Emergency Research
Improving emergency care for children through research and national and international collaboration.
On average, children visit Emergency Departments (EDs) for acute medical care once a year, representing a large interaction with our health system.
Emergency Department presentations are often critical, with some children being at risk of death or substantial disability if not managed appropriately. Therefore, providing evidence-based care for emergency management is 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, such as:
- 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 conduct our research at the Emergency Department of The Royal Children's Hospital, which provides urgent medical care to children and adolescents up to 18 years of age. The department treats 90,000 children a year and is a paediatric tertiary referral. It is also the designated paediatric trauma centre for Victoria.
While we also conduct some single centre studies, most of our projects are multicentre and conducted through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network of Australia and New Zealand.
The research group is also part of the international Paediatric Emergency Research Networks (PERN), which combines the efforts of research networks on several continents to investigate global acute care questions.
Research is often conducted across all three Melbourne Children’s Campus partners, The Royal Children’s Hospital, Murdoch Children’s Research Institute (MCRI) and the University of Melbourne Departments of Paediatrics and Critical Care.
Join our research efforts
Research fellows and visiting international researchers can conduct research with the Emergency Research group, either as trainee clinicians or at consultant level in paediatrics, emergency, paediatric emergency medicine or nursing. Researchers can also complete projects alongside their clinical training, work at the emergency department of The Royal Children’s Hospital or spend time on campus specifically to conduct emergency-related research projects.
Visiting researchers or research fellows have come from many centres across Australia and the world, such as New Zealand, Canada, the United Kingdom, Ireland, Thailand, Switzerland, the United States, Costa Rica, Germany, Indonesia and Singapore.
While often based on campus, research can also be conducted with the clinician researcher based at their home institutions, with affiliations with one of the campus partners (MCRI or the University of Melbourne).
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.
Melbourne Children’s Campus research pathways
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 smaller part of the training experience. Clinical work as a full time trainee is reasonably intense, and it can be difficult to conduct meaningful research.
Trainees are 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 can come self-funded (or funded by their home institution) or they can apply for a paid hospital appointment via the ED 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). On average we have about five PhD/MD students in the department at any one time. For non-resident students, higher degrees in Australia can be costly.
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 clinicians and researchers wanting to conduct research within our group, please contact:
Marian Chandler
Administrative Assistant
Email:
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Group Leaders
Team Leaders
Group Members
Our projects
Biomarkers in Sepsis (BASIS)
Biomarker discovery, verification, and validation for early sepsis diagnosis and risk stratification in children.
Read more...Paediatric Adaptive Sepsis Platform Trial (PASSPORT)
This study evaluates multiple treatments for sepsis under a single platform using adaptive methods. This means that treatments can be adjusted over time based on the data collected and ensures all study participants receive the best and most evidence-based care.
Read more...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).
Read more...PEAChY-O Study
This study is complete.
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).
Read more...PRoMPT BOLUS Australia and New Zealand
PRoMPT BOLUS is a large clinical trial that will enrol over 8,000 children with sepsis across the United States, Canada, Australia, and New Zealand.
Read more...SENTINEL International: Sepsis Epidemiology in Paediatric Acute Care International Study
This international observational study will provide a landscape analysis of paediatric sepsis across countries with access to different healthcare resources.
Read more...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...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 Dr Laila Ibrahim's PhD thesis, and in collaboration with Hospital-In-The-Home (HITH) and the Infectious Diseases Unit at The 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 led by Dr Laila Ibrahim, Associate Professor Penelope Bryant and Professor Franz Babl. Core papers were published in The Lancet Infectious Diseases and Pediatrics (USA).
