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Contact us
For further information, prospective overseas clinicians and researchers wanting to conduct research within our group please contact:
Marian Chandler
Administrative Assistant
Email:
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Group Leaders

Group Members








Our projects

PEAChY-M Study
This clinical drug trial aims to determine whether intramuscular (IM) olanzapine is more effective than IM droperidol for the management of acute severe behavioural disturbance (ASBD) in children and adolescents presenting to Emergency Departments (EDs).
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PEAChY-O Study
This clinical drug trial aims to determine whether oral olanzapine is more effective than oral diazepam for the management of acute severe behavioural disturbance (ASBD) in children and adolescents presenting to Emergency Departments (EDs).
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PRoMPT BOLUS Australia and New Zealand
PRoMPT BOLUS is a large clinical trial that will enroll over 8,000 children with sepsis across the United States, Canada, Australia, and New Zealand.
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SENTINEL Study: Sepsis Epidemiology in Australian and New Zealand Children
The SENTINEL Study aims to describe the epidemiology of hospitalised children treated for sepsis in Australia and New Zealand.
Read more...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. We conducted a Murdoch Children's Research Institute-funded double-blind, placebo-controlled randomised clinical trial to investigate whether ondansetron is better than a placebo in reducing the emesis rate in fentanyl and nitrous oxide sedations. The randomised controlled trial (RCT) has been published in the Annals of Emergency Medicine with other analyses pending (led by Dr Emmanuelle Fauteux-Lamarre, A/Professor Sandy Hopper, A/Professor Greta Palmer, Professor Andrew Davidson, Professor Franz Babl).
Cellulitis treatment at Home Or Inpatient in Children presenting to ED (CHOICE):
Many conditions could be treated at home with visiting nurses, rather than in hospital. As part of a PhD thesis (Dr Laila Ibrahim) and in collaboration with Hospital-In-The-Home (HITH) and the infectious diseases group at Royal Children's Hospital we investigated if children with cellulitis can be safely treated with intravenous antibiotics at home. The Royal Children’s Hospital Foundation funded the studies. Core papers were published in The Lancet Infectious Diseases and Pediatrics (cellulitis scoring system) (led by Dr Laila Ibrahim, A/Professor Penelope Bryant, Professor 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 (Dr Barry Scanlon) 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, Dr Laila Ibrahim, Associate Professor Penelope Bryant, Professor 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 identify predictors of delayed recovery. Protocol paper and initial results papers published in the Journal of Neurotrauma and Pediatrics (led by Professors Vicki Anderson, Gavin Davis and Franz Babl).
The Concussion Essentials study
One-third of children with concussion have post-concussive symptoms beyond 4 weeks after a head injury. We are conducting an RCT comparing whether an individualised approach to treatment (including education, physiotherapy, and psychology), improves outcomes and recovery time for young people following a concussion compared to usual care. This is a joint research project with neuropsychology, neurosurgery, sports medicine, and rehabilitation medicine and is funded by the Medical Research Future Fund (MRFF), led by Professors Vicki Anderson, Gavin Davis and Franz Babl.
Head Injury 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 Professors Jamie Hutchison, Vicki Anderson and 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 (CISG) we validated the SCAT3 and ChildSCAT 3 test (published in Pediatrics) and SCAT 5 and ChildSCAT5 test (published in the International Journal of Sports Medicine). We 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 (led by Professors Gavin Davis, Vicki Anderson and Franz Babl).
Procedural pain and distress
Children undergo many procedures that can cause pain and distress, yet we do not have a good way of measuring this. As part of a PhD thesis (Associate Professor Dianne Crellin), 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 Associate Professor Dianne Crellin and Professor 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, aimed to better define and identify brain attacks - acute neurological changes, including strokes. The group has published multiple papers in Stroke, Neurology, and Annals of Emergency Medicine (led by Associate Professor Mark Mackay and Professor 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 (A/Prof Elliot Long), we have investigated the use of echocardiography and ultrasound to determine fluid responsiveness in sepsis in children. The resulting papers have been published in Shock, Pediatric Critical Care Medicine and Emergency Medicine Australasia. In addition, we have initiated improvement processes in sepsis in the emergency department (led by Associate Professor Elliot Long and Professors Ed Oakley and Franz Babl).
