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Sasse R, Borland ML, George S, Jani S, Tan E, Neutze J, Phillips N, Kochar A, Craig S, Lithgow A, Rao A, Dalziel SR, Williams A, Babl FE, Went G, Long E. Appraisal of Australian and New Zealand paediatric sepsis guidelines. Emerg Med Australas 2024; 36:436-442. [PMID: 38403429 DOI: 10.1111/1742-6723.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) are an important tool for the management of children with sepsis. The quality, consistency and concordance of Australian and New Zealand (ANZ) childhood sepsis CPGs with the Australian Commission on Safety and Quality in Healthcare (ACSQHC) sepsis clinical care standards and international sepsis guidelines is unclear. METHODS We accessed childhood sepsis CPGs for all ANZ states and territories through Paediatric Research in Emergency Departments International Collaborative members. The guidelines were assessed for quality using the AGREE-II instrument. Consistency between CPG treatment recommendations was assessed, as was concordance with the ACSQHC sepsis clinical care standards and international sepsis guidelines. RESULTS Overall, eight CPGs were identified and assessed. CPGs used a narrative and pathway format, with those using both having the highest quality overall. CPG quality was highest for description of scope and clarity of presentation, and lowest for editorial independence. Consistency between guidelines for initial treatment recommendations was poor, with substantial variation in the choice and urgency of empiric antimicrobial administration; the choice, volume and urgency of fluid resuscitation; and the choice of first-line vasoactive agent. Most CPGs were concordant with time-critical components of the ACSQHC sepsis clinical care standard, although few addressed post-acute care. Concordance with international sepsis guidelines was poor. CONCLUSION Childhood sepsis CPGs in current use in ANZ are of variable quality and lack consistency with key treatment recommendations. CPGs are concordant with the ACSQHC care standard, but not with international sepsis guidelines. A bi-national sepsis CPG may reduce unnecessary variation in care.
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Affiliation(s)
- Rosemary Sasse
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Department of Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Shane George
- Department of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Shefali Jani
- Department of Emergency Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Eunicia Tan
- Kidz First Middlemore Hospital, Auckland, New Zealand
| | | | - Natalie Phillips
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Amit Kochar
- Department of Emergency Medicine, Women and Children's Hospital, Adelaide, South Australia, Australia
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Craig
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Anna Lithgow
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Arjun Rao
- Department of Emergency Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - 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 Hospital, Auckland, New Zealand
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Went
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Florin TA, Freedman SB, Xie J, Funk AL, Tancredi DJ, Kim K, Neuman MI, Yock-Corrales A, Bergmann KR, Breslin KA, Finkelstein Y, Ahmad FA, Avva UR, Lunoe MM, Chaudhari PP, Shah NP, Plint AC, Sabhaney VJ, Sethuraman U, Gardiner MA, Sartori LF, Wright B, Navanandan N, Mintegi S, Gangoiti I, Borland ML, Chong SL, Kwok MY, Eckerle M, Poonai N, Romero CMA, Waseem M, Nebhrajani JR, Bhatt M, Caperell K, Campos C, Becker SM, Morris CR, Rogers AJ, Kam AJ, Pavlicich V, Palumbo L, Dalziel SR, Morrison AK, Rino PB, Cherry JC, Salvadori MI, Ambroggio L, Klassen TP, Payne DC, Malley R, Simon NJ, Kuppermann N. Features Associated With Radiographic Pneumonia in Children with SARS-CoV-2. J Pediatric Infect Dis Soc 2024; 13:257-259. [PMID: 38391389 DOI: 10.1093/jpids/piae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 02/24/2024]
Abstract
14% of children with SARS-CoV-2 infections had radiographic pneumonia. Hypoxemia, cough, higher temperature, and older age were associated with pneumonias. In children tested, SARS-CoV-2 test results were not associated with radiographic pneumonia.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, USA
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Canada
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York, USA
| | - Maren M Lunoe
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Michael A Gardiner
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, USA
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Meredith L Borland
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Perth, Australia
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Pediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, NY, New York, USA
| | - Michelle Eckerle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, USA
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | | | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, New York City, Bronx, New York, USA
| | | | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Kerry Caperell
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, USA
| | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah M Becker
- Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, USA
| | - Claudia R Morris
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor, USA
| | - April J Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Facultad de Medicina, Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Laura Palumbo
- Department of Pediatrics, ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Pedro B Rino
- Department of Pediatrics, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", RIDEPLA, Buenos Aires, Argentina
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Lilliam Ambroggio
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Norma-Jean Simon
- Data Analytics and Reporting and Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, USA
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Robertson T, Borland ML, O'Brien S, Haskell L, Babl FE, Dalziel SR, Tavender E. Understanding the uptake and adaption of targeted implementation interventions for reducing bronchiolitis investigations and therapies. Acta Paediatr 2024; 113:802-811. [PMID: 38189212 DOI: 10.1111/apa.17090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/10/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
AIM To understand and evaluate the uptake and local adaptations of proven targeted implementation interventions that have effectively reduced unnecessary investigations and therapies in infants with bronchiolitis within emergency departments. METHODS A multi-centred, mixed-methods quality improvement study in four Australian hospitals that provide paediatric emergency and inpatient care from May to December 2021. All hospitals were provided with the same implementation intervention package and training. Real-time tracking logs of adaptions were completed followed by semi-structured interviews. Interviews were recorded, transcribed and subsequently coded using FRAME-IS to further describe the adaptions made. RESULTS Tracking logs were summarised and data from 12 interviews were compared from participating sites. The intervention resulted in 116 education sessions and a total of 23 adaptations made to educational materials, both content and contextual. Shortening education presentations, addition of bronchiolitis definitions, formatting of materials and novel interventions were the most common modifications. Audit and feedback were completed across all sites with varying utilisation. Targeted teaching was noted to dictate adaptions prior to and during implementation. CONCLUSION Quantitative and qualitative analysis of clinical 'real-world' adaptations to proven targeted implementation interventions allows invaluable insight for future de-implementation initiatives and national roll-out of implementation packages in the ED setting.
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Affiliation(s)
- Tim Robertson
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Sharon O'Brien
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Libby Haskell
- Starship Children's Hospital, Auckland, New Zealand
- Departments Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Royal Children's Hospital, Parkville, Victoria, Australia
- Departments of Paediatrics and Critical Care, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Starship Children's Hospital, Auckland, New Zealand
- Cure Kids Chair of Child Health Research, Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Emma Tavender
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Departments of Paediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia
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4
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Oakley E, Wilson CL, Hopper SM, Cheek JA, Hearps S, Mackay MT, Dalziel SR, Lee KJ. Facial Function in Bell Palsy in a Cohort of Children Randomized to Prednisolone or Placebo 12 Months After Diagnosis. Pediatr Neurol 2024; 153:44-47. [PMID: 38320457 DOI: 10.1016/j.pediatrneurol.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Information on the medium-term recovery of children with Bell palsy or acute idiopathic lower motor neuron facial paralysis is limited. METHODS We followed up children aged 6 months to <18 years with Bell palsy for 12 months after completion of a randomized trial on the use of prednisolone. We assessed facial function using the clinician-administered House-Brackmann scale and the modified parent-administered House-Brackmann scale. RESULTS One hundred eighty-seven children were randomized to prednisolone (n = 93) or placebo (n = 94). At six months, the proportion of patients who had recovered facial function based on the clinician-administered House-Brackmann scale was 98% (n = 78 of 80) in the prednisolone group and 93% (n = 76 of 82) in the placebo group. The proportion of patients who had recovered facial function based on the modified parent-administered House-Brackmann scale was 94% (n = 75 of 80) vs 89% (n = 72 of 81) at six months (OR 1.88; 95% CI 0.60, 5.86) and 96% (n = 75 of 78) vs 92% (n = 73 of 79) at 12 months (OR 3.12; 95% CI 0.61, 15.98). CONCLUSIONS Although the vast majority had complete recovery of facial function at six months, there were some children without full recovery of facial function at 12 months, regardless of prednisolone use.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia.
| | - David Herd
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Perth Children's Hospital, Perth, Australia; Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia
| | - Amit Kochar
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Katherine J Lee
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, Dalziel SR. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial. Arch Dis Child 2024; 109:227-232. [PMID: 38049992 DOI: 10.1136/archdischild-2023-325381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis. METHODS This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups. RESULTS Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain). CONCLUSIONS Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease. TRIAL REGISTRATION NUMBER ACTRN12615000563561.
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Affiliation(s)
- Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Herd
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Amit Kochar
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ben Lawton
- Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Andrew Davidson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T MacKay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Pavlos R, Bhuiyan MU, Jones M, Oakes D, O'Brien S, Borland ML, Doyle S, Richmond P, Martin AC, Snelling TL, Blyth CC. Pragmatic Adaptive Trial for Respiratory Infection in Children (PATRIC) Clinical Registry protocol. BMJ Open 2024; 14:e074308. [PMID: 38272557 PMCID: PMC10824052 DOI: 10.1136/bmjopen-2023-074308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Acute respiratory infections (ARI) are the most common cause of paediatric hospitalisation. There is an urgent need to address ongoing critical knowledge gaps in ARI management. The Pragmatic Adaptive Trial for Respiratory Infections in Children (PATRIC) Clinical Registry will evaluate current treatments and outcomes for ARI in a variety of paediatric patient groups. The registry will provide a platform and data to inform a number of PATRIC clinical trials, testing various interventions in ARI treatment and management to optimise paediatric ARI care. METHODS AND ANALYSIS The PATRIC Clinical Registry is a single-centre, prospective observational registry recruiting from a tertiary paediatric Emergency Department in Western Australia. Through characterising demographic, clinical, treatment and outcome data, the PATRIC Clinical Registry will improve our understanding of antibiotic utilisation and ARI outcomes in children. ETHICS AND DISSEMINATION The PATRIC Clinical Registry is conducted in accordance with the Declaration of Helsinki, and the International Council for Harmonisation (ICH) Guidelines for Good Clinical Practice (CPMP/ICH/13595) July 1996. Approval is provided by the Child and Adolescent Health Service Human Research Ethics Committee (HREC). Study results will be communicated by presentation and publication (HREC: RGS0000003078.) TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000903189. UTN: U1111-1231-3365.
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Affiliation(s)
- Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Mejbah U Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Mark Jones
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sarah Doyle
- What the Doctor Said, North Perth, Western Australia, Australia
| | - Peter Richmond
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Long E, Borland ML, George S, Jani S, Tan E, Neutze J, Phillips N, Kochar A, Craig S, Lithgow A, Rao A, Dalziel S, Oakley E, Hearps S, Singh S, Gelbart B, McNab S, Balamuth F, Weiss S, Kuppermann N, Williams A, Babl FE. Sepsis epidemiology in Austral ian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study. BMJ Open 2024; 14:e077471. [PMID: 38216206 PMCID: PMC10806766 DOI: 10.1136/bmjopen-2023-077471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Sepsis affects 25.2 million children per year globally and causes 3.4 million deaths, with an annual cost of hospitalisation in the USA of US$7.3 billion. Despite being common, severe and expensive, therapies and outcomes from sepsis have not substantially changed in decades. Variable case definitions, lack of a reference standard for diagnosis and broad spectrum of disease hamper efforts to evaluate therapies that may improve sepsis outcomes. This landscape analysis of community-acquired childhood sepsis in Australia and New Zealand will characterise the burden of disease, including incidence, severity, outcomes and cost. Sepsis diagnostic criteria and risk stratification tools will be prospectively evaluated. Sepsis therapies, quality of care, parental awareness and understanding of sepsis and parent-reported outcome measures will be described. Understanding these aspects of sepsis care is fundamental for the design and conduct of interventional trials to improve childhood sepsis outcomes. METHODS AND ANALYSIS This prospective observational study will include children up to 18 years of age presenting to 12 emergency departments with suspected sepsis within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand. Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, clinician assessment of severity of disease, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length-of-stay, mortality censored at hospital discharge or 30 days from enrolment (whichever comes first) and parent-reported outcomes 90 days from enrolment. We will use these data to determine sepsis epidemiology based on existing and novel diagnostic criteria. We will also validate existing and novel sepsis risk stratification criteria, characterise antimicrobial stewardship, guideline adherence, cost and report parental awareness and understanding of sepsis and parent-reported outcome measures. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/69948/RCHM-2021). This included incorporated informed consent for follow-up. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621000920897; Pre-results.