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 Dr Barry Scanlon's PhD thesis, and in collaboration with HITH and the Infectious Diseases Unit at The Royal Children's Hospital, we are conducting a series of studies to determine which children with UTI are at increased risk of adverse outcomes. This project is led by Dr Laila Ibrahim, Associate Professor Penelope Bryant and 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. Multiple papers have so far explored epidemiological risk factors in concussion, the role of blood biomarkers and sophisticated neuroimaging, how to best assess concussion symptoms and long term trajectories of concussion. This study is 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 four weeks after a head injury. We are conducting a single centre randomised controlled trial (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). It is led by Professors Vicki Anderson, Gavin Davis 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 USA) and SCAT 5 and ChildSCAT5 test (published in the International Journal of Sports Medicine). We have also collaborated on a systematic review on concussion in children, which was published in the British Journal of Sports Medicine as part of the Berlin evidence reviews. More recently, we collaborated on a summary of paediatric relevant recommendations from the Amsterdam evidence reviews and consensus works of the Concussion in Sports Group published in Pediatrics (USA). The SCAT study is 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 Associate Professor Dianne Crellin's PhD thesis, we are investigating how to better measure procedural pain and distress in pre-verbal and early verbal children. This work is led by Associate Professor Dianne Crellin and Professor Franz Babl, and has led to publications in Pain and the Journal of Pain.
Brain attacks and stroke
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. The group has published multiple papers in Stroke, Neurology, and Annals of Emergency Medicine. This project is 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 Associate Professor Elliot Long’s PhD thesis, 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 (USA) and Emergency Medicine Australasia. In addition, we have initiated improvement processes in sepsis in the emergency department. This research is led by Associate Professor Elliot Long and Professors Ed Oakley and Franz Babl.
Large multi-centre randomised controlled trials and observational studies
PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children
Children frequently present with head injuries to acute care settings. This project is led by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, and is funded by an NHMRC Centre of Research Excellence grant. The project’s 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.
PREDICT Algorithm: Imaging & observation decision-making for children with head injuries
PREDICT incorporates the core imaging and observation guideline recommendations for clinicians assessing a child with a 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.
Bronchiolitis Knowledge Translation study and Sustainability Studies
Based on a series of PREDICT studies and a detailed literature review, PREDICT developed a bi-national guideline for bronchiolitis management. The guideline is endorsed by many relevant professional bodies. A key recommendation was to reduce interventions proven to be of no benefit in bronchiolitis, such as use of bronchodilators, steroids, antibiotics and X-rays. 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. This study is led by Ms Libby Haskell, Dr Emma Tavender and Professors Stuart Dalziel, Ed Oakley and Franz Babl. It is published in JAMA Pediatrics (USA).
As part of Ms Tory Ramsden's PhD, we are now conducting a follow up study to assess how to sustain changes in care at intervention and control sites. This is led by Associate Professor Emma Tavender and Professor Franz Babl.
High-Flow studies – Paediatric Acute Respiratory Intervention Study (PARIS I, II and III)
The role of nasal cannula high-flow therapy in children with respiratory failure is evolving. In collaboration with the University of Queensland, the Wesley Research Institute 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 published in JAMA. Further projects are ongoing. These studies are funded by the National Health and Medical Research Council (NHMRC) and led by Associate Professor Donna Franklin, and Professors Andreas Schibler, Ed Oakley and Franz Babl.
Paediatric 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. PERN is led by Dr Todd Florin and Professor Nate Kuppermann, with Professor Franz Babl as the local lead.
Asthma outcomes study
It is currently 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 Professor Simon Craig’s PhD thesis and will clarify key parameters for future interventional studies. It is led by Professors Simon Craig and Franz Babl.
Million Minds
There has been an alarming increase in the number of children and adolescents presenting to emergency departments in mental health crises. The MRFF-funded Million Minds project is conducting studies to work out why this is happening and how we can improve care across the PREDICT network. As part of Dr Elyssia Bourke’s PhD thesis, the study includes multicentre randomised medication trials for oral and intramuscular drugs for children with acute severe behavioural disturbance. Million Minds is led by Professors Simon Craig and 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 Dr Natalie Phillips’ PhD project, 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, USA. It is funded by the Medical Research Future Fund (MRFF) and 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 white 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, the Peter MacCallum Cancer Centre and 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. PICNICC is funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC). It is 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. In collaboration with the Stroke Foundation, this project aims to improve the acute diagnosis of stroke in children and increase the number of children receiving emergency stroke treatment. The PACS study is funded by the Medical Research Future Fund (MRFF) and led by Associate Professor Mark Mackay and Professor Franz Babl.