Large multi-centre randomised controlled trials and observational studies
Australian Paediatric Head Injury Rules study (APHIRST)
The National Health and Medical Research Council (NHMRC) funded this 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 computed tomography (CT) scan. 20,000 children presenting to 10 PREDICT EDs with head injury were enrolled and >25 papers have been published including in The Lancet. In collaboration with investigators from Israel and Scandinavia, we have used 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 most head injured children are seen outside tertiary centres. In this study, funded by an NHMRC Centre of Research Excellence grant, we investigated management practice for head injuries at non-tertiary hospitals. Results of APHIRST and APHIRST-Gap, together with an ongoing systematic review of the literature, formed the basis for the planned bi-national head injury guideline under the aegis of PREDICT (led by Ms Catherine Wilson, Associate Professor Emma Tavender, and Professors Ed Oakley and 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 Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, and funded a funded by an NHMRC Centre of Research Excellence grant, a multidisciplinary working group developed the first Australian and New Zealand guidelines for mild-to-moderate head injuries in children. It contains 71 recommendations and an imaging/observation algorithm. The Guideline provides practical clinical guidance for the care of children with head injuries and was endorsed by key professional bodies.
Bronchiolitis Knowledge Translation study (BronchKT)
Based on a series of PREDICT studies and a detailed literature review PREDICT developed a bi-national guideline for bronchiolitis management endorsed by many relevant professional bodies. A key recommendation was to reduce interventions proven to be of no benefit. 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. Published in JAMA Pediatrics (led by Ms Libby Haskell, Dr Emma Tavender, Professors Stuart Dalziel, Ed Oakley and Franz Babl).
Convulsive Status Epilepticus Paediatric Trial (ConSEPT) and seizure studies
Ongoing seizures in children are difficult to treat. In a randomised clinical trial at ten PREDICT sites, we investigated the best drug to stop status epilepticus in children. The core paper of this Health Research Council New Zealand funded study was published in The Lancet. As part of a PhD thesis (A/Prof Jeremy Furyk) we also investigated research priorities and consent in seizures studies; another PhD (Ms Christina Pfeiffer) investigated problems of seizure management pre-hospital on ambulances. (led by Professors Stuart Dalziel, Ed Oakley and Franz Babl).
Bell’s Palsy in Children (BellPIC)
In contrast to adults, where steroids have been shown to improve outcomes 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 one month. The protocol paper has been published in BMC Pediatrics (led by Associate Professors Sandy Hopper and Ed Oakley, Dr John Cheek and Professor 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 collaboration with the University of Queensland and the PREDICT network, we have conducted a series of multicentre randomised controlled trials to clarify the role of high-flow nasal therapy. PARIS I on high flow in bronchiolitis has been published in the New England Journal of Medicine. PARIS II on high flow use in asthma and pneumonia has been completed (led by Associate Professor Donna Franklin, and Professors Andreas Schibler, Ed Oakley and Franz Babl).
Pediatric Emergency Research Networks (PERN) Bronchiolitis study
Bronchiolitis is the most frequent reason for admission in infants. In collaboration with 38 hospitals within the PERN network, we are investigating variability in bronchiolitis care across countries and determining 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 collaboration with more than 100 hospitals worldwide within the PERN network, we are investigating which children are at increased risk of severe outcomes (led by Dr Todd Florin, Professor Nate Kuppermann; local lead Professor 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 (Prof Simon Craig) and will probably 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 in mental health crisis. The MRFF funded Million Minds project is conducting projects to work out why this is happening and how we can improve care across the PREDICT network. As part of a PhD thesis (Dr Elyssia Bourke) it includes multicentre randomised medication trials for oral and intramuscular drugs for children with acute severe behavioural disturbance (led by Prof Simon Craig and Professor Franz Babl).
Study of Neck Injury Imaging in Children (SONIC)
It is unclear under what circumstances children should undergo neck imaging in the emergency department, especially with increasing concerns about radiation-induced cancer and the discomfort and delays of immobilisation prior to imaging. As part of a PhD (Dr Natalie Phillips), this multicentre PREDICT study aims to investigate the accuracy of clinical decision rules to detect neck injuries in children. This project is conducted in collaboration with Dr Julie Leonard from Nationwide Children's Hospital in the USA and funded by MRFF (led by Dr Natalie Phillips and Professor Franz Babl).
