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Velasco R, Alonso-Cadenas JA, de la Torre M, Martínez-Mejias A, Mintegi S, Yañez S, Gomez B. Setting priorities for an agenda within the Spanish pediatric emergency medicine research network. Eur J Pediatr 2023; 182:3549-3558. [PMID: 37211549 DOI: 10.1007/s00431-023-04957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Abstract
The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4). Conclusion: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain. What is Known: • Some pediatric emergency medicine networks have established their priorities for research. What is New: • After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network.
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Affiliation(s)
- Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
- , Valladolid, Spain.
| | | | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | | | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Sandra Yañez
- Pediatric Emergency Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
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Oruganti S, Evans J, Cromarty T, Javaid A, Roland D. Identification of sepsis in paediatric emergency departments: A scoping review. Acta Paediatr 2022; 111:2262-2277. [PMID: 36053116 PMCID: PMC9826118 DOI: 10.1111/apa.16536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
AIM Sepsis is an acute illness associated with significant morbidity and mortality. Early detection and time-sensitive management of sepsis has been shown to improve outcomes. We report the results of a scoping review to explore methods evaluated for the identification of sepsis in children presenting to emergency departments. METHODS A systematic literature search was carried out on two databases, Medline and Web of Science, to identify relevant studies published from 1990 to 2022. Data were extracted for age groups including study design, reference standard used for comparison, sepsis identification method evaluated and study quality. RESULTS A total of 89 studies were identified from the literature search. There was significant heterogeneity in the age groups including study design and reference standards used for evaluating the performance of the sepsis identification methods. There has been a substantial increase in the number of published studies in the last 2 years. CONCLUSION Our scoping review identifies marked heterogeneity in approaches to identifying sepsis but demonstrates a recent focus of research on patient outcomes. Using appropriate core outcome sets, developing reference standards, monitoring sepsis prevalence via registries and continuously monitoring process measures will provide robust evidence to identify the best performing identification tools and the impact they have on patient-orientated outcomes.
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Affiliation(s)
- Sivakumar Oruganti
- Noah's Ark Children's Hospital for WalesCardiffUK,Cardiff UniversityCardiffUK
| | - Jordan Evans
- Paediatric Emergency DepartmentUniversity Hospital of WalesCardiffUK
| | - Thomas Cromarty
- Paediatric Emergency DepartmentUniversity Hospital of WalesCardiffUK
| | - Assim Javaid
- Cardiff UniversityCardiffUK,Paediatric Emergency DepartmentUniversity Hospital of WalesCardiffUK
| | - Damian Roland
- Leicester Academic (PEMLA) groupLeicester Royal InfirmaryLeicesterUK,SAPPHIRE group Health SciencesLeicester UniversityLeicesterUK
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3
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Snelling PJ, Shefrin AE, Moake MM, Bergmann KR, Constantine E, Deanehan JK, Dessie AS, Elkhunovich MA, Gold DL, Kornblith AE, Lin‐Martore M, Nti B, Pade KH, Parri N, Sivitz A, Lam SHF. Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study. Acad Emerg Med 2022; 29:1338-1346. [PMID: 36043227 PMCID: PMC9826219 DOI: 10.1111/acem.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Pediatric Emergency Medicine (PEM) Point-of-care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research. METHODS Online surveys were administered in a two-stage, modified Delphi study. A steering committee of 16 PEM POCUS experts was identified within the P2Network, with representation from the United States, Canada, Italy, and Australia. We solicited the participation of international PEM POCUS experts through professional society mailing lists, research networks, social media, and "word of mouth." After each round, responses were refined by the steering committee before being reissued to participants to determine the ranking of all the research questions based on means and to identify the high-level consensus topics. The final stage was a modified Hanlon process of prioritization round (HPP), which emphasized relevance, impact, and feasibility. RESULTS Fifty-four eligible participants (16.6%) provided 191 items to Survey 1 (Round 1). These were refined and consolidated into 52 research questions by the steering committee. These were issued for rating in Survey 2 (Round 2), which had 45 participants. At the completion of Round 2, all questions were ranked with six research questions reaching high-level consensus. Thirty-one research questions with mean ratings above neutral were selected for the HPP round. Highly ranked topics included clinical applications of POCUS to evaluate and manage children with shock, cardiac arrest, thoracoabdominal trauma, suspected cardiac failure, atraumatic limp, and intussusception. CONCLUSIONS This consensus study has established a research agenda to inform future international multicenter PEM POCUS trials. This study has highlighted the ongoing need for high-quality evidence for PEM POCUS applications to guide clinical practice.
