10/25/07
Areas of Current Research
(alphabetical order)
Application of Transcriptional Signatures for
Diagnosis of Febrile Infants within the PECARN Network:
The ultimate goal of this project is to incorporate a new RNA-based diagnostic technology (called transcriptional signatures) to distinguish between bacterial and non-bacterial infections in febrile infants who present to the EDs. The project aims to demonstrate a PECARN wide infrastructure can be created for conducting transcriptional signature research in infants and demonstrate that the network investigators can consistently obtain high-quality RNA samples from febrile infants. We further plan to define the initial diagnostic “bacterial” biosignatures using RNA microarray transcriptional technologies in young febrile infants presenting to the ED and distinguish them from non-bacterial biosignatures. Finally, we will conduct limited validation testing of the initial diagnostic biosignatures on an independent group of febrile infants presenting to the participating EDs.
Clinical Decision Rule to Identify
Children
with Intra-abdominal Injuries:
This is a prospective study of children with blunt torso trauma with a goal of identifying high-risk and low-risk indicators of intra-abdominal injury (IAI). The long term objective of the study is to derive, validate, disseminate and implement decision support tools to optimize the evaluation of children with blunt torso trauma, which will lead to reduced morbidity and mortality. The overall objective of this particular study is to develop a clinical decision rule for appropriate use of abdominal computerized tomography (CT) scanning in children with blunt torso trauma. We will create a decision rule that identifies those children in need of emergent CT scan and treatment, while reducing the use of abdominal CT scans in those children with minimal risk of IAI. The study is funded by the Centers for Disease Control and Prevention. Patient enrollment began in May, 2007 and will continue for 2 years.
Clinical Decision Rules for Identifying Children at Low and High Risk for Traumatic Brain Injuries after Mild Blunt Head Trauma:
Childhood Head Trauma: A Neuroimaging Decision Rule. This is a prospective study of children with minor-to-moderate blunt head trauma with a goal of identifying high-risk and low-risk indicators of traumatic brain injury (TBI). The goal is to derive the evidence on which to base appropriate use of head computerized tomography (CT) in children with acute head injury, which will hopefully reduce the number of unnecessary CT scans for children at very low risk for TBI. This will minimize the exposure of these children to the significant drawbacks related to this procedure (ionizing radiation, transport of children away from the direct observation of the emergency department, pharmacological sedation, and additional health care costs).
The study is co-funded by the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB) Emergency Medical Services for Children (EMSC) Program and the Research Program. Data collection began in June, 2004 at all PECARN sites, and concluded in September, 2006. The network successfully enrolled 34,000 patients for the derivation of a clinical decision rule, and an additional 9,000 patients to validate the decision rule. Data cleaning and query resolution are in their final phases for the main analysis. Two abstracts were presented at the PAS and SAEM meetings in 2007. We anticipate that we will draft the main manuscript by Fall, 2007.
Development of Research Partnerships with EMS Agencies and Descriptive Study of EMS Pediatric Population within PECARN:
The objective of this protocol is to study pediatric emergency medical services (EMS) within the PECARN network and establish the network’s capability to collect pre-hospital data. This is a descriptive study that will initiate data collection from EMS agencies. We plan to do this using methodology similar to the PECARN Core Data Project (PCDP) which has been previously approved by the University of Utah IRB. The project aims to demonstrate that pediatric EMS research is possible within PECARN and that data transmission from EMS agencies to the data center is feasible. This study will establish research relationships between PECARN sites and respective EMS agencies and gather data to understand the demographics and disease/injury patterns of the sample that is available to the PECARN network. The data collected will be invaluable in the future for generating hypotheses for pediatric EMS studies and providing preliminary data for grant applications. Similar to the PECARN Core Data Project mentioned above, this project will provide the groundwork for further meaningful pre-hospital research within the network.
Effectiveness of Oral Dexamethasone in Acute Bronchiolitis:
This study assesses the effectiveness and safety of the administration of oral dexamethasone for acute moderate to severe bronchiolitis in children seen in the ED, both with regard to the need for hospitalization (primary outcome), and severity and duration of disease (secondary outcomes). The study hypothesized that dexamethasone would be more effective than placebo in preventing hospital admission of infants with bronchiolitis.
This study was endorsed by the PECARN Steering Committee in January 2003 and was conducted at selected sites within PECARN for a three-year period (during Bronchiolitis seasons). The study was co-funded by the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB) Emergency Medical Services for Children (EMSC) Program and the Research Program. Data collection began in January, 2004. The study concluded in Spring, 2006. We successfully enrolled 600 patients in this study, and we determined that there was no reduction in hospitalizations or improvement in respiratory scores associated with the administration of oral dexamethasone. Findings were published in the New England Journal of Medicine on July 26th, 2007.
PECARN Core Data Project (PCDP):
This study has several aims:
- to identify the frequency and type of PECARN Emergency Department (ED) visits;
- to identify the availability of data elements from existing electronic databases and chart reviews at each HEDA;
- to identify the availability of clinical parameters collected during usual medical care of patients with selected diagnoses (asthma and long bone fractures);
- to measure the agreement between, and completeness of, data elements collected by electronic methods and chart review.
This study provides important epidemiological information regarding pediatric emergency department visits in the PECARN network. Data will be collected annually from all hospital sites.
Predicting Cervical Spine Injury (CSI) in Children:
Cervical spine injuries (CSI) are serious, but rare events in children. Immobilization of children with CSI in the out-of-hospital setting may be beneficial, but is poorly studied. In contrast, immobilization for transport of pediatric trauma patients without CSI is common and known to be associated with adverse effects. As a result, more than 99% of immobilized children have no CSI and are exposed to harm with no demonstrable benefit. The purpose of this study is to identify a set of variables that separate injured children with negligible risk of CSI from those at non-negligible risk for CSI. Specifically, project goals are to describe CSI and to identify factors associated with increased risk for CSI among a diverse pediatric blunt trauma population. This retrospective study will conclude data collection at the end of 2007.
Referral and Utilization Patterns for Psychiatric
Related Visits to the Pediatric Emergency Department:
Pediatric psychiatric emergencies appear to have reached epidemic proportions over the past 10 years. ED visits related to mental health problems are known to be resource intensive, but data in this area has mainly occurred at individual sites. The aim of this retrospective chart review was to describe the patterns of referral and utilization of ED resources for children with a psychiatric related visit presenting to PECARN EDs. The findings of this study were presented at the Pediatric Ambulatory Society Annual Meeting in 2007 and the manuscript is in preparation.
Therapeutic Hypothermia After
Cardiac Arrest in Children (THAPCA):
This is a prospective cohort study of children experiencing cardiopulmonary arrest to determine whether children have higher survival rates and improved neurologic outcomes if treated with mild hypothermia after cardiac arrest. To date this has only been studied in adults. This feasibility study is in preparation for a future randomized controlled trial.
