Spring 2020 Edition
University of Alberta Division of Pediatric Emergency Medicine: Providing a vision, guidance, and leadership for high quality research within the Division of Pediatric Emergency Medicine
Welcome to the Spring 2020 edition of the Pediatric Emergency Medicine Research Newsletter! This newsletter serves as an update on the activities of the Division of Pediatric Emergency Medicine at the University of Alberta and provides resources and information that may be of interest to readers.
Questions? Comments? Contact us at pemres@ualberta.ca
COVID-19 Update
During this unprecedented time, the division of Pediatric Emergency Medicine has undergone a number of changes. Many of our members have been deployed to the front lines and are working hard to keep the children in our community safe and healthy. Our regular research program has also been suspended, with research now focusing on the COVID-19 pandemic. Our current studies are as follows:
Emergency providers’ experiences during the COVID-19 pandemic: a qualitative study of Canadian pediatric emergency departments: Through focus groups and interviews, our objective is to explore the experiences and perspectives of ED professionals and staff during the COVID-19 pandemic. This information will help us understand how to better prepare emergency professionals to care in the time of a pandemic, and how to inform policies that respond to the frontline’s needs during a pandemic.
COVID-19: what families think and do: The objective of this study is to assess parental attitudes towards COVID-19, to understand the reasons they decided to come to the ED, and to learn about their attitudes about vaccination during a time of a global pandemic.
Predicting severe pneumonia in the emergency department: a global study of the pediatric emergency research networks (COVID-19 arm): The purpose of this research study arm is to create tools to identify which children are most likely to be infected with SARS-CoV-2, and of these, which children might deteriorate and become sicker following their emergency department visit.
PERC COVID-19 study: The aim of this multi-site study is to understand pediatric ED physicians' perspectives on providing patient care during a pandemic and how it affects their interactions.
Spring 2020 Highlights
Highlight: Ongoing PEM Study
A randomized controlled trial comparing epinephrine and dexamethasone to placebo in the treatment of infants with bronchiolitis
Bronchiolitis is the leading cause of infant hospitalization in North America. Despite the longstanding desire to improve outcomes for affected infants, decades of research were limited by small sample sizes and methodological issues, contributing to the controversy and variance around appropriate interventions for these infants. Thus, the objective of this study is to determine if treatment of infants presenting with bronchiolitis to the ED with nebulized epinephrine and a 2-day course of oral dexamethasone is effective in reducing the need for admission to hospital (for bronchiolitis) compared to placebo. This study is enrolling patients at six Canadian pediatric EDs and internationally in New Zelanad and Australia as well! We have recruited 9 participants in the Stollery Emergency Department so far!
PEM Research Team Member of the Month: Dr. Andrew Dixon
Andrew Dixon is a clinical investigator in the emergency department (ED) at the Stollery Children’s Hospital, where he has been for over 10 years. He has been a lead investigator for several local studies and collaborates on many multi-centre trials. His interests lie in technology in medicine and trauma-related medicine. Recent studies include adverse events in the ED, tympanometry for ear infections, temporal artery thermometers for infants, and the current BIPED and DOSAGE studies. He holds a Bachelor of Science in Chemistry from the University of Victoria, completed medical school and his pediatric residency at the University of Manitoba, and completed his pediatric emergency medicine fellowship at the University of Ottawa and Children’s Hospital of Eastern Ontario.
UK-Canadian AI Project Funded
Using AI-Enhanced Social Robots to Improve Children's Healthcare Experiences
Dr. Mary Ellen Foster of the University of Glasgow and Dr. Samina Ali of the University of Alberta: Children experience pain and distress in clinical settings daily, with negative short-term and long-term consequences. Working with stakeholders, we will develop a robust, adaptive, socially intelligent robot designed to distract children during painful clinical procedures, thereby reducing pain and distress. The robot's effectiveness will be evaluated through a clinical trial.
In Local Research
Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M … Craig W, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA 2016;315(10):1014-1025. doi: 10.1001/jama.2016.1203
Thousands of children visit the emergency department (ED) every year due to an acute concussion. While most children recover within 2 weeks, approximately one-third of children continue to have somatic, cognitive, psychological, and/or behavioural symptoms beyond this time. Persistent postconcussion symptoms (PPCS) last longer than 28 days and may result in children missing school, performing poorly at school, experiencing a depressed mood, and engaging in fewer social activities.
Prior to this study, no validated tools existed to assess children’s risk of developing PPCS, although adolescence, being female, and having a physician-diagnosed history of migraines had been associated with higher risk in some studies. This study aimed to derive and validate a clinical risk score to determine a child’s risk of developing PPCS following a concussion.
The study team was able to determine 9 predictor variables that can be used to derive a clinical risk score of PPCS. This score was demonstrated to be significantly better than physician judgment when determining a child’s risk of developing PPCS. Predictor variables included adolescence, being female, having a prior concussion with symptoms lasting 1 week or more, having a physician-diagnosed history of migraine, answering questions slowly, being physically unable to undergo balance testing, having a headache, being sensitive to noise, and experiencing fatigue.
While this tool must be externally validated before being adopted into routine practice, this clinical risk score may be of future benefit when determining a child’s risk of developing PPCS when presenting to the ED for acute concussion.
PEM Resources Updates
SKIP: Solutions for Kids in Pain
COVID-19 Pain Management Resources for Kids
SKIP has compiled a list of apps and online resources that may be of use to kids who experience chronic pain. Access this list here.
Opioids and Our Kids: Scoping Meeting
Contrary to what many expect, children experience pain much the same as adults. Appropriate pain relief is needed for painful procedures and trauma, to reduce harm, and to help reduce the risk of acute pain transitioning to chronic pain over time. Effective management of pain requires a comprehensive approach, incorporating pharmacological, psychological, and physical dimensions.