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Affiliation(s)
- Peter J. Snelling
- Department of Emergency MedicineGold Coast University Hospital and Griffith UniversitySouthportQueenslandAustralia
| | - Allan E. Shefrin
- Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Matthew M. Moake
- Department of Pediatric Emergency MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Kelly R. Bergmann
- Department of Pediatric Emergency MedicineChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Erika Constantine
- Division of Pediatric Emergency MedicineHasbro Children's Hospital/Rhode Island Hospital and Brown UniversityProvidenceRhode IslandUSA
| | - J. Kate Deanehan
- Division of Pediatric Emergency MedicineJohns Hopkins Children's Center BaltimoreBaltimoreMarylandUSA
| | - Almaz S. Dessie
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Marsha A. Elkhunovich
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Delia L. Gold
- Division of Emergency MedicineNationwide Children's Hospital and Ohio State UniversityColumbusOhioUSA
| | - Aaron E. Kornblith
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Margaret Lin‐Martore
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Benjamin Nti
- Riley Hospital for Children at Indiana University HealthIndianapolisIndianaUSA
| | - Kathryn H. Pade
- Division of Pediatric Emergency MedicineRady Children's Hospital San Diego and University of California at San DiegoSan DiegoCaliforniaUSA
| | - Niccolò Parri
- Department of Emergency MedicineMeyer University Children's HospitalFlorenceItaly
| | - Adam Sivitz
- Children's Hospital of New JerseyNewark Beth Israel Medical CenterNewarkNew JerseyUSA
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4
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Wismer AC, Rakic M, Kuehni CE, Jaboyedoff M, Romano F, Kopp MV, Brandenberger J, Staubli G, Keitel K. Consensus Minimal Dataset for Pediatric Emergency Medicine in Switzerland. Pediatr Emerg Care 2022; 38:511-516. [PMID: 36099537 PMCID: PMC9555753 DOI: 10.1097/pec.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Standardized, harmonized data sets generated through routine clinical and administrative documentation can greatly accelerate the generation of evidence to improve patient care. The objective of this study was to define a pediatric emergency medicine (PEM) minimal dataset for Switzerland (Swiss PEM minimal dataset) and to contribute a subspecialty module to a national pediatric data harmonization process (SwissPedData). METHODS We completed a modified Delphi survey, inviting experts from all major Swiss pediatric emergency departments (PEDs). RESULTS Twelve experts from 10 Swiss PEDs, through 3 Delphi survey rounds and a moderated e-mail discussion, suggested a subspecialty module for PEM to complement the newly developed SwissPedData main common data model (CDM). The PEM subspecialty CDM contains 28 common data elements (CDEs) specific to PEM. Additional CDEs cover PEM-specific admission processes (type of arrival), timestamps (time of death), greater details on investigations and treatments received at the PED, and PEM procedures (eg, procedural sedation). In addition to the 28 CDEs specific to PEM, 43 items from the SwissPedData main CDM were selected to create a Swiss PEM minimal dataset. The final Swiss PEM minimal dataset was similar in scope and content to the registry of the Pediatric Emergency Care Applied Research Network. CONCLUSIONS A practical minimal dataset for PEM in Switzerland was developed through recognized consensus methodology. The Swiss PEM minimal dataset developed by Swiss PEM experts will facilitate international data sharing for PEM research and quality improvement projects.