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Affiliation(s)
- Elliot Long
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith L Borland
- Department of Emergency Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
- Division of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Shane George
- Division of Emergency Medicine and Children’s Critical Care, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Menzies Institute Queensland, Griffith University, Southport, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Department of Emergency Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Eunicia Tan
- Kidz first Middlemore Hospital, Auckland, New Zealand
| | | | - Natalie Phillips
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
| | - Amit Kochar
- Department of Emergency Medicine, Women and Children’s Hospital, Adelaide, South Australia, Australia
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Craig
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Emergency Medicine, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Anna Lithgow
- Department of Paediatrics, The Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Arjun Rao
- Department of Emergency Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Department of Surgery and Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Ed Oakley
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
| | - Sonia Singh
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- University of California Davis School of Medicine, Sacremento, California, USA
| | - Ben Gelbart
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Intensive Care Unit, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Sarah McNab
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Fran Balamuth
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott Weiss
- Nemours Children’s Health and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine and University of California Davis Health, Sacremento, California, USA
| | - Amanda Williams
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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8
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Crowe LM, Rausa VC, Anderson V, Borland ML, Kochar A, Lyttle MD, Gilhotra Y, Dalziel SR, Oakley E, Furyk J, Neutze J, Bressan S, Davis GA, Babl FE. Mild Traumatic Brain Injury Characteristics and Symptoms in Preschool Children: How Do They Differ to School Age Children? A Multicenter Prospective Observational Study. Arch Phys Med Rehabil 2024; 105:120-124. [PMID: 37715760 DOI: 10.1016/j.apmr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/20/2023] [Accepted: 08/06/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To investigate if preschool children differ to school age children with mild traumatic brain injury (TBI) with respect to injury causes, clinical presentation, and medical management. DESIGN A secondary analysis of a dataset from a large, prospective and multisite cohort study on TBI in children aged 0-18 years, the Australian Paediatric Head Injury Rules Study. SETTING Nine pediatric emergency departments (ED) and 1 combined adult and pediatric ED located across Australia and New Zealand. PARTICIPANTS 7080 preschool aged children (2-5 years) were compared with 5251 school-age children (6-12 years) with mild TBI (N= (N=12,331) MAIN OUTCOME MEASURES: Clinical report form on medical symptoms, injury causes, and management. RESULTS Preschool children were less likely to be injured with a projectile than school age children (P<.001). Preschool children presented with less: loss of consciousness (P<.001), vomiting (P<.001), drowsiness (P=.002), and headache (P<.001), and more irritability and agitation (P=.003), than school-age children in the acute period after mild TBI. Preschool children were less likely to have neuroimaging of any kind (P<.001) or to be admitted for observation than school age children (P<.001). CONCLUSIONS Our large prospective study has demonstrated that preschool children with mild TBI experience a different acute symptom profile to older children. There are significant clinical implications with symptoms post-TBI used in medical management to aid decisions on neuroimaging and post-acute intervention.
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Affiliation(s)
- Louise M Crowe
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Vanessa C Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Australia; School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
| | - Amit Kochar
- Emergency Department, Women's & Children's Hospital, Adelaide, Australia
| | - Mark D Lyttle
- Faculty of Health & Life Sciences, University of the West of England, Bristol, UK
| | - Yuri Gilhotra
- Emergency Medicine Education and Training, Retrieval Services, Queensland, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, Australia; Emergency Department, University Hospital Geelong, Geelong, Australia; School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Australia; Department of Critical Care Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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9
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Xie J, Kuppermann N, Florin TA, Tancredi DJ, Funk AL, Kim K, Salvadori MI, Yock-Corrales A, Shah NP, Breslin KA, Chaudhari PP, Bergmann KR, Ahmad FA, Nebhrajani JR, Mintegi S, Gangoiti I, Plint AC, Avva UR, Gardiner MA, Malley R, Finkelstein Y, Dalziel SR, Bhatt M, Kannikeswaran N, Caperell K, Campos C, Sabhaney VJ, Chong SL, Lunoe MM, Rogers AJ, Becker SM, Borland ML, Sartori LF, Pavlicich V, Rino PB, Morrison AK, Neuman MI, Poonai N, Simon NJE, Kam AJ, Kwok MY, Morris CR, Palumbo L, Ambroggio L, Navanandan N, Eckerle M, Klassen TP, Payne DC, Cherry JC, Waseem M, Dixon AC, Ferre IB, Freedman SB. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children. Open Forum Infect Dis 2023; 10:ofad485. [PMID: 37869403 PMCID: PMC10588618 DOI: 10.1093/ofid/ofad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. Methods We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. Results We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Conclusions Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
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Affiliation(s)
| | - Nathan Kuppermann
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Todd A Florin
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Daniel J Tancredi
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Anna L Funk
- University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Nipam P Shah
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Fahd A Ahmad
- Washington University School of Medicine, St.Louis, Missouri, USA
| | | | - Santiago Mintegi
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Amy C Plint
- University of Ottawa, Ottawa, Ontario, Canada
| | - Usha R Avva
- Montefiore-Nyack Hospital, Nyack, NewYork, New York, USA
| | | | | | | | | | - Maala Bhatt
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Carmen Campos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Shu-Ling Chong
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Maren M Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah M Becker
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Laura F Sartori
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Pedro B Rino
- Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” RIDEPLA, Buenos Aires, Argentina
| | | | | | - Naveen Poonai
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Norma-Jean E Simon
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - April J Kam
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maria Y Kwok
- Columbia University Irving Medical Center, NewYork, New York, USA
| | - Claudia R Morris
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Palumbo
- ASST Spedali Civili di Brescia—Pronto Soccorso Pediatrico, Brescia, Italy
| | | | | | - Michelle Eckerle
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rueter K, Moseley N, Ta B, Bear N, Borland ML, Prescott SL. Increasing emergency department visits for anaphylaxis in very early childhood: A canary in the coal mine. Acta Paediatr 2023; 112:2182-2188. [PMID: 37485861 DOI: 10.1111/apa.16917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
AIM The incidence of anaphylaxis is increasing globally in tandem with changing environmental and lifestyle factors. There is very limited data on very early childhood presentations. We aim to assess changes in rates, characteristics and management of infant anaphylaxis in a paediatric ED over a 15-year period. METHODS We conducted a retrospective study of children <2 years of age who presented with verified anaphylaxis comparing cases in years 2003-2007 with those in 2013-2017. Standardised information was collected on demographics, clinical presentation, management and triggers. RESULTS Manually confirmed anaphylaxis rates in <2 year olds increased from 3.6 to 6.2 per 104 population (OR 1.7, 95% CI: 1.3-2.7; p < 0.001) with the greatest increase in <1 year olds. Anaphylaxis severity increased between 2003-2007 and 2013-2017 (OR 2.3, 95% CI: 1.2-4.3; p = 0.018). Failure to administer adrenaline was reduced in 2013-2017 (p = 0.007). Food was the leading anaphylaxis trigger (97.85%). CONCLUSION This is the first study to suggest an increase in the incidence and severity of ED anaphylaxis presentations in children aged <2 years. Increased awareness of specific characteristics in this age group is required to facilitate timely recognition and optimal management. Further large-scale studies are warranted to understand underlying environmental drivers and find prevention strategies to reduce the burden of disease.
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Affiliation(s)
- Kristina Rueter
- Department of Paediatric Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatric Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- InVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), New York, New Jersey, USA
| | - Natasha Moseley
- Department of Paediatric Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Paediatric General Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Brennan Ta
- Department of Paediatric Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Statistics, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Susan L Prescott
- Department of Paediatric Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- InVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), New York, New Jersey, USA
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Foley DA, Yeoh DK, Minney-Smith CA, Shin C, Hazelton B, Hoeppner T, Moore HC, Nicol M, Sikazwe C, Borland ML, Levy A, Blyth CC. A surge in human metapneumovirus paediatric respiratory admissions in Western Australia following the reduction of SARS-CoV-2 non-pharmaceutical interventions. J Paediatr Child Health 2023; 59:987-991. [PMID: 37219060 DOI: 10.1111/jpc.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
AIM Western Australian laboratory data demonstrated a decrease in human metapneumovirus (hMPV) detections through 2020 associated with SARS-CoV-2-related non-pharmaceutical interventions (NPIs), followed by a subsequent surge in metropolitan region in mid-2021. We aimed to assess the impact of the surge in hMPV on paediatric hospital admissions and the contribution of changes in testing. METHODS All respiratory-coded admissions of children aged <16 years at a tertiary paediatric centre between 2017 and 2021 were matched with respiratory virus testing data. Patients were grouped by age at presentation and by ICD-10 AM codes into bronchiolitis, other acute lower respiratory infection (OALRI), wheeze and upper respiratory tract infection (URTI). For analysis, 2017-2019 was utilised as a baseline period. RESULTS hMPV-positive admissions in 2021 were more than 2.8 times baseline. The largest increase in incidence was observed in the 1-4 years group (incidence rate ratio (IRR) 3.8; 95% confidence interval (CI): 2.5-5.9) and in OALRI clinical phenotype (IRR 2.8; 95% CI: 1.8-4.2). The proportion of respiratory-coded admissions tested for hMPV in 2021 doubled (32-66.2%, P < 0.001), with the greatest increase in wheeze (12-75% in 2021, P < 0.001). hMPV test percentage positivity in 2021 was higher than in the baseline period (7.6% vs. 10.1% in 2021, P = 0.004). CONCLUSION The absence and subsequent surge underline the susceptibility of hMPV to NPIs. Increased hMPV-positive admissions in 2021 can be partially attributable to testing, but test-positivity remained high, consistent with a genuine increase. Continued comprehensive testing will help ascertain true burden of hMPV respiratory diseases.
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Affiliation(s)
- David A Foley
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cara A Minney-Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | | | - Briony Hazelton
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tobias Hoeppner
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark Nicol
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Marshall Centre, Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chris C Blyth
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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Borland ML, O'Brien S, Tavender E, Haskell L, Babl FE, Schembri R, Smedley B, Mitenko H, Robertson T, Mukherjee A, Dalziel SR. Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with bronchiolitis. Acta Paediatr 2023. [PMID: 37026175 DOI: 10.1111/apa.16786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
AIM To evaluate the impact of locally adapted targeted implementation interventions on bronchiolitis management through reduction in ineffective investigation and therapies within emergency departments. METHODS A multi-centred, quality improvement study in four different grades of hospitals in Western Australia who provide paediatric emergency and inpatient care. All hospitals incorporated an adapted implementation intervention package for infants under 1 year with bronchiolitis. The proportion whose care complied with guideline recommendations to not receive investigations and therapies of minimal benefit were compared to pre-intervention care in a previous bronchiolitis season. RESULTS 457 infants in 2019 (pre-intervention) and 443 in 2021 (post-intervention) were included, with mean age 5.6 months (SD 3.2, 2019; SD 3.0, 2021). In 2019, compliance was 78.1% versus 85.6% in 2021, RD 7.4 (95%CI -0.6;15.5). The strongest evidence was reduced salbutamol use (compliance improvement: 88.6% to 95.7%, RD 7.1 95%CI (1.7;12.4). Hospitals initially at <80% compliance demonstrated greatest improvements (Hospital 2: 95 (78.5%) to 108 (90.8%) RD 12.2 95%CI (3.3;21.2); Hospital 3: 67 (62.6%) to 63 (76.8%) RD 14.2 95%CI (1.3;27.2). CONCLUSION Targeted site-adapted implementation interventions resulted in improvement in compliance with guideline recommendations, particularly for those hospitals with initial low compliance. Maximising benefit through guidance on how to adapt and effectively use interventions will enhance sustainable practice change.
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Affiliation(s)
- Meredith L Borland
- Paediatric Emergency Physician Perth Children's Hospital, Western Australia, Australia
- School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia
| | - Sharon O'Brien
- Emergency Research Nurse Coordinator Perth Children's Hospital, School of Nursing, Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Emma Tavender
- Implementation Scientist Clinical Sciences, Murdoch, Victoria, Australia
- Departments of Paediatrics and Critical Care, The University of Melbourne
| | - Libby Haskell
- Paediatric Emergency Nurse Practitioner Starship Children's Hospital, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health University of Auckland
| | - Franz E Babl
- Paediatric Emergency Physician Royal Children's Hospital, Victoria, Australia
- Murdoch Children's Research Institute Departments of Paediatrics and Critical Care, University of Melbourne
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Children's Research Institute, Murdoch, Victoria, Australia
- Department of Paediatrics, University of Melbourne
| | - Ben Smedley
- Rockingham General Hospital, Western Australia, Australia
| | - Hugh Mitenko
- Bunbury Regional Hospital, Western Australia, Australia
- Clinical Senior Lecturer, Rural Clinical School, University of Western Australia
| | - Tim Robertson
- Perth Children's Hospital, Western Australia, Australia
| | | | - Stuart R Dalziel
- Starship Children's Hospital, New Zealand
- Cure Kids Chair of Child Health Research Departments of Surgery and Paediatrics: Child and Youth Health University of Auckland
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13
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Borland ML, Dalziel SR, Phillips N, Dalton S, Lyttle MD, Bressan S, Oakley E, Kochar A, Furyk J, Cheek JA, Neutze J, Eapen N, Hearps SJC, Rausa VC, Babl FE. Incidence of traumatic brain injuries in head-injured children with seizures. Emerg Med Australas 2023; 35:289-296. [PMID: 36323396 PMCID: PMC10947265 DOI: 10.1111/1742-6723.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/01/2022] [Accepted: 10/05/2022] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature. METHODS Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores. RESULTS Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR -16.1 [95% CI -20.4 to -11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6-7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1-15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8-12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8-12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8-4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4-3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13. CONCLUSIONS PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.
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Affiliation(s)
- Meredith L Borland
- Emergency DepartmentPerth Children's HospitalPerthWestern AustraliaAustralia
- Divisions of Paediatrics and Emergency Medicine, School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Stuart R Dalziel
- Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand
- Departments of Surgery and Paediatrics: Child and Youth HealthThe University of AucklandAucklandNew Zealand
| | - Natalie Phillips
- Emergency DepartmentQueensland Children's HospitalBrisbaneQueenslandAustralia
- Child Health Research Centre, School of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Sarah Dalton
- Emergency DepartmentThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Mark D Lyttle
- Emergency DepartmentBristol Royal Hospital for ChildrenBristolUK
- Academic Department of Emergency CareUniversity of the West of EnglandBristolUK
| | - Silvia Bressan
- Department of Women's and Children's HealthUniversity of PadovaPadovaItaly
| | - Ed Oakley
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Amit Kochar
- Emergency DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Jeremy Furyk
- Emergency DepartmentThe Townsville HospitalTownsvilleQueenslandAustralia
- School of MedicineDeakin UniversityMelbourneVictoriaAustralia
- University Hospital GeelongGeelongVictoriaAustralia
| | - John A Cheek
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Jocelyn Neutze
- Emergency DepartmentKidz First Children's HospitalAucklandNew Zealand
| | - Nitaa Eapen
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | | | - Vanessa C Rausa
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Franz E Babl
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
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14
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Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Prakash C, Lee K, Davidson A, Knott JC, Craig S, Babl FE. Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ Open 2023; 13:e067436. [PMID: 36997241 PMCID: PMC10069493 DOI: 10.1136/bmjopen-2022-067436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of intramuscular olanzapine is more effective than intramuscular droperidol at successfully sedating young people with ASBD requiring intramuscular sedation. METHODS AND ANALYSIS This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of intramuscular olanzapine and intramuscular droperidol. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital Human Research Ethics Committee (HREC/69948/RCHM-2021). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621001238864.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Deparment, Grampians Health, Ballarat, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amit Kochar
- Emergency Department, Women and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Shane George
- Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Deborah Shellshear
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kent Perkins
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Doris Tham
- Paediatric Emergency Department, Western Health, Footscray, Victoria, Australia
| | - Michael Solomon Gordon
- Psychological Medicine, Monash Health, Clayton, Victoria, Australia
- Monash University, Monash University, Clayton, Victoria, Australia
| | - Kate Klein
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Chidambaram Prakash
- Department of Psychiatry, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katherine Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andrew Davidson
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jonathan C Knott
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
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15
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Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Prakash C, Lee K, Davidson A, Knott JC, Craig S, Babl FE. Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O). BMJ Open 2023; 13:e067433. [PMID: 36997250 PMCID: PMC10069548 DOI: 10.1136/bmjopen-2022-067433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of oral olanzapine is more effective than a dose of oral diazepam at successfully sedating young people with ASBD. METHODS AND ANALYSIS This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 years and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of oral olanzapine and oral diazepam. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital Human Research Ethics Committee (HREC/66478/RCHM-2020). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621001236886.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Grampians Health, Ballarat, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amit Kochar
- Emergency Department, Women and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Shane George
- Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Deborah Shellshear
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kent Perkins
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Doris Tham
- Paediatric Emergency Department, Western Health, Footscray, Victoria, Australia
| | - Michael Solomon Gordon
- Psychological Medicine, Monash Health, Clayton, Victoria, Australia
- Monash University, Monash University, Clayton, Victoria, Australia
| | - Kate Klein
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Chidambaram Prakash
- Department of Psychiatry, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katherine Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andrew Davidson
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jonathan C Knott
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
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16
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Wu Y, Mascaro S, Bhuiyan M, Fathima P, Mace AO, Nicol MP, Richmond PC, Kirkham LA, Dymock M, Foley DA, McLeod C, Borland ML, Martin A, Williams PCM, Marsh JA, Snelling TL, Blyth CC. Predicting the causative pathogen among children with pneumonia using a causal Bayesian network. PLoS Comput Biol 2023; 19:e1010967. [PMID: 36913404 PMCID: PMC10035934 DOI: 10.1371/journal.pcbi.1010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/23/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incorporating both domain expert knowledge and numerical data. METHODS We used domain expert knowledge and data in combination and iteratively, to construct, parameterise and validate a causal BN to predict causative pathogens for childhood pneumonia. Expert knowledge elicitation occurred through a series of group workshops, surveys and one-on-one meetings involving 6-8 experts from diverse domain areas. The model performance was evaluated based on both quantitative metrics and qualitative expert validation. Sensitivity analyses were conducted to investigate how the target output is influenced by varying key assumptions of a particularly high degree of uncertainty around data or domain expert knowledge. RESULTS Designed to apply to a cohort of children with X-ray confirmed pneumonia who presented to a tertiary paediatric hospital in Australia, the resulting BN offers explainable and quantitative predictions on a range of variables of interest, including the diagnosis of bacterial pneumonia, detection of respiratory pathogens in the nasopharynx, and the clinical phenotype of a pneumonia episode. Satisfactory numeric performance has been achieved including an area under the receiver operating characteristic curve of 0.8 in predicting clinically-confirmed bacterial pneumonia with sensitivity 88% and specificity 66% given certain input scenarios (i.e., information that is available and entered into the model) and trade-off preferences (i.e., relative weightings of the consequences of false positive versus false negative predictions). We specifically highlight that a desirable model output threshold for practical use is very dependent upon different input scenarios and trade-off preferences. Three commonly encountered scenarios were presented to demonstrate the potential usefulness of the BN outputs in various clinical pictures. CONCLUSIONS To our knowledge, this is the first causal model developed to help determine the causative pathogen for paediatric pneumonia. We have shown how the method works and how it would help decision making on the use of antibiotics, providing insight into how computational model predictions may be translated to actionable decisions in practice. We discussed key next steps including external validation, adaptation and implementation. Our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings.
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Affiliation(s)
- Yue Wu
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Mascaro
- Bayesian Intelligence Pty Ltd, Upwey, Victoria, Australia
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Mejbah Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Parveen Fathima
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Ariel O Mace
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mark P Nicol
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Michael Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - David A Foley
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Microbiology, PathWest Laboratory Medicine QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Charlie McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew Martin
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Phoebe C M Williams
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Children's Hospitals Network, New South Wales, Australia
- School of Women's and Children's Health, The University of New South Wales, Kensington, New South Wales, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Thomas L Snelling
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Sydney Children's Hospitals Network, New South Wales, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Microbiology, PathWest Laboratory Medicine QEII Medical Centre, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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17
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Franklin D, Babl FE, George S, Oakley E, Borland ML, Neutze J, Acworth J, Craig S, Jones M, Gannon B, Shellshear D, McCay H, Wallace A, Hoeppner T, Wildman M, Mattes J, Pham TMT, Miller L, Williams A, O’Brien S, Lawrence S, Bonisch M, Gibbons K, Moloney S, Waugh J, Hobbins S, Grew S, Fahy R, Dalziel SR, Schibler A. Effect of Early High-Flow Nasal Oxygen vs Standard Oxygen Therapy on Length of Hospital Stay in Hospitalized Children With Acute Hypoxemic Respiratory Failure: The PARIS-2 Randomized Clinical Trial. JAMA 2023; 329:224-234. [PMID: 36648469 PMCID: PMC9856857 DOI: 10.1001/jama.2022.21805] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown. OBJECTIVE To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial was conducted at 14 metropolitan and tertiary hospitals in Australia and New Zealand, including 1567 children aged 1 to 4 years (randomized between December 18, 2017, and March 18, 2020) requiring hospital admission for acute hypoxemic respiratory failure. The last participant follow-up was completed on March 22, 2020. INTERVENTIONS Enrolled children were randomly allocated 1:1 to high-flow oxygen therapy (n = 753) or standard oxygen therapy (n = 764). The type of oxygen therapy could not be masked, but the investigators remained blinded until the outcome data were locked. MAIN OUTCOMES AND MEASURES The primary outcome was length of hospital stay with the hypothesis that high-flow oxygen therapy reduces length of stay. There were 9 secondary outcomes, including length of oxygen therapy and admission to the intensive care unit. Children were analyzed according to their randomization group. RESULTS Of the 1567 children who were randomized, 1517 (97%) were included in the primary analysis (median age, 1.9 years [IQR, 1.4-3.0 years]; 732 [46.7%] were female) and all children completed the trial. The length of hospital stay was significantly longer in the high-flow oxygen group with a median of 1.77 days (IQR, 1.03-2.80 days) vs 1.50 days (IQR, 0.85-2.44 days) in the standard oxygen group (adjusted hazard ratio, 0.83 [95% CI, 0.75-0.92]; P < .001). Of the 9 prespecified secondary outcomes, 4 showed no significant difference. The median length of oxygen therapy was 1.07 days (IQR, 0.50-2.06 days) in the high-flow oxygen group vs 0.75 days (IQR, 0.35-1.61 days) in the standard oxygen therapy group (adjusted hazard ratio, 0.78 [95% CI, 0.70-0.86]). In the high-flow oxygen group, there were 94 admissions (12.5%) to the intensive care unit compared with 53 admissions (6.9%) in the standard oxygen group (adjusted odds ratio, 1.93 [95% CI, 1.35-2.75]). There was only 1 death and it occurred in the high-flow oxygen group. CONCLUSIONS AND RELEVANCE Nasal high-flow oxygen used as the initial primary therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not significantly reduce the length of hospital stay compared with standard oxygen therapy. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12618000210279.
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Affiliation(s)
- Donna Franklin
- Children’s Emergency and Critical Care Research, Gold Coast University Hospital, Southport, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
| | - Franz E. Babl
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Shane George
- Children’s Emergency and Critical Care Research, Gold Coast University Hospital, Southport, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meredith L. Borland
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Crawley
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Jason Acworth
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Australia
- Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Mark Jones
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brenda Gannon
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - Deborah Shellshear
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Australia
| | - Hamish McCay
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Alexandra Wallace
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
| | - Mark Wildman
- Emergency Department, Townsville University Hospital, Douglas, Australia
| | - Joerg Mattes
- Paediatric Respiratory and Sleep Medicine, John Hunter Children’s Hospital, New Lambton Heights, Australia
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, Australia
| | - Trang M. T. Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Letitia Miller
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Amanda Williams
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sharon O’Brien
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
| | - Shirley Lawrence
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Megan Bonisch
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
| | - Kristen Gibbons
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Susan Moloney
- Paediatric Department, Gold Coast University Hospital, Griffith University School of Medicine, Southport, Australia
| | - John Waugh
- Paediatric Department, Ipswich General Hospital, Ipswich, Australia
- Paediatric Department, Caboolture Hospital, Caboolture, Australia
| | - Sue Hobbins
- Paediatric and Emergency Departments, Prince Charles Hospital, Chermside, Australia
| | - Simon Grew
- Paediatric Department, Redcliffe Hospital, Redcliffe, Australia
| | - Rose Fahy
- Paediatric and Emergency Departments, Prince Charles Hospital, Chermside, Australia
| | - Stuart R. Dalziel
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- St Andrew’s War Memorial Hospital, Brisbane, Australia
- Critical Care Research Group, St Andrew’s War Memorial Hospital, Brisbane, Australia
- Wesley Medical Research, Wesley Hospital, Auchenflower, Australia
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O’Brien SL, Haskell L, Tavender EJ, Wilson S, Borland ML, Oakley E, Dalziel SR, Gill FJ. Factors influencing health professionals' use of high-flow nasal cannula therapy for infants with bronchiolitis - A qualitative study. Front Pediatr 2023; 11:1098577. [PMID: 37009298 PMCID: PMC10060553 DOI: 10.3389/fped.2023.1098577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
Aim To explore the factors influencing the use of high-flow nasal cannula (HFNC) therapy for infants with bronchiolitis. Design Qualitative approach using semi-structured interviews. Methods The semi-structured interviews (face-to-face or virtual) were conducted between September 2020 and February 2021. Deductive content analysis was used to map key influencing factors for use of HFNC therapy to the Theoretical Domains Framework (TDF). Results Nineteen interviews were undertaken before reaching thematic saturation (7 nurses, 12 doctors) in emergency departments and paediatric wards from four purposively selected hospitals in Australia and New Zealand. Influencing factors were mapped to eight domains in the TDF with 21 themes identified. Main findings included: (1) Health professionals' expectations of HFNC therapy on patient deterioration, work of breathing and oxygenation; (2) Staff emotions relating to concern and anxiety about deterioration and "need to do something"; (3) Social influences from other health professionals and parents and (4) Environmental factors relating to logistics of care and patient transfer considerations. These factors, combined with the ready availability of HFNC equipment and health professionals having the required skills to administer the therapy, contributed to its initiation. Conclusion Individual/personal and contextual/environmental factors contribute to the use of HFNC therapy for infants with bronchiolitis. It is evident these influences contribute substantially to increased use, despite evidence-based guidelines recommending a more nuanced approach to this therapy. These findings will inform a targeted implementation intervention to promote evidence-based use of HFNC therapy in infants with bronchiolitis.
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Affiliation(s)
- Sharon L. O’Brien
- Emergency Department, Perth Children's Hospital, Nedlands, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Correspondence: Sharon L. O’Brien sharon.o’
| | - Libby Haskell
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Emma J. Tavender
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, VIC, Australia
| | - Sally Wilson
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Meredith L. Borland
- Emergency Department, Perth Children's Hospital, Nedlands, WA, Australia
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ed Oakley
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Emergency Department, Royal Children’s Hospital, Parkville, VIC, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, VIC, Australia
| | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Fenella J. Gill
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- enAble Institute, Curtin University, Bentley, WA, Australia
- Nursing Research, Perth Children’s Hospital, Child & Adolescent Health Service, Nedlands, WA, Australia
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19
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Zhang M, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, Mackay MT, Lee KJ, Hearps S. Agreement of Clinician‐Administered and Modified Parent‐Administered House‐Brackmann Scales in Children with Bell's Palsy. OTO Open 2023; 7:e44. [PMID: 36998545 PMCID: PMC10046699 DOI: 10.1002/oto2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/30/2023] Open
Abstract
Objective Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy. Study Design Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years). Setting Multicenter study at pediatric hospitals with recruitment in emergency departments. Methods Children were recruited within 72 hours of symptom onset and assessed using the clinician-administered and the parent-administered modified HB scales at baseline, and at 1, 3, and 6 months until recovered. Agreement between the 2 scales was assessed using intraclass coefficient (ICC) and a Bland-Altman plot. Results Data were available for 174 of the 187 children randomized from at least 1 study time point. The mean ICC between clinician and parent HB scores across all time points was 0.88 (95% confidence interval, CI: 0.86, 0.90). The ICC for the data collected at baseline was 0.53 (95% CI: 0.43, 0.64), at 1 month was 0.88 (95% CI: 0.84, 0.91), at 3 months was 0.80 (95% CI: 0.71, 0.87) and at 6 months was 0.73 (95% CI: 0.47, 0.89). A Bland-Altman plot indicated a mean difference between the 2 scores (clinician-reported minus parent-reported) of only -0.07 (95% limits of agreement -1.37 to 1.23). Conclusion There was good agreement between the modified parent-administered and the clinician-administered HB scales.
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Affiliation(s)
- Franz E. Babl
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Nitaa Eapen
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - David Herd
- Emergency DepartmentQueensland Children's HospitalBrisbaneQueenslandAustralia
- Child Health Research CentreUniversity of QueenslandBrisbaneQueenslandAustralia
- Mater Research InstituteBrisbaneQueenslandAustralia
| | - Meredith L. Borland
- Emergency DepartmentPerth Children's HospitalPerthAustralia
- Divisions of Emergency Medicine and PaediatricsUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Amit Kochar
- Emergency DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Michael Zhang
- Emergency DepartmentJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Ed Oakley
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Sandy M. Hopper
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Robert G. Berkowitz
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of OtolaryngologyRoyal Children's HospitalParkvilleVictoriaAustralia
| | - Catherine L. Wilson
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Amanda Williams
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Mark T. Mackay
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyRoyal Children's HospitalParkvilleVictoriaAustralia
| | - Katherine J. Lee
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Melbourne Children's Trial Centre, Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteVictoriaParkvilleAustralia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Critical Care, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
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O'Brien S, Haskell L, Schembri R, Gill FJ, Wilson S, Borland ML, Oakley E, Dalziel SR. Prevalence of high flow nasal cannula therapy use for management of infants with bronchiolitis in Australia and New Zealand. J Paediatr Child Health 2022; 58:2230-2235. [PMID: 36066264 PMCID: PMC10947204 DOI: 10.1111/jpc.16199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 11/27/2022]
Abstract
AIM To determine the prevalence of high flow nasal cannula (HFNC) therapy in infants presenting to hospital in Australia and New Zealand with bronchiolitis over four bronchiolitis seasons. Secondary aims were to determine temporal trends in HFNC use, and associations between HFNC, hospital length of stay (LOS) and intensive care unit (ICU) admission. METHODS A planned sub-study of a multi-centre international cluster randomised controlled trial investigating knowledge translation strategies for a bi-national bronchiolitis guideline. Demographics, management and outcomes data were collected retrospectively for infants presenting with bronchiolitis to 26 hospitals between 1 May 2014 and 30 November 2017. Prevalence data are presented as absolute frequencies (95% confidence interval (CI)) with differences between groups for continuous and categorical variables analysed using linear and logistic regression, respectively. RESULTS 11 715 infants were included with 3392 (29.0%, 95% CI (28.1-29.8%)) receiving oxygen therapy; of whom 1817 (53.6%, 95% CI (51.9-55.3%)) received HFNC. Use of oxygen therapy did not change over the four bronchiolitis seasons (P = 0.12), while the proportion receiving HFNC increased (2014, 336/2587 (43.2%); 2017, 609/3720 (57.8%); P ≤ 0.001). Infants who received HFNC therapy were not substantially different to infants who received oxygen therapy without HFNC. HFNC use was associated with increases in both hospital LOS (P < 0.001) and ICU admissions (P < 0.001). CONCLUSION Use of HFNC therapy for infants with bronchiolitis increased over 4 years. Of those who received oxygen therapy, the majority received HFNC therapy without improvement in hospital LOS or ICU admissions. Strategies to guide appropriate HFNC use in infants with bronchiolitis are required.
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Affiliation(s)
- Sharon O'Brien
- Emergency DepartmentPerth Children's HospitalPerthWestern AustraliaAustralia
- School of Nursing, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Libby Haskell
- Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Rachel Schembri
- Clinical Epidemiology and BiostatisticsMelbourne Children's Trials Centre, Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Fenella J Gill
- School of Nursing, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Child & Adolescent Health ServicePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Sally Wilson
- School of Nursing, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Meredith L Borland
- Emergency DepartmentPerth Children's HospitalPerthWestern AustraliaAustralia
- Divisions of Emergency Medicine and Paediatrics, School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Ed Oakley
- Emergency DepartmentRoyal Children's HospitalParkvilleVictoriaAustralia
- Emergency ResearchMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Departments of Paediatrics and Critical CareUniversity of MelbourneMelbourneVictoriaAustralia
| | - Stuart R Dalziel
- Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand
- Departments of Surgery and Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
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21
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Zhang M, Velusamy K, Sullivan F, Oakley E, Davidson A, Hopper SM, Cheek JA, Berkowitz RG, Hearps S, Wilson CL, Williams A, Elborough H, Legge D, Mackay MT, Lee KJ, Dalziel SR. Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology 2022; 99:e2241-e2252. [PMID: 36008143 DOI: 10.1212/wnl.0000000000201164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. METHODS We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). RESULTS Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. DISCUSSION In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. TRIAL REGISTRATION INFORMATION Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.
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Affiliation(s)
- Franz E Babl
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand.
| | - David Herd
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Meredith L Borland
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amit Kochar
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ben Lawton
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Jason Hort
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Adam West
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Shane George
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Michael Zhang
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Karthik Velusamy
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Frank Sullivan
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ed Oakley
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Andrew Davidson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Sandy M Hopper
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - John A Cheek
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Robert G Berkowitz
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stephen Hearps
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Catherine L Wilson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amanda Williams
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Hannah Elborough
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Donna Legge
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Mark T Mackay
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Katherine J Lee
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stuart R Dalziel
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
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22
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Ramsay JA, Mascaro S, Campbell AJ, Foley DA, Mace AO, Ingram P, Borland ML, Blyth CC, Larkins NG, Robertson T, Williams PCM, Snelling TL, Wu Y. Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data. BMC Med Res Methodol 2022; 22:218. [PMID: 35941543 PMCID: PMC9358867 DOI: 10.1186/s12874-022-01695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing urinary tract infections (UTIs) in children in the emergency department (ED) is challenging due to the variable clinical presentations and difficulties in obtaining a urine sample free from contamination. Clinicians need to weigh a range of observations to make timely diagnostic and management decisions, a difficult task to achieve without support due to the complex interactions among relevant factors. Directed acyclic graphs (DAG) and causal Bayesian networks (BN) offer a way to explicitly outline the underlying disease, contamination and diagnostic processes, and to further make quantitative inference on the event of interest thus serving as a tool for decision support. METHODS We prospectively collected data on children present to ED with suspected UTIs. Through knowledge elicitation workshops and one-on-one meetings, a DAG was co-developed with clinical domain experts (the Expert DAG) to describe the causal relationships among variables relevant to paediatric UTIs. The Expert DAG was combined with prospective data and further domain knowledge to inform the development of an application-oriented BN (the Applied BN), designed to support the diagnosis of UTI. We assessed the performance of the Applied BN using quantitative and qualitative methods. RESULTS We summarised patient background, clinical and laboratory characteristics of 431 episodes of suspected UTIs enrolled from May 2019 to November 2020. The Expert DAG was presented with a narrative description, elucidating how infection, specimen contamination and management pathways causally interact to form the complex picture of paediatric UTIs. Parameterised using prospective data and expert-elicited parameters, the Applied BN achieved an excellent and stable performance in predicting Escherichia coli culture results, with a mean area under the receiver operating characteristic curve of 0.86 and a mean log loss of 0.48 based on 10-fold cross-validation. The BN predictions were reviewed via a validation workshop, and we illustrate how they can be presented for decision support using three hypothetical clinical scenarios. CONCLUSION Causal BNs created from both expert knowledge and data can integrate case-specific information to provide individual decision support during the diagnosis of paediatric UTIs in ED. The model aids the interpretation of culture results and the diagnosis of UTIs, promising the prospect of improved patient care and judicious use of antibiotics.
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Affiliation(s)
- Jessica A Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Steven Mascaro
- Bayesian Intelligence Pty Ltd, Upwey, VIC, 3158, Australia.,Faculty of Information Technology, Monash University, Clayton, VIC, 3168, Australia
| | - Anita J Campbell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, 6009, Australia
| | - David A Foley
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, 6009, Australia
| | - Ariel O Mace
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia.,Department of General Paediatrics, Perth Children's Hospital, Nedlands, WA, 6009, Australia
| | - Paul Ingram
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, 6009, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, WA, 6009, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, 6009, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, 6009, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia
| | - Nicholas G Larkins
- Department of Nephrology, Perth Children's Hospital, Nedlands, WA, 6009, Australia
| | - Tim Robertson
- Child and Adolescent Health Service, Perth Children's Hospital, Nedlands, WA, 6009, Australia
| | - Phoebe C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 2006, Camperdown, NSW , Australia.,Sydney Children's Hospital Network, Randwick, NSW, 2031, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 2006, Camperdown, NSW , Australia.,Sydney Children's Hospital Network, Randwick, NSW, 2031, Australia.,School of Public Health, Curtin University, Bentley, WA, 6102, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0815, Australia
| | - Yue Wu
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, 6009, Australia. .,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 2006, Camperdown, NSW , Australia.
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23
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Abstract
Viral bronchiolitis is the most common cause of admission to hospital for infants in high-income countries. Respiratory syncytial virus accounts for 60-80% of bronchiolitis presentations. Bronchiolitis is diagnosed clinically without the need for viral testing. Management recommendations, based predominantly on high-quality evidence, advise clinicians to support hydration and oxygenation only. Evidence suggests no benefit with use of glucocorticoids or bronchodilators, with further evidence required to support use of hypertonic saline in bronchiolitis. Evidence is scarce in the intensive care unit. Evidence suggests use of high-flow therapy in bronchiolitis is limited to rescue therapy after failure of standard subnasal oxygen only in infants who are hypoxic and does not decrease rates of intensive care unit admission or intubation. Despite systematic reviews and international clinical practice guidelines promoting supportive rather than interventional therapy, universal de-implementation of interventional care in bronchiolitis has not occurred and remains a major challenge.
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Affiliation(s)
- Stuart R Dalziel
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
| | - Libby Haskell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Franz E Babl
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
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24
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Funk AL, Kuppermann N, Florin TA, Tancredi DJ, Xie J, Kim K, Finkelstein Y, Neuman MI, Salvadori MI, Yock-Corrales A, Breslin KA, Ambroggio L, Chaudhari PP, Bergmann KR, Gardiner MA, Nebhrajani JR, Campos C, Ahmad FA, Sartori LF, Navanandan N, Kannikeswaran N, Caperell K, Morris CR, Mintegi S, Gangoiti I, Sabhaney VJ, Plint AC, Klassen TP, Avva UR, Shah NP, Dixon AC, Lunoe MM, Becker SM, Rogers AJ, Pavlicich V, Dalziel SR, Payne DC, Malley R, Borland ML, Morrison AK, Bhatt M, Rino PB, Beneyto Ferre I, Eckerle M, Kam AJ, Chong SL, Palumbo L, Kwok MY, Cherry JC, Poonai N, Waseem M, Simon NJ, Freedman SB. Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Netw Open 2022; 5:e2223253. [PMID: 35867061 PMCID: PMC9308058 DOI: 10.1001/jamanetworkopen.2022.23253] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. OBJECTIVES To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. EXPOSURE SARS-CoV-2 detected via nucleic acid testing. MAIN OUTCOMES AND MEASURES Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. RESULTS Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Kristen A Breslin
- Department of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Michael A Gardiner
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego
| | | | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nidhya Navanandan
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Children's Hospital of Michigan, Detroit
- Department of Pediatrics, Central Michigan University, Mt Pleasant
| | - Kerry Caperell
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, Norton Children's Hospital, Louisville, Kentucky
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Andrew C Dixon
- University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Maren M Lunoe
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah M Becker
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah
| | - Alexander J Rogers
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro B Rino
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan," RIDEPLA, Buenos Aires, Argentina
| | | | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - April J Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia-Pronto soccorso pediatrico, Brescia, Italy
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, New York, New York
| | - Norma-Jean Simon
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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25
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Furyk JS, George S, Phillips N, Emeto TI, Watt K, O'Brien S, Riney K, Wilson C, Hearps SJ, Borland ML, Dalziel SR, Babl FE. Status Epilepticus Australasian Registry for Children: A pilot prospective, observational, cohort study of paediatric status epilepticus. Emerg Med Australas 2022; 34:801-807. [PMID: 35466541 DOI: 10.1111/1742-6723.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Paediatric status epilepticus (SE) has potential for long-term sequelae. Existing data demonstrate delays to aspects of care. The objective of the present study was to examine the feasibility of collecting data on children with paediatric SE and describe current management strategies in pre-hospital and in-hospital settings. METHODS A pilot, prospective, observational cohort study of children 4 weeks to 16 years of age with SE, in four EDs in Australia. Clinical details including medications administered, duration of seizure and short-term outcomes were collected. Follow up occurred by telephone at 1 month. RESULTS We enrolled 167 children with SE. Mean age was 5.4 years (standard deviation [SD] 4.1), and 81 (49%) male. Median seizure duration was 10 min (interquartile range 7-30). Midazolam was the first medication administered in 87/100 (87%) instances, mean dose of 0.21 mg/kg (SD 0.13). The dose of midazolam was adequate in 30 (35%), high (>0.2 mg/kg) in 44 (51%) and low (<0.1 mg/kg) in 13 (15%). For second-line agents, levetiracetam was administered on 33/55 (60%) occasions, whereas phenytoin and phenobarbitone were administered on 11/55 (20%) occasions each. Mean dose of levetiracetam was 26.4 mg/kg (SD 13.5). One hundred and four (62%) patients were admitted to hospital, with 13 (8%) admitted to ICU and seven (4%) intubated. CONCLUSION In children presenting with SE in Australia medical management differed from previous reports, with midazolam as the preferred benzodiazepine, and levetiracetam replacing phenytoin as the preferred second-line agent. This pilot study indicates the feasibility of a paediatric SE registry and its utility to understand and optimise practice.
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Affiliation(s)
- Jeremy S Furyk
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Shane George
- Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Natalie Phillips
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kate Riney
- Neurosciences Unit, Children's Health Queensland/School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Jc Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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26
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Long E, Babl FE, Phillips N, Craig S, Zhang M, Kochar A, McCaskill M, Borland ML, Slavin MA, Phillips R, Lourenco RDA, Michinaud F, Thursky KA, Haeusler G. Prevalence and predictors of poor outcome in children with febrile neutropaenia presenting to the emergency department. Emerg Med Australas 2022; 34:786-793. [PMID: 35419955 DOI: 10.1111/1742-6723.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/20/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Children with acquired neutropaenia due to cancer chemotherapy are at high risk of severe infection. The present study aims to describe the prevalence and predictors of poor outcomes in children with febrile neutropaenia (FN). METHODS This is a multicentre, prospective observational study in tertiary Australian EDs. Cancer patients with FN were included. Fever was defined as a single temperature ≥38°C, and neutropaenia was defined as an absolute neutrophil count <1000/mm3 . The primary outcome was the ICU admission for organ support therapy (inotropic support, mechanical ventilation, renal replacement therapy, extracorporeal life support). Secondary outcomes were: ICU admission, ICU length of stay (LOS) ≥3 days, proven or probable bacterial infection, hospital LOS ≥7 days and 28-day mortality. Initial vital signs, biomarkers (including lactate) and clinical sepsis scores, including Systemic Inflammatory Response Syndrome, quick Sequential Organ Failure Assessment and quick Paediatric Logistic Organ Dysfunction-2 were evaluated as predictors of poor outcomes. RESULTS Between December 2016 and January 2018, 2124 episodes of fever in children with cancer were screened, 547 episodes in 334 children met inclusion criteria. Four episodes resulted in ICU admission for organ support therapy, nine episodes required ICU admission, ICU LOS was ≥3 days in four, hospital LOS was ≥7 days in 153 and two patients died within 28 days. Vital signs, blood tests and clinical sepsis scores, including Systemic Inflammatory Response Syndrome, quick Sequential Organ Failure Assessment and quick Paediatric Logistic Organ Dysfunction-2, performed poorly as predictors of these outcomes (area under the receiver operating characteristic curve <0.6). CONCLUSIONS Very few patients with FN required ICU-level care. Vital signs, biomarkers and clinical sepsis scores for the prediction of poor outcomes are of limited utility in children with FN.
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Affiliation(s)
- Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Craig
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Zhang
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mary McCaskill
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Disease Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, UK.,Leed's Children's Hospital, Leeds General Infirmary, Leeds, UK
| | - Richard De A Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Francoise Michinaud
- Children's Cancer Centre, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Unité d'Hématologie Immunologie Pédiatrique, Hôpital Robert-Debré, APHP Nord Université de Paris, Paris, France
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Disease Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gabrielle Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,The Victorian Paediatric Integrated Cancer Service, Victorian State Government, Melbourne, Victoria, Australia
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27
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Hollaway W, Borland ML. Return visits to the paediatric emergency department. Emerg Med Australas 2022; 34:584-589. [PMID: 35322579 DOI: 10.1111/1742-6723.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the rate of unplanned return visits (uRVs) within 48 h to a paediatric ED over a 12-month period and describe the factors associated with these uRV. METHODS Retrospective review of electronic data regarding the initial and follow-up visit at a tertiary paediatric hospital ED in Western Australia. The primary outcome was the number of patients who presented for uRV within 48 h of their initial ED visit. RESULTS Between August 2018 and July 2019, 2322 patients returned to the ED for a uRV comprising 3.4% of 68 352 ED presentations with more than 53% returning with infectious causes. Triage category 3 patients were most likely to represent (OR 1.11, P = 0.029) with 3-month to 1-year old (OR 1.37, P < 0.00001) and 1-5-year old (OR 1.32, P < 0.00001) the commonest age groups. There was seasonal variation in uRVs demonstrating a greater number in the winter months. The percentage of uRVs to overall ED presentations was greater in the summer months (3.8-4.1%). There was a significant increase in uRVs occurring up to 2 weeks after the changeovers in middle-grade ED doctors only. CONCLUSIONS The present study has demonstrated associations between uRV and initial-visit triage category 3, age between 3 months and 5 years, and presentations because of infectious illness. Middle-grade doctor changeover was also associated with an increase in uRVs.
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Affiliation(s)
- William Hollaway
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Health and Medical Sciences (Pediatrics and Emergency Medicine), The University of Western Australia, Perth, Western Australia, Australia
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28
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Craig S, Powell CVE, Nixon GM, Oakley E, Hort J, Armstrong DS, Ranganathan S, Kochar A, Wilson C, George S, Phillips N, Furyk J, Lawton B, Borland ML, O'Brien S, Neutze J, Lithgow A, Mitchell C, Watkins N, Brannigan D, Wood J, Gray C, Hearps S, Ramage E, Williams A, Lew J, Jones L, Graudins A, Dalziel S, Babl FE. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ Open Respir Res 2022; 9:9/1/e001137. [PMID: 35301198 PMCID: PMC8932260 DOI: 10.1136/bmjresp-2021-001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. OBJECTIVES To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. METHODS Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). MEASUREMENTS AND MAIN RESULTS Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). CONCLUSIONS Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.
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Affiliation(s)
- Simon Craig
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia .,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Department of Emergency Medicine, Sidra Medicine, Ad-Dawhah, Doha, Qatar
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Jason Hort
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - David S Armstrong
- Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Sarath Ranganathan
- Respiratory Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Catherine Wilson
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Shane George
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia.,Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Natalie Phillips
- Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Jeremy Furyk
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ben Lawton
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Emergency Department, Logan Hospital, Loganholme, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Nursing, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Jocelyn Neutze
- Kidz First Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | - Anna Lithgow
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Clare Mitchell
- Emergency Department, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Nick Watkins
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Domhnall Brannigan
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Joanna Wood
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine Gray
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Hearps
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Ramage
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Paediatric Intensive Care, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Amanda Williams
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jamie Lew
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leonie Jones
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Andis Graudins
- Emergency Department, Dandenong Hospital, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand.,Departments of Surgery and Paediatrics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Auckland, New Zealand
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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29
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Foley DA, Phuong LK, Peplinski J, Lim SM, Lee WH, Farhat A, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Hoeppner T, Borland ML, Hazelton B, Moore HC, Blyth C, Yeoh DK, Bowen AC. Examining the interseasonal resurgence of respiratory syncytial virus in Western Australia. Arch Dis Child 2022; 107:e7. [PMID: 34433552 PMCID: PMC8390145 DOI: 10.1136/archdischild-2021-322507] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Following a relative absence in winter 2020, a large resurgence of respiratory syncytial virus (RSV) detections occurred during the 2020/2021 summer in Western Australia. This seasonal shift was linked to SARS-CoV-2 public health measures. We examine the epidemiology and RSV testing of respiratory-coded admissions, and compare clinical phenotype of RSV-positive admissions between 2019 and 2020. METHOD At a single tertiary paediatric centre, International Classification of Diseases, 10th edition Australian Modification-coded respiratory admissions longer than 12 hours were combined with laboratory data from 1 January 2019 to 31 December 2020. Data were grouped into bronchiolitis, other acute lower respiratory infection (OALRI) and wheeze, to assess RSV testing practices. For RSV-positive admissions, demographics and clinical features were compared between 2019 and 2020. RESULTS RSV-positive admissions peaked in early summer 2020, following an absent winter season. Testing was higher in 2020: bronchiolitis, 94.8% vs 89.2% (p=0.01); OALRI, 88.6% vs 82.6% (p=0.02); and wheeze, 62.8% vs 25.5% (p<0.001). The 2020 peak month, December, contributed almost 75% of RSV-positive admissions, 2.5 times the 2019 peak. The median age in 2020 was twice that observed in 2019 (16.4 vs 8.1 months, p<0.001). The proportion of RSV-positive OALRI admissions was greater in 2020 (32.6% vs 24.9%, p=0.01). There were no clinically meaningful differences in length of stay or disease severity. INTERPRETATION The 2020 RSV season was in summer, with a larger than expected peak. There was an increase in RSV-positive non-bronchiolitis admissions, consistent with infection in older RSV-naïve children. This resurgence raises concern for regions experiencing longer and more stringent SARS-CoV-2 public health measures.
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Affiliation(s)
- David Anthony Foley
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Linny Kimly Phuong
- Murdoch Children's Research Institute, Infection and Immunity, Parkville, Victoria, Australia
| | - Joseph Peplinski
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Selina Mei Lim
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wei Hao Lee
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Asifa Farhat
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Cara A Minney-Smith
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ariel O Mace
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chisha T Sikazwe
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Huong Le
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Avram Levy
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infection and Immunity, Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Briony Hazelton
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christopher Blyth
- Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
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30
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Fairbrother SL, Borland ML. Re: Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2022. [PMID: 35132788 DOI: 10.1111/1742-6723.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Susan L Fairbrother
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
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31
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Haskell L, Tavender EJ, O'Brien S, Wilson CL, Borland ML, Cotterell E, Babl FE, Zannino D, Sheridan N, Oakley E, Dalziel SR. Can targeted interventions change the factors influencing variation in management of infants with bronchiolitis? A survey of Australian and New Zealand clinicians: A paediatric research in emergency departments international collaborative (PREDICT) study. J Paediatr Child Health 2022; 58:302-311. [PMID: 34498782 DOI: 10.1111/jpc.15710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to determine whether targeted interventions, proven to be effective at improving evidence-based bronchiolitis management, changed factors previously found to influence variation in bronchiolitis management. METHODS This survey assessed change in factors influencing clinicians' (nurses and doctors) bronchiolitis management at baseline and post-intervention in a cluster randomised controlled trial of targeted, theory-informed interventions aiming to de-implement non-evidence-based bronchiolitis management (no use of chest X-ray, salbutamol, antibiotics, glucocorticoids and adrenaline). Survey questions addressed previously identified factors influencing bronchiolitis management from six Theoretical Domains Framework domains (knowledge; skills; beliefs about consequences; social/professional role and identity; environmental context and resources; social influences). Data analysis was descriptive. RESULTS A total of 1958 surveys (baseline = 996; post-intervention = 962) were completed by clinicians from the emergency department and paediatric inpatient units from 26 hospitals (intervention = 13; control = 13). Targeted bronchiolitis interventions significantly increased knowledge of the Australasian Bronchiolitis Guideline (intervention clinicians = 74%, control = 39%, difference = 34.7%, 95% confidence interval (CI) = 25.6-43.8%), improved skills in diagnosing (intervention doctors = 89%, control = 76%, difference = 12.6%, 95% CI = 6.2-19%) and managing bronchiolitis (intervention doctors = 87%, control = 76%, difference = 9.9%, 95% CI = 3.7-16.1%), positively influenced both beliefs about consequences regarding salbutamol use (intervention clinicians = 49%, control = 29%, difference = 20.3%, 95% CI = 13.2-27.4%) and nurses questioning non-evidence-based bronchiolitis management (chest X-ray: intervention = 71%, control = 51%, difference = 20.8%, 95% CI = 11.4-30.2%; glucocorticoids: intervention = 64%, control = 40%, difference = 21.9%, 95% CI = 10.4-33.5%) (social/professional role and identity). A 14% improvement in evidence-based bronchiolitis management favouring intervention hospitals was demonstrated in the cluster randomised controlled trial. CONCLUSION Targeted interventions positively changed factors influencing bronchiolitis management resulting in improved evidence-based bronchiolitis care. This study has important implications for improving bronchiolitis management and future development of interventions to de-implement low-value care.
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Affiliation(s)
- Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Emma J Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.,School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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32
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Doyle S, Pavlos R, Carlson SJ, Barton K, Bhuiyan M, Boeing B, Borland ML, Hoober S, Blyth CC. Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians. JMIR Form Res 2022; 6:e29889. [PMID: 35037889 PMCID: PMC8804961 DOI: 10.2196/29889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.