Currently, there is no high-level evidence driving safe and effective opioid use for acute pain management in infants, children, and youth.
In February 2020, SKIP hosted a scoping meeting together with the Canadian Foundation for Healthcare Improvement. Stakeholders from across the nation discussed priorities and current activities of providers, patients, and families to improve the safety and effectiveness of opioid prescribing for acute pain management in kids. The purpose of this meeting was to inform future priorities and activities of key stakeholders across Canada to ensure appropriate prescribing of opioids for acute pain.
SKIP is now evaluating the available resources and evidence for patients, families, healthcare providers, and decision makers to co-design evidence summaries with the applicable stakeholder groups that will be of benefit to these knowledge users.
TREKK: Translating Knowledge for Kids
Needle Pokes
TREKK has a variety of knowledge translation tools for parents and caregivers on common acute pediatric conditions. These tools are designed to provide evidence-based health information to parents and families to help them in caring for their sick children at home, and to aid them in understanding when emergency department care should appropriately be sought. TREKK works hard to engage health care providers, parents and caregivers throughout our tool development process.
Needle pokes are one of the most common sources of pain for children seeking emergency medical care. Needle pokes may be used during healthcare visits to collect blood, deliver medication and fluids, or to numb certain body parts while stitching, for example. TREKK has developed tools that provide useful age-specific tips for parents and families who have a child that may require a needle poke.
Tips to reduce the child’s stress before and during a poke include:
– Blowing bubbles
– Listening to music or singing a song
– Reading a book
– Playing a game
Holding the child may help comfort them during procedural pain. Try the bear hug or the kangaroo hold.
When talking to the child, be calm and positive. Don’t say “sorry”, but let them know that it’s okay to cry. If they want to know more about what’s happening, give open and honest answers.
See more at the link below!
PEM Team Publications:
Q4 2019-Q1 2020
Belisle S, Dobrin A, Elsie S, Ali S, Brahmbhatt S, Kumar K, Jasani H, Miller M, Ferlisi F, Poonai N. Video discharge instructions for acute otitis media in children: a randomized controlled open-label trial. Acad Emergency Med 2019;26(12):1326-1335. doi: 10.111/acem.13839
Fernandes RM, Wingert A, Vandermeer B, Featherstone R, Ali S, Plint AC, Stang AS, Rowe BH, Johnson DW, Allain D, Klassen TP, Hartling L. Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis. BMJ Open 2019;9(8): e028511. doi: 10.1136/bmjopen-2018-026847
Gates M, Hartling L, Shulhan-Kilroy J, MacGregor T, Guitard S, Wingert A, Featherstone R, Vandermeer B, Poonai N, Kircher J, Perry S, Graham TAD, Scot SD, Ali S. Digital technology distraction for acute pain in children: a meta-analysis. Pediatrics 2020;145(2):e20191139. doi: 10.1542/peds.2019-1139
Gates M, Shulhan-Kilroy J, Featherstone R, MacGregor T, Scott SD, Hartling L. Parent experiences and information needs related to bronchiolitis: a mixed studies systematic review. Patient Educ Couns 2019;102(5):864-878. doi: 10.1016/j.pec.2018.12.013
Gravel J, Ledoux AA, Tang K, Yeates KO, Craig W, Osmond M, Boutis K, Burns E, Sangha G, Dubrovsky AS, Beer D, Zemek R. Early versus delayed emergency department presentation following mild traumatic brain injury and the presence of symptom at 1, 4 and 12 weeks in children. Emerg Med 2020: emermed-2019-209054 [Epub ahead of print]. doi: 10.1136/emermed-2019-209054
Jun E, Ali S, Yaskina M, Dong K, Rajagopal M, Drendel AL, Fowler M, et al. A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management. Paediatr Child Health 2019;pxz162. doi: 10.1093/pch/pxz162
Mannix R, Zemek R, Yeates KO, Arbogast K, Atabaki S, Badawy M, Beauchamp MH, Beer D, Bin S, Burstein B, Craig W, Corwin D, Doan Q, Ellis M, Freedman SB, Gagnon I, Gravel J, Leddy J, Lumba-Brown A, Master C, Mayer AR, Park G, Penque M, Rhine T, Russell K, Schneider K, Bell M, Wisniewski S. Practice patterns in pharmacological and non-pharmacological therapies for children with mild traumatic brain injury: a survey of 15 Canadian and United States centres. J Neurotrauma 2019;36(20):2886-2894. doi: 10.1089/neu.2018.6290
Poonai N, Spohn J, Vandemeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal dexmedetomidine for procedural distress in children: a systematic review. Pediatrics 2020;145(1):e20191623. doi: 10.1542/peds.2019-1623
Radomski AD, Bagnell A, Curtis S, Hartling L, Newton AS. Examining the usage, user experience, and perceived impact of an internet-based cognitive behavioral therapy program for adolescents with anxiety: randomized controlled trial. JMIR Ment Health 2020;7(2):e15795. doi: 10.2196/15795
Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019;24(8):509-535. doi: 10.1093/pch/pxz026
Vanderkooi OG, Xie J, Lee BE, Pang XL, Chui L, Payne DC, MacDonald J, Ali S, MacDonald S, Drews S, Osterreicher L, Kim K, Freedman SB; Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) and Pediatric Emergency Research Canada (PERC). A prospective comparative study of children with gastroenteritis: emergency department compared with symptomatic care at home. Eur J Clin Microbiol Infect Dis 2019;38(12):2371-2379. doi: 10.1007/s10096-019-03688-8
Questions, feedback, or comments? Contact pemres@ualberta.ca.