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Affiliation(s)
- Alice C. Wismer
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Manon Jaboyedoff
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabrizio Romano
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias V. Kopp
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Julia Brandenberger
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Georg Staubli
- Department of Pediatric Emergency Medicine, Childrens' University Hospital Zurich, Zurich, Switzerland
| | - Kristina Keitel
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
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5
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Diskin C, Malik K, Gill PJ, Rashid N, Chan CY, Nelson KE, Thomson J, Berry J, Agrawal R, Orkin J, Cohen E. Research priorities for children with neurological impairment and medical complexity in high-income countries. Dev Med Child Neurol 2022; 64:200-208. [PMID: 34462917 PMCID: PMC9291325 DOI: 10.1111/dmcn.15037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/16/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023]
Abstract
AIM To identify the highest-priority clinical research areas related to children with neurological impairment and medical complexity among clinicians and caregivers. METHOD A modified, three-stage Delphi study using online surveys and guided by a steering committee was completed. In round 1, clinicians and family caregivers suggested clinical topics and related questions that require research to support this subgroup of children. After refinement of the suggestions by the steering committee, participants contributed to 1 (family caregivers) or 2 (clinicians) subsequent rounds to develop a prioritized list. RESULTS A diverse international expert panel consisting of 49 clinicians and 12 family caregivers provided 601 responses. Responses were distilled into 26 clinical topics comprising 126 related questions. The top clinical topics prioritized for research were irritability and pain, child mental health, disorders of tone, polypharmacy, sleep, aspiration, behavior, dysautonomia, and feeding intolerance. The clinician expert panel also prioritized 10 specific research questions. INTERPRETATION Study findings support a research agenda for children with neurological impairment and medical complexity focused on addressing clinical questions, prioritized by an international group of clinicians and caregivers.
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Affiliation(s)
- Catherine Diskin
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Kristina Malik
- Department of PediatricsUniversity of Colorado School of MedicineAuroraCOUSA,Special Care ClinicChildren’s Hospital ColoradoAuroraCOUSA
| | - Peter J Gill
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada,Centre for Evidence‐Based MedicineUniversity of OxfordOxfordUK
| | - Nada Rashid
- The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Carol Y Chan
- Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada
| | - Katherine E Nelson
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Joanna Thomson
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Division of Hospital MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Jay Berry
- Division of General PediatricsChildren’s Hospital BostonBostonMAUSA,Department of PediatricsHarvard Medical SchoolBostonMAUSA
| | - Rishi Agrawal
- Department of PediatricsHarvard Medical SchoolBostonMAUSA,Division of Hospital‐Based MedicineDepartment of PediatricsAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoILUSA,Section of Chronic DiseaseLa Rabida Children’s HospitalChicagoILUSA
| | - Julia Orkin
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada
| | - Eyal Cohen
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada,Edwin S.H. Leong Centre for Healthy ChildrenUniversity of TorontoTorontoOntarioCanada,CanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanada
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6
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Zanetto L, van de Maat J, Nieboer D, Moll H, Gervaix A, Da Dalt L, Mintegi S, Bressan S, Oostenbrink R. Diagnostic variation for febrile children in European emergency departments. Eur J Pediatr 2022; 181:2481-2490. [PMID: 35314869 PMCID: PMC9110537 DOI: 10.1007/s00431-022-04417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23-14.53), 19.46 (3.66-103.60), 3.13 (2.29-4.26), 10.84 (6.35-18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98-3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00-20.61). CONCLUSION the use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation. WHAT IS KNOWN • Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs. • A deeper knowledge of variability and its determinants can steer optimization of care. WHAT IS NEW • The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. • Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.