Predicting Infectious Complications in Children with Cancer (PICNICC)
Children with cancer often present with fever while their cell counts are low (neutropenia). While they are traditionally admitted to the 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 neutropenic febrile children and implement low-risk pathways for home care (funded by NHMRC and MRFF). Led by Associate Professor Gabrielle Haeusler, and Professor Franz Babl).
Australian Paediatric Acute Code Stroke (PACS) study
Each year, up to 600 Australian children suffer a stroke. Yet care for these children is often delayed and they don’t have access to treatments available in adults with stroke. Led by A/Prof Mark Mackay, in collaboration with the Stroke Foundation and funded by MRFF this project aims to improve the acute diagnosis of stroke in children and increase the number of children receiving emergency stroke treatment (led by Associate Professor Mark Mackay and Professor Franz Babl).
Funding
- National Health and Medical Research Council (NHMRC)
- Medical Research Futures Fund (MRFF)
- Health Research Council New Zealand
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, Dr Louise Crowe
- 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 Warwick Butt, 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: A/Prof G Haeusler, Prof K Thursky
National
- Paediatric Critical Care Research Group, University of Queensland: Dr D Franklin, Prof A Schibler
- Paediatric Research in Emergency Departments International Collaborative (PREDICT)
International
- Pediatric Emergency Research Networks (PERN)
- International Committee for the Advancement of Procedural Sedation
- 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
- 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
- Nationwide Children’s Hospital, USA: Dr Julie Leonard
- University of Cardiff, Wales: Dr L Cowley, Prof A Kemp
- St Justine Children's Hospital, Montreal, Canada: Dr E Trottier
- Hospital Nacional de Ninos, Costa Rica: Dr A Yock
- Ruth Rappaport Children's Hospital, Haifa, Israel: Prof Itay Shavit
Featured publications
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Bronchiolitis. Lancet. 2022 Jul 1:S0140-6736(22)01016-9. doi: 10.1016/S0140-6736(22)01016-9
Dalziel SR, Haskell L, O’Brien S, Borland M, Plint A, Babl FE, Oakley E. - Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr. 2021 Apr 12. doi: 10.1001/jamapediatrics.2021.0295. [Epub ahead of print]. PMID: 33843971. Haskell L, Tavender EJ, Wilson CL, O'Brien S, Babl FE, Borland ML, Cotterell E, Schembri R, Orsini F, Sheridan N, Johnson DW, Oakley E, Dalziel SR.
- An open-label, multicentre randomised controlled trial of levetiracetam versus phenytoin for convulsive status epilepticus in children: Convulsive Status Epilepticus Paediatric Trial (ConSEPT) - a PREDICT study. Lancet April 17, 2019 doi:10.1016/S0140-6736(19)30722-6. Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, Francis KL, Sharpe C, Harvey AS, Davidson A, Craig S, Phillips N, George S, Rao A, Cheng N, Zhang M, Kochar A, Brabyn C, Oakley E, Babl FE.
- Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial. Lancet Infect Dis. 2019 Mar 7. pii: S1473-3099(18)30729-1. doi: 10.1016/S1473-3099(18)30729-1. Ibrahim LF, Hopper SM, Orsini F, Daley AJ, *Babl FE, *Bryant PA. (*joint last author).
- High-Flow for Infants with Bronchiolitis: A Randomized Controlled Trial. A pediatric acute respiratory intervention study (PARIS) from PREDICT and PCCRG. N Engl J Med. 2018 Mar 22;378(12):1121-1131. doi: 10.1056/NEJMoa1714855. Franklin D, Babl FE, Schlapbach L, Oakley E, Craig S, Neutze J, Furyk J, Fraser JF, Jones M, Whitty JA, Dalziel S, Schibler A.
- Paediatric Research in Emergency Departments International Collaborative (PREDICT). Accuracy of PECARN, CATCH and CHALICE Head Injury Decision Rules in Children. A Prospective Cohort Study. The Lancet 2017 Jun 17;389(10087):2393-2402. Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR.