Fall 2021

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 Fall 2021 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

Update:

The Pediatric Emergency Medicine research team has been diligent in adhering to Alberta Health Services (AHS) and University of Alberta Environment Health Services (EHS) guidelines to ensure the safety of staff and participants while conducting research during COVID-19 times. We continue to be in close communication with the University of Alberta Public Health Response Team and Stollery Children’s Hospital Emergency Department AHS administration team to assess the ever-changing COVID-19 situation and to make sure our research team is continuing to meet all public health safety requirements under the current provincial restrictions. 

​Resumption of Research Study: BIPED

We are excited to resume recruitment for the BIPED study: A Randomized controlled Trial Comparing Epinephrine and Dexamethasone to Placebo in Treatment of Infants with Bronchiolitis. Recruitment for this study was put on hold in March 2020 in adherence of COVID-19 restrictions and concerns around aerosol generating procedures. The study now allows for the use of MDIs and has resumed recruitment as of July 2021. The Principal Investigator for this project is Dr. Amy Plint from Children's Hospital of Eastern Ontario Research Institute and the local site Principal Investigator is Dr. Andrew Dixon. The aim of the study is to determine if treatment of infants presengin with bronchiolitis to the emergency department with inhaled epinephrine and a 2-day course of oral daxamethasone is effective in reducing the need for future admissions to hospital (due to bronchiolitis).  

Our current COVID-related studies are as follows:

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. Recruitment has completed and together, the team has recruited over 10,000 children across 10 countries. 

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. The Principal Investigator of this project is Dr. Nathalie Gaucher from the Université de Montréal, and the local site Principal Investigator is Dr. Samina Ali, with Manasi Rajagopal also working on this team. Focus group interviews conducted with emergency healthcare providers from 8 emergency departments across Canada were conducted at three phases during the pandemic. The survey conducted as part of this study and the results of the qualitative interviews were presented at this year's Pediatric Emergency Research Canada annual meeting. Manuscripts on the survey and qualitative analyses have also been submitted for publication. A follow-up study with healthcare professionals is currently being planned.

PEM Team Updates

Effective July 2021, we announce that Dr. William Craig has stepped down from his role as the Research Director for the Pediatric Emergency Medicine Research Program. Dr. Craig has served as the Research Director for the past 8 years and our program has benefited from his strong vision for improving pediatric emergency medicine research and his leadership. He will continue with his clinical, teaching and research activities with the program. Taking over as the Research Director, Pediatric Emergency Medicine is Dr. Samina Ali. 

Highlight: Ongoing PEM Study

Ketodex Trial: Intranasal dexmedetomidine plus ketamine for procedural sedation in children: an adaptive randomized controlled non-inferiority multicenter trial

Orthopedic injuries comprise more than 10% of ED visits in children and 25 to 50% of children will sustain a fracture before age 16 years. Forearm fractures account for 20-32% of fractures in children, making them the most common fracture type. Between 20 and 40% of extremity fractures in children require a closed reduction, often necessitating procedural sedation and analgesia (PSA). Intravenous (IV) ketamine is the most commonly used sedative agent used to perform a closed reduction. However, children rate IV insertion as the most painful hospital experience, second only to the injury itself. IV insertion can be more technically difficult in children because of smaller veins and lack of cooperation, often leading to multiple IV attempts. A combination of intranasal (IN) dexmedetomidine plus IN ketamine (Ketodex) may provide effective sedation for children undergoing a closed reduction without the distress and pain related to IV insertion. A less painful experience has been found to correlate with child satisfaction which may reduce caregiver anxiety and improve the therapeutic relationship with the health care team. This study is a multi-centre, four-arm, adaptive, randomized, blinded, controlled, non-inferiority trial designed to test the hypothesis that IN Ketodex is non-inferior to intravenous (IV) ketamine with respect to depth of sedation as measured using the Pediatric Sedation State Scale (PSSS). Dr. Naveen Poonai is the national PI for this project, and Dr. Samina Ali is the site lead at the Stollery.

In Local Research

In 2016, ARCHE and ECHO developed a parent advisory group to inform their research program in knowledge translation (i.e., sharing research in accessible ways to inform decision-making) for child health. The group provides input from a parent perspective. An  online baseline survey of parent members and a follow-up online survey 16 months after the group had started was conducted. The surveys helped the team understand reasons for parents’ participation, what they thought was working well with the group, and areas for improvement. Parents valued the opportunity to provide constructive feedback on research processes and outputs. They felt the meetings were well-organized and the group was open and welcoming. Parents felt that regular and ongoing communication with the researchers was critical for meaningful engagement. To this end, funding to support a dedicated coordinator was considered essential. Parents appreciated that the researchers organized the group around parents’ needs in terms of timing of meetings (evenings) and reimbursement for expenses to attend meetings (travel, childcare). Parents considered this type of group to be unique, particularly as it supports a research program over the long-term rather than for specific projects, and because of the relative maturity in terms of clearly defining group purpose, structure, and engagement approach. The ongoing involvement allows for benefits in terms of building relationships, providing many and varied opportunities to interact, and allowing parents to see how their input is implemented. Finally, an evaluation mechanism with communication of results and a commitment to implement findings is considered critical. This parent advisory group can provide a model for other researchers or research organizations.

SKIP: Solutions for Kids in Pain

Our partner @KidsInPain has a new bilingual French/English website!
Visit kidsinpain.ca & kidsinpain.ca/fr/ to learn about SKIP and what they do, access evidence-based resources to improve childrens pain management, and much more!
#ItDoesntHaveToHurt

Poster for children requiring an NP COVID swab

SKIP has created a poster that helps children prepare for a COVID nasal swab that includes information on how families can help their children cope before, during, and after the test. It is available as a PDF from the SKIP website.

TREKK: Translating Knowledge for Kids 

Fact sheet for healthcare professionals: Aerosol Generating Medical Procedures

TREKK disseminates 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 their tool development process.

This resource on Aerosol Generating Medical Procedures (AGMP) for emergency department professionals covers current knowledge on AGMP, how to reduce the risk of transmission during aerosol generating procedures and links to provincial definitions and guidelines. 

Update:

Ali, S, Hopkin, G, Poonai, N. et al. A novel preference-informed complementary trial (PICT) design for clinical trial research influenced by strong patient preferences. Trials 22, 206 (2021). https://doi.org/10.1186/s13063-021-05164-1

Balamuth F, Cruz AT, Freedman SB ... Curtis S, et al. Test Characteristics of Cerebrospinal Fluid Gram Stain to Identify Bacterial Meningitis in Infants Younger Than 60 Days. Pediatr Emerg Care. 2021 May 1;37(5):e227-e229. doi: 10.1097/PEC.0000000000001639.

Campbell A, Hartling L, Louie-Poon S, Scott SD. Exploring the Experiences and Information Needs of Parents Caring for a Child With a Urinary Tract Infection: A Qualitative Study. J Patient Exp. 2021 Apr 6;8:23743735211008299. doi: 10.1177/23743735211008299.

Chan M, Scott SD, Campbell A, Elliott SA, Brooks H, Hartling L. Research- and health-related youth advisory groups in Canada: An environmental scan with stakeholder interviews. Health Expect. 2021 Jul 19. doi: 10.1111/hex.13316.

Freedman SB, Xie J, Lee BE, Ali S, et al.; Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE). Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care academic.oup.comdue to Vomiting in the Absence of Diarrhea. Clin Infect Dis. 2021 May 16:ciab451. doi: 10.1093/cid/ciab451.

Finkelstein Y, Maguire B, Zemek R ... Dixon A, et al.; Pediatric Emergency Research Canada (PERC). Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study. Pediatr Emerg Care. 2021 Jun 1;37(8):427–34. doi: 10.1097/PEC.0000000000002484.

Gates A, Rahman S, Sim S ..., Hartling L. Health inequities related to vaccination: An evidence map of potentially influential factors and systematic review of interventions. Vaccine. 2021 Jun 29;39(29):3825-3833. doi: 10.1016/j.vaccine.2021.05.054.