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Affiliation(s)
- Lorenzo Zanetto
- Department of Women’s and Children’s Health, University of Padova, Padua, 35128 Italy
| | - Josephine van de Maat
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Daan Nieboer
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Henriette Moll
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
| | - Alain Gervaix
- Department of Pediatrics, Gynaecology and Obstetrics, University Hospital of Geneva, Geneva, 1205 Switzerland
| | - Liviana Da Dalt
- Department of Women’s and Children’s Health, University of Padova, Padua, 35128 Italy
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padua, 35128, Italy.
| | - Rianne Oostenbrink
- Department of General Pediatrics, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, 3015 CN Netherlands
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7
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Rose K, Bressan S, Honeyford K, Bognar Z, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie I, Moll HA, Roland D, Titomanlio L, Nijman R. Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study. BMJ Paediatr Open 2021; 5:10.1136/bmjpo-2021-001269. [PMID: 35413003 PMCID: PMC8688729 DOI: 10.1136/bmjpo-2021-001269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/14/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Understanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave. DESIGN This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January-May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres. RESULTS Overall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086). CONCLUSION Overall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.
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Affiliation(s)
- Katy Rose
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK .,Division of Emergency Medicine - Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Kate Honeyford
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Danilo Buonsenso
- Department of Pediatrics, Catholic University of Rome, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Hopital Universitaire Robert-Debre Pole de biologie recherche et produits de sante, Paris, Île-de-France, France.,FHU I2-D2 - INSERM U1141, University of Paris, Paris, France
| | - Ruud Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK.,Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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8
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Klassen TP, Dalziel SR, Babl FE, Benito J, Bressan S, Chamberlain J, Chang TP, Freedman SB, Kohn Loncarica G, Lyttle MD, Mintegi S, Mistry RD, Nigrovic LE, Oostenbrink R, Plint AC, Rino P, Roland D, Van de Mosselaer G, Kuppermann N. The Pediatric Emergency Research Network (PERN): A decade of global research cooperation in paediatric emergency care. Emerg Med Australas 2021; 33:900-910. [PMID: 34218513 DOI: 10.1111/1742-6723.13801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in paediatric emergency care to organise globally for the conduct of collaborative research across networks. METHODS PERN has grown from five to eight member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS Beginning as a pandemic response studying H1N1 influenza risk factors in children, PERN research has progressed to multiple observational studies and ongoing global randomised controlled trials (RCTs). As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current COVID-19 pandemic. CONCLUSIONS Following its success with developing global research, the PERN goal now is to promote the implementation of scientific advances into everyday clinical practice by: (i) expanding the capacity for global RCTs; (ii) deepening the focus on implementation science; (iii) increasing attention to healthcare disparities; and (iv) expanding PERN's reach into resource-restricted regions. Through these actions, PERN aims to meet the needs of acutely ill and injured children throughout the world.
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Affiliation(s)
- Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Pediatric Emergency Research Canada (PERC)
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Children's Emergency Department, Starship Children's Health, Auckland, New Zealand.,Paediatric Research in Emergency Departments International Collaborative (PREDICT)
| | - Franz E Babl
- Departments of Paediatrics and Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Javier Benito
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain.,Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG)
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy.,Research in European Pediatric Emergency Medicine (REPEM)
| | - James Chamberlain
- Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Pediatric Emergency Care Applied Research Network (PECARN)
| | - Todd P Chang
- Pediatric Emergency Care Applied Research Network (PECARN).,Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California, USA.,Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC)
| | - Stephen B Freedman
- Pediatric Emergency Research Canada (PERC).,Departments of Pediatrics and Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Guillermo Kohn Loncarica
- Latin American Pediatric Emergency Medicine Society, University of Buenos Aires, Buenos Aires, Argentina.,Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI)
| | - Santiago Mintegi