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Affiliation(s)
- Sarah Doyle
- Emergency Department, Perth Children's Hospital, Perth, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Samantha J Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Katherine Barton
- Emergency Department, Perth Children's Hospital, Perth, Australia
| | - Mejbah Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Bernadett Boeing
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Australia.,University of Western Australia, Perth, Australia
| | | | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,University of Western Australia, Perth, Australia.,Perth Children's Hospital, Perth, Australia
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33
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Funk AL, Florin TA, Kuppermann N, Tancredi DJ, Xie J, Kim K, Neuman MI, Ambroggio L, Plint AC, Mintegi S, Klassen TP, Salvadori MI, Malley R, Payne DC, Simon NJ, Yock-Corrales A, Nebhrajani JR, Chaudhari PP, Breslin KA, Finkelstein Y, Campos C, Bergmann KR, Bhatt M, Ahmad FA, Gardiner MA, Avva UR, Shah NP, Sartori LF, Sabhaney VJ, Caperell K, Navanandan N, Borland ML, Morris CR, Gangoiti I, Pavlicich V, Kannikeswaran N, Lunoe MM, Rino PB, Kam AJ, Cherry JC, Rogers AJ, Chong SL, Palumbo L, Angelats CM, Morrison AK, Kwok MY, Becker SM, Dixon AC, Poonai N, Eckerle M, Wassem M, Dalziel SR, Freedman SB. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open 2022; 5:e2142322. [PMID: 35015063 PMCID: PMC8753506 DOI: 10.1001/jamanetworkopen.2021.42322] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. EXPOSURES Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. MAIN OUTCOMES AND MEASURES Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. RESULTS Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). CONCLUSIONS AND RELEVANCE In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
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Affiliation(s)
- Anna L. Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A. Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark I. Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Amy C. Plint
- Children’s Hospital of Eastern Ontario, Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Richard Malley
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C. Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma-Jean Simon
- Data Analytics and Reporting, Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carmen Campos
- Hospital Universitario Miguel Servet, Pediatric Emergency Department, Zaragoza, Spain
| | - Kelly R. Bergmann
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Maala Bhatt
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fahd A. Ahmad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael A. Gardiner
- Rady Children’s Hospital, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Usha R. Avva
- School of Medicine Hackensack Meridian Health, Hackensack, New Jersey
| | - Nipam P. Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Laura F. Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vikram J. Sabhaney
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Caperell
- Norton Children’s Hospital, University of Louisville, Louisville, Kentucky
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Meredith L. Borland
- Perth Children’s Hospital, Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | | | - Maren M. Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro B. Rino
- Hospital de Pediatría “Prof Dr Juan P. Garrahan”, RIDEPLA, Buenos Aires, Argentina
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jonathan C. Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | | | - Andrea K. Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maria Y. Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York
| | - Sarah M. Becker
- University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah
| | - Andrew C. Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Naveen Poonai
- Child Health Research Institute, Division of Paediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ewe KYH, Blyth CC, McLeod C, Borland ML, Bowen AC, Yeoh DK, Campbell AJ. Re-examining Hepatitis B Postexposure Prophylaxis Following Pediatric Community-acquired Needle-stick Injury in an Era of a National Immunization Registry. Pediatr Infect Dis J 2022; 41:80-84. [PMID: 34862347 DOI: 10.1097/inf.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term hepatitis B immunity has been demonstrated following the completion of the primary vaccination series in childhood. Some guidelines recommend a hepatitis B surface antibody (anti-HBs) directed approach following community-acquired needle-stick injury (CANSI) to inform hepatitis B postexposure prophylaxis (PEP) management. We assessed the utility of anti-HBs testing post-CANSI, as well as the costing of, and adherence to PEP at a pediatric hospital. METHODS Children presenting to an Australian tertiary pediatric hospital post-CANSI (2014-2019) were identified retrospectively using medical and laboratory records. Immunization status was obtained from the Australian Immunisation Registry. RESULTS Fifty-six children with CANSI were identified. Of those with immunization records, all had completed hepatitis B vaccinations (n = 52). At presentation, 44% (n = 23) had anti-HBs <10 IU/L, which was more likely in older (≥6 years, 68%) versus younger children (OR 4.59, P < 0.02). HBIG and hepatitis B vaccine adherence was 65% (15/23) and 78% (18/23), respectively. All children (n = 14) with anti-HBs ≥4 weeks postvaccination ±HBIG, demonstrated an anamnestic response. No hepatitis B infections were detected. Using completed immunizations versus anti-HBs levels as a marker of immunity to direct PEP resulted in a projected cost savings of AUD$ 4234. CONCLUSION Anti-HBs levels <10 IU/L, despite previous vaccinations, were frequent in children post-CANSI, with many demonstrating an anamnestic response. Adherence to postexposure HBIG and hepatitis B vaccine was suboptimal using an anti-HBs directed approach. These data support re-evaluating PEP in an era of the national immunization registry; completion of hepatitis B vaccinations as a marker of immunity provides a practical approach, ensuring optimized care for pediatric CANSI.
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Affiliation(s)
- Krist Y H Ewe
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - Christopher C Blyth
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia
| | - Charlie McLeod
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Perth, Western Australia
- Department of Emergency Medicine, Perth Children's Hospital, Nedlands, Australia
| | - Asha C Bowen
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
| | - Daniel K Yeoh
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria
| | - Anita J Campbell
- From the Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
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Abstract
BACKGROUND Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED). OBJECTIVES The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED. METHODS A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site. The primary outcome was to describe the prevalence of CSAP and appendicitis. Age, sex, length of stay, surgery or interventional procedure, investigations, and analgesia use were recorded. RESULTS There were 555 presentations with abdominal pain during the study period with a median age of 9 years (interquartile range, 6-12 years). Eighty-two patients (14.8%; 95% confidence interval, 11.8-17.7) had CSAP, of which 41 (7.4%, 5.2-9.6) had appendicitis. Three hundred forty-eight (62.7%, 58.7-66.7) were discharged directly from ED, and 207 (37.3%, 33.2-41.3) were admitted. Two hundred fifty-five (45.9%, 41.8-50.1) had pathology tests, and 173 (31.2%, 27.3-35.1) had imaging tests in ED. Of those contacted for telephone follow-up, 100 (50.5%, 43.5-57.5) of 198 reported ongoing pain after discharge, and 13.1% (8.4-17.8) had missed over a week of school due to abdominal pain. CONCLUSIONS The prevalence of CSAP and appendicitis in our study was 14.8% (11.8-17.7) and 7.4% (5.2-9.6), respectively. Fewer than half of patients received blood tests, and a third received imaging during their ED attendance. The presentation of abdominal pain conveys a significant health burden on families with time off school and ongoing symptoms of pain.
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Affiliation(s)
- Wei Hao Lee
- From the Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia
| | - Sharon O'Brien
- From the Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia
| | - Dmitry Skarin
- From the Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia
| | | | - Jessica Deitch
- Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria
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Haskell L, Tavender EJ, O'Brien S, Wilson CL, Babl FE, Borland ML, Schembri R, Orsini F, Cotterell E, Sheridan N, Oakley E, Dalziel SR. Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management - a PREDICT mixed-methods study. BMC Health Serv Res 2021; 21:1282. [PMID: 34844605 PMCID: PMC8628472 DOI: 10.1186/s12913-021-07279-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchiolitis is the most common reason for hospitalisation in infants. All international bronchiolitis guidelines recommend supportive care, yet considerable variation in practice continues with infants receiving non-evidence based therapies. We developed six targeted, theory-informed interventions; clinical leads, stakeholder meeting, train-the-trainer, education delivery, other educational materials, and audit and feedback. A cluster randomised controlled trial (cRCT) found the interventions to be effective in reducing use of five non-evidence based therapies in infants with bronchiolitis. This process evaluation paper aims to determine whether the interventions were implemented as planned (fidelity), explore end-users' perceptions of the interventions and evaluate cRCT outcome data with intervention fidelity data. METHODS A pre-specified mixed-methods process evaluation was conducted alongside the cRCT, guided by frameworks for process evaluation of cRCTs and complex interventions. Quantitative data on the fidelity, dose and reach of interventions were collected from the 13 intervention hospitals during the study and analysed using descriptive statistics. Qualitative data identifying perception and acceptability of interventions were collected from 42 intervention hospital clinical leads on study completion and analysed using thematic analysis. RESULTS The cRCT found targeted, theory-informed interventions improved bronchiolitis management by 14.1%. The process evaluation data found variability in how the intervention was delivered at the cluster and individual level. Total fidelity scores ranged from 55 to 98% across intervention hospitals (mean = 78%; SD = 13%). Fidelity scores were highest for use of clinical leads (mean = 98%; SD = 7%), and lowest for use of other educational materials (mean = 65%; SD = 19%) and audit and feedback (mean = 65%; SD = 20%). Clinical leads reflected positively about the interventions, with time constraints being the greatest barrier to their use. CONCLUSION Our targeted, theory-informed interventions were delivered with moderate fidelity, and were well received by clinical leads. Despite clinical leads experiencing challenges of time constraints, the level of fidelity had a positive effect on successfully de-implementing non-evidence-based care in infants with bronchiolitis. These findings will inform widespread rollout of our bronchiolitis interventions, and guide future practice change in acute care settings. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415 .
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Affiliation(s)
- Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Private Bag, Auckland, 92019, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Emma J Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials, Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials, Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, Armidale, NSW, Australia.,School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | | | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Private Bag, Auckland, 92019, New Zealand. .,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Weiss SL, Balamuth F, Long E, Thompson GC, Hayes KL, Katcoff H, Cook M, Tsemberis E, Hickey CP, Williams A, Williamson-Urquhart S, Borland ML, Dalziel SR, Gelbart B, Freedman SB, Babl FE, Huang J, Kuppermann N. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials 2021; 22:776. [PMID: 34742327 PMCID: PMC8572061 DOI: 10.1186/s13063-021-05717-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background/aims Despite evidence that preferential use of balanced/buffered fluids may improve outcomes compared with chloride-rich 0.9% saline, saline remains the most commonly used fluid for children with septic shock. We aim to determine if resuscitation with balanced/buffered fluids as part of usual care will improve outcomes, in part through reduced kidney injury and without an increase in adverse effects, compared to 0.9% saline for children with septic shock. Methods The Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) study is an international, open-label pragmatic interventional trial being conducted at > 40 sites in the USA, Canada, and Australia/New Zealand starting on August 25, 2020, and continuing for 5 years. Children > 6 months to < 18 years treated for suspected septic shock with abnormal perfusion in an emergency department will be randomized to receive either balanced/buffered crystalloids (intervention) or 0.9% saline (control) for initial resuscitation and maintenance fluids for up to 48 h. Eligible patients are enrolled and randomized using serially numbered, opaque envelopes concurrent with clinical care. Given the life-threatening nature of septic shock and narrow therapeutic window to start fluid resuscitation, patients may be enrolled under “exception from informed consent” in the USA or “deferred consent” in Canada and Australia/New Zealand. Other than fluid type, all decisions about timing, volume, and rate of fluid administration remain at the discretion of the treating clinicians. For pragmatic reasons, clinicians will not be blinded to study fluid type. Anticipated enrollment is 8800 patients. The primary outcome will be major adverse kidney events within 30 days (MAKE30), a composite of death, renal replacement therapy, and persistent kidney dysfunction. Additional effectiveness, safety, and biologic outcomes will also be analyzed. Discussion PRoMPT BOLUS will provide high-quality evidence for the comparative effectiveness of buffered/balanced crystalloids versus 0.9% saline for the initial fluid management of children with suspected septic shock in emergency settings. Trial registration PRoMPT BOLUS was first registered at ClinicalTrials.gov (NCT04102371) on September 25, 2019. Enrollment started on August 25, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05717-4.
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Affiliation(s)
- Scott L Weiss
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA.
| | - Fran Balamuth
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Graham C Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katie L Hayes
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA
| | - Hannah Katcoff
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marlena Cook
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elena Tsemberis
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher P Hickey
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA
| | - Amanda Williams
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sarah Williamson-Urquhart
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meredith L Borland
- Divisions of Emergency Medicine and Pediatrics, Perth Children's Hospital, School of Medicine at the University of Western Australia, Crawley, Australia
| | - Stuart R Dalziel
- Departments of Surgery and Pediatrics: Child and Youth Health, Starship Children's Hospital, University of Auckland, Auckland, New Zealand
| | - Ben Gelbart
- Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Society Paediatric Study Group, Camberwell, Australia.,Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jing Huang
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatrics, UC Davis School of medicine and UC Davis Health, Sacramento, CA, USA
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38
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Bressan S, Eapen N, Phillips N, Gilhotra Y, Kochar A, Dalton S, Cheek JA, Furyk J, Neutze J, Williams A, Hearps S, Donath S, Oakley E, Singh S, Dalziel SR, Borland ML, Babl FE. PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study. Acad Emerg Med 2021; 28:1124-1133. [PMID: 34236116 DOI: 10.1111/acem.14308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors. METHODS This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables. RESULTS Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%-11.6%), 0.2% (95% CI = 0.0%-0.6%), and 0.0% (95% CI = 0.0%-0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%-7.2%), 0.7% (95% CI = 0.5%-1.0%), and 0.0% (95% CI = 0.0%-0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was "signs of palpable skull fracture" for younger children (11.4%, 95% CI = 5.3%-20.5%) and "signs of basilar skull fracture" in children ≥2 years (11.1%, 95% CI = 3.7%-24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%-80.6%) followed by the combination of "severe mechanism of injury" and "severe headache" (7.7%, 95% CI = 0.2%-36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis. CONCLUSIONS The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predictors will help further refine clinical judgment and decision making on neuroimaging.
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Affiliation(s)
- Silvia Bressan
- Department of Women's and Children's Health University of Padova Padova Italy
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Nitaa Eapen
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
| | - Natalie Phillips
- Queensland Children's Hospital Brisbane Queensland Australia
- Child Health Research Centre University of Queensland Brisbane Queensland Australia
| | - Yuri Gilhotra
- Queensland Children's Hospital Brisbane Queensland Australia
| | - Amit Kochar
- Emergency Department Women's & Children's Hospital Adelaide South Australia Australia
| | - Sarah Dalton
- Emergency Department The Children's Hospital at Westmead Sydney New South Wales Australia
| | - John A. Cheek
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
- Emergency Department Monash Medical Centre Melbourne Victoria Australia
| | - Jeremy Furyk
- Emergency Department The Townsville Hospital Townsville Queensland Australia
- Emergency Department University Hospital Geelong Geelong Victoria Australia
- School of Medicine Faculty of Health Deakin University Geelong Victoria Australia
| | - Jocelyn Neutze
- Emergency Department Kidzfirst Middlemore Hospital Auckland New Zealand
| | - Amanda Williams
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Stephen Hearps
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Susan Donath
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
| | - Ed Oakley
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
| | - Sonia Singh
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
- University of California Davis Medical Center Sacramento California USA
| | - Stuart R. Dalziel
- Emergency Department Starship Children's Health Auckland New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
| | - Meredith L. Borland
- Emergency Department Perth Children's Hospital Perth Western Australia Australia
- Divisions of Emergency Medicine and Paediatrics School of Medicine University of Western Australia Perth Western Australia Australia
| | - Franz E. Babl
- Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics and Centre for Integrated Critical Care Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia
- Emergency Department Royal Children's Hospital Melbourne Victoria Australia
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39
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Babl FE, Rausa VC, Borland ML, Kochar A, Lyttle MD, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Davis GA, Anderson V, Williams A, Oakley E, Dalziel SR, Crowe LM, Hearps SJC. Characteristics of concussion based on patient age and sex: a multicenter prospective observational study. J Neurosurg Pediatr 2021:1-10. [PMID: 34598158 DOI: 10.3171/2021.6.peds20953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with concussion frequently present to emergency departments (EDs). There is limited understanding of the differences in signs, symptoms, and epidemiology of concussion based on patient age. Here, the authors set out to assess the association between age and acute concussion presentations. METHODS The authors conducted a multicenter prospective observational study of head injuries at 10 EDs in Australia and New Zealand. They identified children aged 5 to < 18 years, presenting with a Glasgow Coma Scale score of 13-15, presenting < 24 hours postinjury, with no abnormalities on CT if performed, and one or more signs or symptoms of concussion. They extracted demographic, injury-related, and signs and symptoms information and stratified it by age group (5-8, 9-12, 13 to < 18 years). RESULTS Of 8857 children aged 5 to < 18 years, 4709 patients met the defined concussion criteria (5-8 years, n = 1546; 9-12 years, n = 1617; 13 to < 18 years, n = 1546). The mean age of the cohort was 10.9 years, and approximately 70% of the patients were male. Sport-related concussion accounted for 43.7% of concussions overall, increasing from 19.1% to 48.9% to 63.0% in the 5-8, 9-12, and 13 to < 18 years age groups. The most common acute symptoms postinjury were headache (64.6%), disorientation (36.2%), amnesia (30.0%), and vomiting (27.2%). Vomiting decreased with increasing age and was observed in 41.7% of the 5-8 years group, 24.7% of the 9-12 years group, and 15.4% of the 13 to < 18 years group, whereas reported loss of consciousness (LOC) increased with increasing age, occurring in 9.6% in the 5-8 years group, 21.0% in the 9-12 years group, 36.7% in the 13 to < 18 years group, and 22.4% in the entire study cohort. Headache, amnesia, and disorientation followed the latter trajectory. Symptom profiles were broadly similar between males and females. CONCLUSIONS Concussions presenting to EDs were more sports-related as age increased. Signs and symptoms differed markedly across age groups, with vomiting decreasing and headache, LOC, amnesia, and disorientation increasing with increasing age.
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Affiliation(s)
- Franz E Babl
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Vanessa C Rausa
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Meredith L Borland
- 20Emergency Department, Perth Children's Hospital, Perth, Australia; and.,21School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
| | - Amit Kochar
- 7Emergency Department, Women's & Children's Hospital, Adelaide, Australia
| | - Mark D Lyttle
- 8Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Natalie Phillips
- 9Emergency Department, Queensland Children's Hospital, Brisbane.,10Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane
| | - Yuri Gilhotra
- 9Emergency Department, Queensland Children's Hospital, Brisbane
| | - Sarah Dalton
- 11Emergency Department, The Children's Hospital at Westmead, Sydney
| | - John A Cheek
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,12Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Jeremy Furyk
- 13Emergency Department, The Townsville Hospital, Townsville, Queensland.,15School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Jocelyn Neutze
- 16Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,17Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,4Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne
| | - Vicki Anderson
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
| | - Amanda Williams
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Ed Oakley
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Stuart R Dalziel
- 18Emergency Department, Starship Children's Health, Auckland.,19Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Louise M Crowe
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
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40
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Haskell L, Tavender EJ, Wilson CL, O'Brien S, Babl FE, Borland ML, Cotterell E, Sheridan N, Oakley E, Dalziel SR. Development of targeted, theory-informed interventions to improve bronchiolitis management. BMC Health Serv Res 2021; 21:769. [PMID: 34344383 PMCID: PMC8335893 DOI: 10.1186/s12913-021-06724-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite international guidelines providing evidence-based recommendations on appropriate management of infants with bronchiolitis, wide variation in practice occurs. This results in infants receiving care of no benefit, with associated cost and is potentially harmful. Theoretical frameworks are increasingly used to develop interventions, utilising behaviour change techniques specifically chosen to target factors contributing to practice variation, with de-implementation often viewed as harder than implementing. This paper describes the stepped process using the Theoretical Domains Framework (TDF) to develop targeted, theory-informed interventions which subsequently successfully improved management of infants with bronchiolitis by de-implementing ineffective therapies. Explicit description of the process and rationale used in developing de-implementation interventions is critical to dissemination of these practices into real world clinical practice. METHODS A stepped approach was used: (1) Identify evidence-based recommendations and practice variation as targets for change, (2) Identify factors influencing practice change (barriers and enablers) to be addressed, and (3) Identification and development of interventions (behaviour change techniques and methods of delivery) addressing influencing factors, considering evidence of effectiveness, feasibility, local relevance and acceptability. The mode of delivery for the intervention components was informed by evidence from implementation science systematic reviews, and setting specific feasibility and practicality. RESULTS Five robust evidence-based management recommendations, targeting the main variation in bronchiolitis management were identified: namely, no use of chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline. Interventions developed to target recommendations addressed seven TDF domains (identified following qualitative clinician interviews (n = 20)) with 23 behaviour change techniques chosen to address these domains. Final interventions included: (1) Local stakeholder meetings, (2) Identification of medical and nursing clinical leads, (3) Train-the-trainer workshop for all clinical leads, (4) Local educational materials for delivery by clinical leads, (5) Provision of tools and materials targeting influencing factors, and prompting recommended behaviours, and (6) Audit and feedback. CONCLUSION A stepped approach based on theory, evidence and issues of feasibility, local relevance and acceptability, was successfully used to develop interventions to improve management of infants with bronchiolitis. The rationale and content of interventions has been explicitly described allowing others to de-implement unnecessary bronchiolitis management, thereby improving care.
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Affiliation(s)
- Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand. .,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Emma J Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Curtin University, Perth, Western Australia, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Austalia, Western Australia, Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.,School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | | | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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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. Effectiveness of Targeted Interventions on Treatment of Infants With Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:797-806. [PMID: 33843971 PMCID: PMC8042564 DOI: 10.1001/jamapediatrics.2021.0295] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non-evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care. OBJECTIVE To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020. INTERVENTIONS Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback. MAIN OUTCOMES AND MEASURES The primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions. RESULTS A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014-2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%; 95% CI, 6.5%-21.7%; P < .001). CONCLUSIONS AND RELEVANCE Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.
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Affiliation(s)
- Libby Haskell
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
| | - Emma J. Tavender
- Emergency Research, Murdoch Children’s Research Institute, Victoria, Australia,Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Catherine L. Wilson
- Emergency Research, Murdoch Children’s Research Institute, Victoria, Australia
| | - Sharon O’Brien
- Emergency Department, Perth Children’s Hospital, Western Australia, Australia,Curtin University, Bentley, Western Australia, Australia
| | - Franz E. Babl
- Emergency Research, Murdoch Children’s Research Institute, Victoria, Australia,Pediatric Emergency Medicine, University of Melbourne, Victoria, Australia,The Royal Children’s Hospital Melbourne, Victoria, Australia
| | - Meredith L. Borland
- Emergency Department, Perth Children’s Hospital, Western Australia, Australia,Faculty of Health and Medical Sciences (Pediatrics and Emergency Medicine), The University of Western Australia, Western Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, New South Wales, Australia,School of Rural Medicine, University of New England, New South Wales, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials Center, Murdoch Children’s Research Institute, Victoria, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials Center, Murdoch Children’s Research Institute, Victoria, Australia
| | - Nicolette Sheridan
- Center for Nursing and Health Research, Massey University, Auckland, Auckland, New Zealand
| | - David W. Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ed Oakley
- Emergency Research, Murdoch Children’s Research Institute, Victoria, Australia,The Royal Children’s Hospital Melbourne, Victoria, Australia,University of Melbourne, Victoria, Australia
| | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand,Departments of Surgery and Pediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Eapen N, Kochar A, Lyttle MD, Phillips N, Cheek JA, Furyk J, Neutze J, Bressan S, Williams A, Hearps S, Oakley E, Dalziel SR, Borland ML, Babl FE. Seizure- and syncope-related head injuries in children: A prospective PREDICT cohort study. Emerg Med Australas 2021; 33:769-771. [PMID: 34105253 DOI: 10.1111/1742-6723.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nitaa Eapen
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - John A Cheek
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidz First Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Amanda Williams
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, Divisions of Emergency Medicine and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Haeusler GM, De Abreu Lourenco R, Bakos C, O'Brien T, Slavin MA, Clark JE, McMullan B, Borland ML, Babl FE, Krishnasamy M, Vanevski M, Thursky KA, Hall L. Managing low-risk febrile neutropenia in children in the time of COVID-19: What matters to parents and clinicians. J Paediatr Child Health 2021; 57:826-834. [PMID: 33533525 PMCID: PMC8013774 DOI: 10.1111/jpc.15330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
AIM The Australian 'There is no place like home' project is implementing a paediatric low-risk febrile neutropenia (FN) programme across eight paediatric hospitals. We sought to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on programme implementation. METHODS Paediatric oncology, infectious diseases and emergency medicine health-care workers and parent/carers were surveyed to explore the impact of the COVID-19 pandemic on home-based FN care. Online surveys were distributed nationally to health-care workers involved in care of children with FN and to parents or carers of children with cancer. RESULTS Surveys were completed by 78 health-care workers and 32 parents/carers. Overall, 95% of health-care workers had confidence in the safety of home-based FN care, with 35% reporting changes at their own hospitals in response to the pandemic that made them more comfortable with this model. Compared to pre-pandemic, >50% of parent/carers were now more worried about attending the hospital with their child and >80% were interested in receiving home-based FN care. Among both groups, increased telehealth access and acceptance of home-based care, improved patient quality of life and reduced risk of nosocomial infection were identified as programme enablers, while re-direction of resources due to COVID-19 and challenges in implementing change during a crisis were potential barriers. CONCLUSION There is strong clinician and parent/carer support for home-based management of low-risk FN across Australia. Changes made to the delivery of cancer care in response to the pandemic have generally increased acceptance for home-based treatments and opportunities exist to leverage these to refine the low-risk FN programme.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,The Paediatric Integrated Cancer ServiceMelbourneVictoriaAustralia,Infection Diseases Unit, Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and EvaluationUniversity of Technology SydneySydneyNew South WalesAustralia
| | | | - Tracey O'Brien
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Monica A Slavin
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Julia E Clark
- Infection Management ServiceQueensland Children's Hospital and Centre for Children's Health Research, CHQBrisbaneQueenslandAustralia
| | - Brendan McMullan
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia
| | - Meredith L Borland
- Department of Emergency MedicinePerth Children's HospitalPerthWestern AustraliaAustralia,Emergency DepartmentPerth Children's HospitalNedlandsPerthWestern AustraliaAustralia,Divisions of Paediatrics and Emergency Medicine, School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Franz E Babl
- Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Emergency MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Meinir Krishnasamy
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Academic Nursing UnitPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,Department of NursingUniversity of MelbourneMelbourneVictoriaAustralia
| | - Marijana Vanevski
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Karin A Thursky
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia,NHMRC National Centre for Antimicrobial StewardshipThe Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
| | - Lisa Hall
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,School of Public Health, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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Tavender E, Ballard DW, Wilson A, Borland ML, Oakley E, Cotterell E, Wilson CL, Ring J, Dalziel SR, Babl FE. Review article: Developing the Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children: An adoption/adaption approach. Emerg Med Australas 2021; 33:195-201. [PMID: 33528917 DOI: 10.1111/1742-6723.13716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022]
Abstract
The Paediatric Research in Emergency Departments International Collaborative (PREDICT) released the Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children in 2021. We describe innovative and practical methods used to develop this guideline. Informed by GRADE-ADOLOPMENT and ADAPTE frameworks, we adopted or adapted recommendations from multiple high-quality guidelines or developed de novo recommendations. A Guideline Steering Committee and a multidisciplinary Guideline Working Group of 25 key stakeholder representatives formulated the guideline scope and developed 33 clinical questions. We identified four relevant high-quality source guidelines; their recommendations were mapped to clinical questions. The choice of guideline recommendation, if more than one guideline addressed a question, was based on its appropriateness, currency of the literature, access to evidence, and relevance. Updated literature searches identified 440 new studies and key new evidence identified. The decision to develop adopted, adapted or de novo recommendations was based on the supporting evidence-base and its transferability to the local setting. The guideline underwent a 12-week consultation period. The final guideline consisted of 35 evidence-informed and 17 consensus-based recommendations and 19 practice points. An algorithm to inform imaging and observation decision-making was also developed. The resulting process was an efficient and rigorous way to develop a guideline based on existing high-quality guidelines from different settings.
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Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dustin W Ballard
- Clinical Research on Emergency Services and Treatment (CREST) Network and Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Agnes Wilson
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, Divisions of Emergency Medicine and Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Ed Oakley
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Cotterell
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Catherine L Wilson
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jenny Ring
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Babl FE, Tavender E, Ballard DW, Borland ML, Oakley E, Cotterell E, Halkidis L, Goergen S, Davis GA, Perry D, Anderson V, Barlow KM, Barnett P, Bennetts S, Bhamjee R, Cole J, Craven J, Haskell L, Lawton B, Lithgow A, Mullen G, O'Brien S, Paproth M, Wilson CL, Ring J, Wilson A, Leo GS, Dalziel SR. Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children. Emerg Med Australas 2021; 33:214-231. [PMID: 33528896 DOI: 10.1111/1742-6723.13722] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings. METHODS A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas - triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high-quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation. RESULTS The GWG developed 71 recommendations (evidence-informed = 35, consensus-based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision-making for Children with Head Injuries. CONCLUSIONS The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high-level evidence and practical guidance for front line clinicians.