Past projects
Australian Paediatric Head Injury Rules Study (APHIRST)
The National Health and Medical Research Council (NHMRC) funded the APHIRST study which 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. The study involved 20,000 children who presented to 10 PREDICT EDs with head injury and has produced more than 25 publications. In collaboration with investigators from Israel and Scandinavia, we have used the dataset to assess the accuracy of overseas head injury management guidelines. APHIRST is led by Professors Franz Babl and Ed Oakley and Dr John Cheek.
APHIRST-Gap Study
APHIRST focused on children with head injuries who were seen at hospitals with paediatric emergency departments. Yet most children with head injuries 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 bi-national head injury guideline under the aegis of PREDICT. APHIRST-Gap is led by Ms Catherine Wilson, Associate Professor Emma Tavender and Professors 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 10 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 Associate Professor Jeremy Furyk’s PhD thesis, we also investigated research priorities and consent in seizures studies. Additionally, Ms Christina Pfeiffer’s PhD investigated problems of seizure management pre-hospital on ambulances. These studies are 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 conducted 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. This study is published in Neurology and led by Associate Professor Sandy Hopper, Dr John Cheek and Professors Franz Babl and Ed Oakley.
Funding
- National Health and Medical Research Council (NHMRC)
- Medical Research Futures Fund (MRFF)
- Health Research Council of New Zealand
Additional funding
- The Royal Children's Hospital Foundation
- Murdoch Children's Research Institute
- A+ Trust Research Grant
- Auckland Medical Research Foundation
- Perpetual Philanthropic Services
- Emergency Medicine Foundation
- Victorian Managed Insurance Authority
- Foundation for Children
- Stroke Foundation
- Collier Charitable Fund
- Victorian Neurotrauma Initiative
- Angior Foundation
- Shepherd Foundation
Collaborations
Campus
- Neuropsychology: Professor Vicki Anderson, Dr Louise Crowe
- Neurology: Associate Professor Mark Mackay
- General Medicine/Hospital in the Home: Dr Laila Ibrahim, Dr Sarah McNab, Associate Professor Penelope Bryant
- Intensive Care: Professor Warwick Butt, Dr Ben Gelbart
- Anaesthesia/Pain Service: Professor Andrew Davidson, Dr Stefano Sabato, Associate Professor Greta Palmer
- Health Economics Group, Centre for Health Policy, University of Melbourne: Associate Professor Kim Dalziel
- Community Health Services Research: Professor Harriet Hiscock, Dr Anthea Rhodes
State
- Neurosurgery, Austin Hospital: Professor G Davis
- Florey Institute & National Stroke Institute: Professor L Churilov
- Emergency Department, Monash University: Professor S Craig, Dr A West
- Infectious Diseases, Victorian Comprehensive Cancer Centre: Associate Professor G Haeusler, Professor K Thursky
National
- Paediatric Critical Care Research Group, Wesley Research Institute: Dr D Franklin, Professor 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: Professor S Dalziel
- Royal Bristol Hospital for Children, United Kingdom: Dr M Lyttle
- Hospital for Sick Children, Canada; Dr S Schuh
- Alberta Health Services, Canada: Dr S Freedman
- St Justine Children's Hospital, Montreal, Canada: Dr E Trottier
- Izaak Walton Killam Health Centre, Halifax, Canada
- University of Padua, Italy: Associate Professor S Bressan
- University of California Davis, USA: Prof Nate Kupperman, Professor J Holmes, Professor J Hoch, Dr S Singh
- Nationwide Children’s Hospital, USA: Dr Julie Leonard
- Children’s Hospital of Philadelphia, USA: Dr Fran Balamuth
- Nemours Children’s Hospital, USA: Dr Scott Weiss
- University of Cardiff, Wales: Dr L Cowley, Professor A Kemp
- Cork University Hospital, Ireland: Dr E Fauteux-Lamarre
- Hospital Nacional de Ninos, Costa Rica: Dr A Yock
- Hadassah Hebrew University Medical Center Professor 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.