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG).,Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC).,Department of Paediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Lise E Nigrovic
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEM CRC).,Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rianne Oostenbrink
- Research in European Pediatric Emergency Medicine (REPEM).,General Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amy C Plint
- Pediatric Emergency Research Canada (PERC).,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro Rino
- Latin American Pediatric Emergency Medicine Society, University of Buenos Aires, Buenos Aires, Argentina.,Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA)
| | - Damian Roland
- Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI).,Children's Emergency Department, University of Leicester, Leicestershire, UK
| | - Greg Van de Mosselaer
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Translating Emergency Knowledge for Kids, Winnipeg, Manitoba, Canada
| | - Nathan Kuppermann
- Pediatric Emergency Care Applied Research Network (PECARN).,Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
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9
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Klassen T, Dalziel SR, Babl FE, Benito J, Bressan S, Chamberlain J, Chang TP, Freedman SB, Kohn-Loncarica G, Lyttle MD, Mintegi S, Mistry RD, Nigrovic LE, Oostenbrink R, Plint AC, Rino P, Roland D, Van De Mosselaer G, Kuppermann N. The Pediatric Emergency Research Network: A Decade of Global Research Cooperation in Pediatric Emergency Care. Pediatr Emerg Care 2021; 37:389-396. [PMID: 34091572 PMCID: PMC8244934 DOI: 10.1097/pec.0000000000002466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in pediatric emergency care to organize globally for the conduct of collaborative research across networks. METHODS The Pediatric Emergency Research Network has grown from 5- to 8-member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed, and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS Beginning as a pandemic response with a high-quality retrospective case-controlled study of H1N1 influenza risk factors, PERN research has progressed to multiple observational studies and ongoing global randomized controlled trials. As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current coronavirus disease 2019 pandemic. In light of the ongoing need for translation of research knowledge into equitable clinical practice and to promote health equity, PERN is committed to a coordinated international effort to increase the uptake of evidence-based management of common and treatable acute conditions in all emergency department settings. CONCLUSIONS The Pediatric Emergency Research Network's successes with global research, measured by prospective observational and interventional studies, mean that the network can now move to improve its ability to promote the implementation of scientific advances into everyday clinical practice. Achieving this goal will involve focus in 4 areas: (1) expanding the capacity for global randomized controlled trials; (2) deepening the focus on implementation science; (3) increasing attention to healthcare disparities and their origins, with growing momentum toward equity; and (4) expanding PERN's global reach through addition of sites and networks from resource-restricted regions. Through these actions, PERN will be able to build on successes to face the challenges ahead and meet the needs of acutely ill and injured children throughout the world.
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Affiliation(s)
- Terry Klassen
- From the Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Pediatric Emergency Research Canada
| | - Stuart R. Dalziel
- Departments of Surgery
- Paediatrics: Child and Youth Health, University of Auckland
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
- Paediatric Research in Emergency Departments International Collaborative
| | - Franz E. Babl
- Paediatric Research in Emergency Departments International Collaborative
- Departments of Paediatrics
- Critical Care, University of Melbourne, Australia
- Emergency Research, Murdoch Children's Research Institute, Melbourne
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Javier Benito
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo
- University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
- Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group
| | - Silvia Bressan
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
- Research in European Pediatric Emergency Medicine
| | - James Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
- Pediatric Emergency Care Applied Research Network
| | - Todd P. Chang
- Pediatric Emergency Care Applied Research Network
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Calgary, AB, Canada
- Division of Pediatric Emergency Medicine, Pediatric Emergency Care Applied Research Network (PECARN), Los Angeles, CA
| | - Stephen B. Freedman
- Pediatric Emergency Research Canada
- Section of Pediatric Emergency Medicine, Department of Pediatrics
- Section of Gastroenterology, Department of Emergency Medicine, Cumming School of Medicine, University of Calgary
- Division of Pediatric Emergency Medicine, Pediatric Emergency Research Canada (PERC), Calgary, AB, Canada
| | - Guillermo Kohn-Loncarica
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children
- Faculty of Health and Applied Sciences, University of the West of England
- Paediatric Emergency Research in the United Kingdom and Ireland, Bristol, United Kingdom
| | - Santiago Mintegi
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo
- University of the Basque Country (UPV/EHU), Bilbao, Basque Country, Spain
| | - Rakesh D. Mistry
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine
- Division of Pediatric Emergency Medicine, Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Denver, CO
| | - Lise E. Nigrovic
- Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Emergency Medicine, Boston Children's Hospital
- Department of Emergency Medicine, Harvard Medical School
- Division of Pediatric Emergency Medicine, Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics, Boston, MA
| | - Rianne Oostenbrink
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
- Department of General Pediatrics, ErasmusMC–Sophia
- Division of Pediatric Emergency Medicine, Research in European Pediatric Emergency Medicine, Rotterdam, the Netherlands
| | - Amy C. Plint
- Pediatric Emergency Research Canada
- Children's Hospital of Eastern Ontario
- Pediatrics
- Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pedro Rino
- Unidad Emergencias Hospital J.P. Garrahan, Sociedad Latinoamericana de Emergencia Pediátrica, Universidad de Buenos Aires, Buenos Aires, Argentina
- Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica
| | - Damian Roland
- Faculty of Health and Applied Sciences, University of the West of England
- Paediatric Emergency Medicine Leicester Academic Group
- Children's Emergency Department, Leicester Royal Infirmary
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, United Kingdom
| | - Gregory Van De Mosselaer
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Translating Emergency Knowledge for Kids
| | - Nathan Kuppermann
- Pediatric Emergency Care Applied Research Network
- Departments of Emergency Medicine
- Pediatrics, University of California Davis School of Medicine, Sacramento, CA
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10
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Hall NJ, Rees CM, Rhodes H, Williams A, Vipond M, Gordon A, Evans DA, Wood RJ, Bytheway J, Sutcliffe J. Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK. BJS Open 2021; 5:6174410. [PMID: 33728468 PMCID: PMC7966780 DOI: 10.1093/bjsopen/zraa062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The evidence base underlying clinical practice in children's general surgery is poor and high-quality collaborative clinical research is required to address current treatment uncertainties. The aim of this study was, through a consensus process, to identify research priorities for clinical research in this field amongst surgeons who treat children. METHODS Questions were invited in a scoping survey amongst general surgeons and specialist paediatric surgeons. These were refined by the study team and subsequently prioritized in a two-stage modified Delphi process. RESULTS In the scoping survey, a total of 226 questions covering a broad scope of children's elective and emergency general surgery were submitted by 76 different clinicians. These were refined to 71 research questions for prioritization. A total of 168 clinicians took part in stage one of the prioritization process, and 157 in stage two. A 'top 10' list of priority research questions was generated for both elective and emergency general surgery of childhood. These cover a range of conditions and concepts, including inguinal hernia, undescended testis, appendicitis, abdominal trauma and enhanced recovery pathways. CONCLUSION Through consensus amongst surgeons who treat children, 10 priority research questions for each of the elective and emergency fields have been identified. These should provide a basis for the development of high-quality multicentre research projects to address these questions, and ultimately improve outcomes for children requiring surgical care.
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Affiliation(s)
- N J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - C M Rees
- Department of Paediatric Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - H Rhodes
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK.,Bristol Renal, University of Bristol, Bristol, UK
| | - A Williams
- Department of Paediatric Surgery and Urology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - M Vipond
- Department of Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - A Gordon
- Department of Surgery, The Belford Hospital, Fort William, UK
| | - D A Evans
- Department of Surgery, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - R J Wood
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - J Sutcliffe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK
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11
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Borensztajn DM, Hagedoorn NN, Rivero Calle I, Maconochie IK, von Both U, Carrol ED, Dewez JE, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Lim E, Martinon-Torres F, Nieboer D, Nijman RG, Pokorn M, Strle F, Tsolia M, Vermont C, Yeung S, Zavadska D, Zenz W, Levin M, Moll HA. Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study. PLoS One 2021; 16:e0244810. [PMID: 33411810 PMCID: PMC7790386 DOI: 10.1371/journal.pone.0244810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1). Conclusions Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.
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Affiliation(s)
- Dorine M. Borensztajn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Nienke N. Hagedoorn
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Irene Rivero Calle
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ian K. Maconochie
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Enitan D. Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Juan Emmanuel Dewez
- Faculty of Tropical and Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marieke Emonts
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald de Groot
- Stichting Katholieke Universiteit, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Emma Lim
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni Klinični Center, Ljubljana, Slovenia
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni Klinični Center, Ljubljana, Slovenia
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Clementien Vermont
- Department Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Shunmay Yeung
- Faculty of Tropical and Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dace Zavadska
- Department of Pediatrics, Rīgas Stradiņa Universitāte, Children Clinical University Hospital, Riga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Henriette A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
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12
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Cost Study of a Cluster Randomized Trial on a Clinical Decision Rule Guiding Antibiotic Treatment in Children With Suspected Lower Respiratory Tract Infections in the Emergency Department. Pediatr Infect Dis J 2020; 39:1026-1031. [PMID: 33075037 DOI: 10.1097/inf.0000000000002794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with fever and respiratory symptoms represent a large patient group at the emergency department (ED). A decision rule-based treatment strategy improved targeting of antibiotics in these children in a recent clinical trial. This study aims to evaluate the impact of the decision rule on healthcare and societal costs, and to describe costs of children with suspected lower respiratory tract infections (RTIs) in the ED in general. METHODS In a stepped-wedge, cluster randomized trial, we collected cost data of children 1 month to 5 years of age with fever and cough/dyspnea in 8 EDs in The Netherlands (2016-2018). We calculated medical costs and societal costs per patient, during usual care (n = 597), and when antibiotic prescription was guided by the decision rule (n = 402). We calculated cost-of-illness of this patient group and estimated their annual costs at national level. RESULTS The cost-of-illness of children under 5 years with suspected lower RTIs in the ED was on average &OV0556;2130 per patient. At population level this is &OV0556;15 million per year in The Netherlands (&OV0556;1.7 million/100,000 children under 5). Mean costs per patient in usual care (&OV0556;2300) were reduced to &OV0556;1870 in the intervention phase (P = 0.01). Main cost drivers were hospitalization and lost parental workdays. CONCLUSIONS Implementation of a decision rule-based treatment strategy in children with suspected lower RTI was cost-saving, due to a reduction in hospitalization and parental absenteeism. Given the high frequency of this disease in children, the decision rule has the potential to result in a considerable cost reduction at population level.
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13
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Zeitlin J, Sentenac M, Morgan AS, Ancel PY, Barros H, Cuttini M, Draper E, Johnson S, Lebeer J, Maier RF, Norman M, Varendi H. Priorities for collaborative research using very preterm birth cohorts. Arch Dis Child Fetal Neonatal Ed 2020; 105:538-544. [PMID: 32029530 PMCID: PMC7547907 DOI: 10.1136/archdischild-2019-317991] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To develop research priorities on the consequences of very preterm (VPT) birth for the RECAP Preterm platform which brings together data from 23 European VPT birth cohorts. DESIGN AND SETTING This study used a two-round modified Delphi consensus process. Round 1 was based on 28 research themes related to childhood outcomes (<12 years) derived from consultations with cohort researchers. An external panel of multidisciplinary stakeholders then ranked their top 10 themes and provided comments. In round 2, panel members provided feedback on rankings and on new themes suggested in round 1. RESULTS Of 71 individuals contacted, 64 (90%) participated as panel members comprising obstetricians, neonatologists, nurses, general and specialist paediatricians, psychologists, physiotherapists, parents, adults born preterm, policy makers and epidemiologists from 17 countries. All 28 initial themes were ranked in the top 10 by at least six panel members. Highest ranking themes were: education (73% of panel members' top 10 choices); care and outcomes of extremely preterm births, including ethical decisions (63%); growth and nutrition (60%); emotional well-being and social inclusion (55%); parental stress (55%) and impact of social circumstances on outcomes (52%). Highest ranking themes were robust across panel members classified by background. 15 new themes had at least 6 top 10 endorsements in round 2. CONCLUSIONS This study elicited a broad range of research priorities on the consequences of VPT birth, with good consensus on highest ranks between stakeholder groups. Several highly ranked themes focused on the socioemotional needs of children and parents, which have been less studied.