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Affiliation(s)
- Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dustin W Ballard
- Clinical Research on Emergency Services and Treatment (CREST) Network and Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Cotterell
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Lambros Halkidis
- Emergency Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Stacy Goergen
- Monash Health Imaging, Monash Health, Melbourne, Victoria, Australia.,Departments of Surgery and Medical Imaging, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurosurgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - David Perry
- Radiology Department, Starship Children's Hospital, Auckland, New Zealand
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Karen M Barlow
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Neurosciences Unit, Queensland Paediatric Rehabilitation Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Peter Barnett
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Scott Bennetts
- Clinical Effectiveness, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Roisin Bhamjee
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Cole
- Emergency Department, Tauranga Hospital, Tauranga, New Zealand
| | - John Craven
- Emergency Department, Women and Children's Hospital, Adelaide, South Australia, Australia.,MedSTAR, SA Ambulance, Adelaide, South Australia, Australia.,Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Ben Lawton
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Don't Forget the Bubbles, Sydney, New South Wales, Australia.,Emergency Department, Logan Hospital, Logan, Queensland, Australia
| | - Anna Lithgow
- Emergency Department, The Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Glenda Mullen
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Nursing, Curtin University, Perth, Western Australia, Australia
| | | | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jenny Ring
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Agnes Wilson
- Health Research Consulting, Sydney, New South Wales, Australia
| | - Grace Sy Leo
- Don't Forget the Bubbles, Sydney, New South Wales, Australia.,Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Lim JC, Borland ML, Middleton PM, Moore K, Shetty A, Babl FE, Lee RS, Acworth J, Wilson C, Than M, Craig S. Where are children seen in Australian emergency departments? Implications for research efforts. Emerg Med Australas 2021; 33:631-639. [PMID: 33393221 DOI: 10.1111/1742-6723.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs. METHODS Retrospective epidemiological study assessing paediatric case-mix and time-based performance metrics (aged 0-14 years) obtained from a national health service minimum dataset for the 2017-2018 financial year, comparing tertiary paediatric EDs and all other EDs. We defined a 'major tertiary paediatric hospital' as one which was accredited for training in both paediatric emergency medicine and paediatric intensive care. RESULTS Of the 1 695 854 paediatric ED presentations, 23.8% were seen in nine major metropolitan tertiary paediatric hospitals. Reasons for presentations were more distinctive between cohorts among children aged 10-14 years, where psychiatric illness (5.2% vs 2.5%) and neurological illness (4.5% vs 2.5%) were more commonly seen in major tertiary paediatric EDs. Australian Indigenous children were significantly less likely to present to tertiary paediatric EDs (3.0%), compared with other EDs (9.7%) (odds ratio 0.27, 95% confidence interval 0.26-0.27). While median waiting times were longer in major tertiary paediatric EDs (28 min [interquartile range 11-65]) than in other EDs (20 min [interquartile range 8-48], P < 0.001), patients were also less likely to leave without being seen (5.5% in tertiary paediatric EDs vs 6.9% in other EDs; odds ratio 0.80, 95% confidence interval 0.78-0.81). CONCLUSIONS The present study identified key areas of difference in paediatric presentations between tertiary paediatric EDs and other EDs. It is vital to broaden paediatric ED research beyond tertiary paediatric centres, to ensure relevance and generalisability.
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Affiliation(s)
- Jolene Cj Lim
- Policy and Research Division, Department of Policy and Strategic Partnerships, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Ingham Institute, Liverpool Hospital, Sydney, New South Wales, Australia.,Emergency Department Epidemiology Network, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,MARCS Institute, Western Sydney University, Sydney, New South Wales, Australia.,Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Katie Moore
- Policy and Research Division, Department of Policy and Strategic Partnerships, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Amith Shetty
- Emergency Department Epidemiology Network, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.,Emergency Department, NSW Ministry of Health, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Franz E Babl
- Department of Paediatrics and Centre of Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Robert S Lee
- Policy and Research Division, Department of Policy and Strategic Partnerships, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Jason Acworth
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Catherine Wilson
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Martin Than
- Emergency Department Epidemiology Network, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.,Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Simon Craig
- Emergency Department Epidemiology Network, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Emergency Program, Monash Health, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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47
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Wilson CL, Hearps SJ, Tavender EJ, Phillips NT, Lawton B, Kinnear F, Beattie A, Mitenko H, Young R, Cole J, Kochar A, George S, Teo SS, Georgeson T, Michael A, Mukherjee A, King A, Gamage L, Archer P, Cassidy C, Rao A, Thosar D, Borland ML, Babl FE. Factors predictive for computed tomography use and abnormality in paediatric head injuries in Australia and New Zealand. Emerg Med Australas 2020; 33:157-160. [PMID: 33354919 DOI: 10.1111/1742-6723.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate patient-level factors predictive for computed tomography of the brain (CTB) use and abnormality in head injured children in Australia and New Zealand. METHODS Retrospective data from tertiary, urban/suburban and regional/rural EDs including factors predictive for CTB use and abnormality. RESULTS Of 3072 children at 31 EDs, 212 (6.9%) had a CTB scan, of which 66 (31%) were abnormal. Increasing age, serious mechanisms of injury and decreasing Glasgow Coma Score were predictive for ordering CTB. Decreasing age was predictive for CTB abnormalities. Other factors were not. CONCLUSION Patient-level drivers of CTB use in children in Australia and New Zealand are consistent with international data.
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Affiliation(s)
- Catherine L Wilson
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stephen Jc Hearps
- Brain and Mind, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma J Tavender
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie T Phillips
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ben Lawton
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Emergency Department, Logan Hospital, Logan, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Don't Forget the Bubbles, Brisbane, Queensland, Australia
| | - Frances Kinnear
- Adult and Children's Emergency Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Amie Beattie
- Emergency Department, Tamworth Hospital, Tamworth, New South Wales, Australia.,Westpac Rescue Helicopter Service, Tamworth, New South Wales, Australia
| | - Hugh Mitenko
- Emergency Department, Bunbury Hospital, Bunbury, Western Australia, Australia.,Emergency Medicine Research, The University of Western Australia Medical School, Bunbury, Western Australia, Australia
| | - Russell Young
- Emergency Department, Albany Hospital, Albany, Western Australia, Australia
| | - Joanne Cole
- Emergency Department, Tauranga Hospital, Tauranga, New Zealand
| | - Amit Kochar
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shane George
- Department of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Stephen Ss Teo
- Emergency and Paediatric Departments, Blacktown and Mt Druitt Hospitals, Sydney, New South Wales, Australia.,Paediatrics and Child Health, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Thomas Georgeson
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Adam Michael
- Emergency Department, Bundaberg Hospital, Bundaberg, Queensland, Australia.,School of Medicine, Rural Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Ashes Mukherjee
- Emergency Department, Armadale Kelmscott District Memorial Hospital, Perth, Western Australia, Australia.,Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Alex King
- School of Medicine, Rural Clinical School, The University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, Toowoomba Hospital, South Toowoomba, Queensland, Australia
| | - Lalith Gamage
- Paediatric Department, Port Augusta Hospital and Regional Health Services, Port Augusta, South Australia, Australia.,Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Peter Archer
- Emergency Department, Eastern Health, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Corey Cassidy
- Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Arjun Rao
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Medicine, School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Deepali Thosar
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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48
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Bressan S, Monagle P, Dalziel SR, Borland ML, Phillips N, Kochar A, Lyttle MD, Cheek JA, Neutze J, Oakley E, Dalton S, Gilhotra Y, Hearps S, Furyk J, Babl FE. Risk of traumatic intracranial haemorrhage in children with bleeding disorders. J Paediatr Child Health 2020; 56:1891-1897. [PMID: 32810331 DOI: 10.1111/jpc.15073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
AIM To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma. METHODS Design: Multicentre prospective observational study. SETTING 10 paediatric emergency departments (ED) in Australia and New Zealand. PATIENTS Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014. INTERVENTIONS Data collection of patient characteristics, management and outcomes. MAIN OUTCOME MEASURES Rate of CT use and frequency of ICH on CT. RESULTS Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up. CONCLUSIONS Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.
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Affiliation(s)
- Silvia Bressan
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Paul Monagle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Phillips
- Emergency Department, Children's Hospital Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, University of Queensland, Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Mark D Lyttle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Bristol Children's Hospital, Bristol, UK.,Academic Department of Emergency Care, University of the West of England, Bristol, UK
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Dalton
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuri Gilhotra
- Emergency Department, Children's Hospital Queensland, Brisbane, Queensland, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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49
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Babl FE, Lyttle MD, Phillips N, Kochar A, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Williams A, Hearps SJC, Oakley E, Davis GA, Dalziel SR, Borland ML. Mild traumatic brain injury in children with ventricular shunts: a PREDICT study. J Neurosurg Pediatr 2020; 27:196-202. [PMID: 33254139 DOI: 10.3171/2020.7.peds2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs. METHODS The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS. RESULTS A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%-14.9%) compared with 1.4% (95% CI 1.2%-1.6%) (difference 1.5% [95% CI -4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%-14.9%) compared with 2.0% (95% CI 1.8%-2.2%) (difference 0.9%, 95% CI -4.6% to 6.4%). CONCLUSIONS The authors' data provide further support that the risk of TBI is similar for children with and without a VS.
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Affiliation(s)
- Franz E Babl
- 1Emergency Department, Royal Children's Hospital, Melbourne.,2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,18Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Mark D Lyttle
- 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,3Emergency Department, Bristol Royal Hospital for Children, Bristol.,4Faculty of Health and Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Natalie Phillips
- 7Emergency Department, Queensland Children's Hospital, and Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane
| | - Amit Kochar
- 8Emergency Department, Women's and Children's Hospital, Adelaide
| | - Sarah Dalton
- 9Emergency Department, The Children's Hospital at Westmead, Sydney
| | - John A Cheek
- 1Emergency Department, Royal Children's Hospital, Melbourne.,2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,10Emergency Department, Monash Medical Centre, Melbourne.,18Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Jeremy Furyk
- 11Emergency Department, The Townsville Hospital, Townsville.,12Emergency Department, University Hospital Geelong.,13School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jocelyn Neutze
- 14Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,15Department of Women's and Children's Health, University of Padova, Italy
| | - Amanda Williams
- 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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- 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ed Oakley
- 1Emergency Department, Royal Children's Hospital, Melbourne.,2Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,18Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Gavin A Davis
- 2Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- 16Emergency Department, Starship Children's Health, Auckland.,17Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, New Zealand; and
| | - Meredith L Borland
- 5Emergency Department, Perth Children's Hospital.,6School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth
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50
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Yeo YL, O'Brien S, Bear N, Borland ML. Knowledge translation in Western Australia tertiary paediatric emergency department: An audit cycle of effectiveness of guideline dissemination on bronchiolitis management. J Paediatr Child Health 2020; 56:1358-1364. [PMID: 32663366 DOI: 10.1111/jpc.14930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
AIM Bronchiolitis is the commonest cause of hospitalisation for infants. Evidence-based Australasian bronchiolitis guideline was developed and introduced in 2017. This audit was to determine if the knowledge translation process of the updated local tertiary hospital bronchiolitis guideline (based on the Australasian guideline) reduced unnecessary interventions. METHODS A retrospective chart review of infants with bronchiolitis diagnosis during the pre-guideline (1 July to 31 August 2015) and post-guideline (1 July to 31 August 2017) period, with the primary outcome of the number/proportion of unnecessary interventions. RESULTS Presentations between 1 July to 31 August 2015 (n = 465) were compared with 2017 (n = 343). There was no difference in undertaking chest X-ray (24 (5.2%) vs. 17 (5.0%), odds ratio (OR) 0.98 (95% confidence interval (CI) 0.71-1.35), P = 0.911), salbutamol (23 (4.9%) vs. 10 (2.9%), OR 0.86 (95% CI 0.65-1.13), P = 0.279), glucocorticoids (2 (0.4%) vs. 5 (1.5%), OR 1.89 (95% CI 0.83-4.31), p = 0.129), antibiotics (11 (2.4%) vs. 5 (1.5%), OR 0.86 (95% CI 0.65-1.15), P = 0.307) or nasopharyngeal aspirate (172 (37%) vs. 124 (36.2%), OR 1.00 (95% CI 0.87-1.67), P = 0.937) in hospital. Adrenaline was not administered in both years. There was reduced hospital admissions (303 (65.2%) vs. 192 (56.0%), OR 0.82 (95% CI 0.71-0.95), P = 0.008) with no difference in paediatric intensive care unit admissions (10 (2.2%) vs. 8 (2.3%), OR 1.04 (95% CI 0.65-1.67), P = 0.863). CONCLUSION The dissemination process of the updated local hospital bronchiolitis guideline did not show any statistically significant reduction of unnecessary interventions in the hospital. Further studies are required to determine the effective process to instigate changes in health services.
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Affiliation(s)
- Yee Lymn Yeo
- Emergency Department, Perth Children's Hospital (formerly Princess Margaret Hospital for Children), Perth, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital (formerly Princess Margaret Hospital for Children), Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Child Health Research, Perth Children's Hospital (formerly Princess Margaret Hospital for Children), Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital (formerly Princess Margaret Hospital for Children), Perth, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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