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Affiliation(s)
- Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
| | - Mariane Sentenac
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
| | - Andrei S Morgan
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
| | - Pierre Yves Ancel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004, Paris, France
| | - Henrique Barros
- EPIUnit-- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jo Lebeer
- Department of Primary & Interdisciplinary Care, Disability Studies, Faculty of Medicine, University of Antwerp, Antwerpen, Belgium
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
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14
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Preparedness and Response to Pediatric COVID-19 in European Emergency Departments: A Survey of the REPEM and PERUKI Networks. Ann Emerg Med 2020; 76:788-800. [PMID: 32419713 PMCID: PMC7225691 DOI: 10.1016/j.annemergmed.2020.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Study objective We aim to describe the variability and identify gaps in preparedness and response to the coronavirus disease 2019 pandemic in European emergency departments (EDs) caring for children. Methods A cross-sectional point-prevalence survey was developed and disseminated through the pediatric emergency medicine research networks for Europe (Research in European Pediatric Emergency Medicine) and the United Kingdom and Ireland (Paediatric Emergency Research in the United Kingdom and Ireland). We aimed to include 10 EDs for countries with greater than 20 million inhabitants and 5 EDs for less populated countries, unless the number of eligible EDs was less than 5. ED directors or their delegates completed the survey between March 20 and 21 to report practice at that time. We used descriptive statistics to analyze data. Results Overall, 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. Wide variation on personal protective equipment (PPE) items was shown for recommended PPE use at pretriage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2 and N95 masks. Only 17% of EDs had negative-pressure isolation rooms. Coronavirus disease 2019–positive ED staff was reported in 25% of centers. Conclusion We found variation and identified gaps in preparedness and response to the coronavirus disease 2019 epidemic across European referral EDs for children. A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.
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15
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Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe. Eur J Pediatr 2020; 179:1097-1106. [PMID: 32036433 PMCID: PMC7314716 DOI: 10.1007/s00431-020-03601-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 11/07/2022]
Abstract
Vital signs can help clinicians identify children at risk of serious illness. The NICE guideline for fever in under-fives recommends a routine measurement of temperature, heart rate, capillary refill and respiratory rate in all febrile children visiting the emergency department (ED). This study aims to evaluate the measurement of paediatric vital signs in European EDs, with specific attention to adherence to this NICE guideline recommendation. In a prospective observational study, we included 4560 febrile children under 16 years from the ED of 28 hospitals in 11 European countries (2014-2016). Hospitals were academic (n = 17), teaching (n = 10) and non-teaching (n = 1) and ranged in annual paediatric ED visits from 2700 to 88,000. Fifty-four percent were male, their median age was 2.4 years (IQR 1.1-4.7). Temperature was measured most frequently (97%), followed by capillary refill (86%), heart rate (73%), saturation (56%) and respiratory rate (51%). In children under five (n = 3505), a complete measurement of the four NICE-recommended vital signs was performed in 48% of patients. Children under 1 year of age, those with an urgent triage level and with respiratory infections had a higher likelihood of undergoing complete measurements. After adjustment for these factors, variability between countries remained. Conclusion: Measuring vital signs in children with fever in the ED occurs with a high degree of practice variation between different European hospitals, and adherence to the NICE recommendation is moderate. Our study is essential as a benchmark for current clinical practice, in order to tailor implementation strategies to different European settings.What is Known:• Vital signs can quickly provide information on disease severity in children in the emergency department (ED), and the NICE guideline for fever in under-fives recommends to routinely measure temperature, heart rate, capillary refill and respiratory rate.• Data regarding measurement of vital signs in routine practice across European EDs is currently unavailable.What is New:• Measurement of vital signs in febrile children is highly variable across European EDs and across patient subgroups, and compliance to the NICE recommendation is <50%.• Children under 1 year of age, those with an urgent triage level and with respiratory infections had a higher likelihood of undergoing complete measurements.
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16
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Moylan A, Maconochie I. Demand, overcrowding and the pediatric emergency department. CMAJ 2019; 191:E625-E626. [PMID: 32392478 DOI: 10.1503/cmaj.190610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alexander Moylan
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, UK
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, UK
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