Gaucher N, Trottier ED, Côté AJ ... Ali S, et al.; for Pediatric Emergency Research Canada. A survey of Canadian emergency physicians' experiences and perspectives during the COVID-19 pandemic. CJEM. 2021 Jul;23(4):466-474. doi: 10.1007/s43678-021-00129-4.

Golden-Plotnik S, Ali S, Moir M, et al. Parental Perspectives on Children's Functional Experiences After Limb Fracture: A Qualitative Study. Pediatr Emerg Care. 2021 Jul 20. doi: 10.1097/PEC.0000000000002500.

Hartling L, Elliott SA, Buckreus K, Leung J, Scott SD. Development and evaluation of a parent advisory group to inform a research program for knowledge translation in child health. Res Involv Engagem. 2021 Jun 7;7(1):38. doi: 10.1186/s40900-021-00280-3.

Killackey T, Noel M, Birnie KA ... Ali S, et al. COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals. Can J Pain. 2021 Jun 30;5(1):139-150. doi: 10.1080/24740527.2021.1931069.

Ly A, Zemek R, Wright B, et al. "What is the actual goal of the pathway?": examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework. BMC Health Serv Res. 2021 Feb 5;21(1):119. doi: 10.1186/s12913-021-06110-2.

Li BCM, Wright B, Black T, et al. Utility of MyHEARTSMAP in Youth Presenting to the Emergency Department with Mental Health Concerns. J Pediatr. 2021 Aug;235:124-129. doi: 10.1016/j.jpeds.2021.03.062.

Lin CY, Xie J, Freedman SB ... Dixon A, et al.; Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Medicine Collaborative Research Committee (PEMCRC) STEC Study Group. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. J Pediatr. 2021 May;232:200-206.e4. doi: 10.1016/j.jpeds.2020.12.077.

Mayan M, Alvadj T, Punja S, Jou H, Wildgen S, Vohra S. A caregiver, an expert, a patient: How complementary therapies support the roles of parents of children with life threatening conditions in hospital settings. Explore (NY). 2021 Jul-Aug;17(4):297-302. doi: 10.1016/j.explore.2020.02.017.

Mayan M, Alvadj T, Wildge S, Punja S, Jou H, Vohra S. Toward integrated pediatric medicine: Key learnings from the pediatric integrative medicine trial. Explore (NY). 2021 Jul 10:S1550-8307(21)00145-2. doi: 10.1016/j.explore.2021.07.003.

Meherali S, Hartling L, Campbell A, Robin F, Scott S. Parent information needs and experience regarding acute otitis media in children: A systematic review. Patient Educ Couns. 2021 Mar;104(3):554-562. doi: 10.1016/j.pec.2020.09.013. 

O'Brien H, Minich NM, Langevin LM, ..., Craig WR, et al. Normative and Psychometric Characteristics of the Health and Behavior Inventory Among Children With Mild Orthopedic Injury Presenting to the Emergency Department: Implications for Assessing Postconcussive Symptoms Using the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). Clin J Sport Med. 2021 May 11. doi: 10.1097/JSM.0000000000000943.

Schlegelmilch M, Roback MG, Bhatt M; Sedation Safety Study Group of Pediatric Emergency Research Canada (PERC). Impact of young age on outcomes of emergency department procedural sedation. Am J Emerg Med. 2021 Aug;46:116-120. doi: 10.1016/j.ajem.2021.03.014.

Schuh S, Freedman SB, Zemek R ... Curtis S, et al.; Pediatric Emergency Research Canada. Association Between Intravenous Magnesium Therapy in the Emergency Department and Subsequent Hospitalization Among Pediatric Patients With Refractory Acute Asthma: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2117542. doi: 10.1001/jamanetworkopen.2021.17542.

Tarr GAM, Pang XL, Zhuo R ... Ali S, et al. Attribution of Pediatric Acute Gastroenteritis Episodes and Emergency Department Visits to Norovirus Genogroups I and II. J Infect Dis. 2021 Feb 13;223(3):452-461. doi: 10.1093/infdis/jiaa391.

Vohra S, Punja S, Jou H, Schlegelmilch M, Wilson B, Spavor M, Grundy P, Mackie AS, Conway J, Hartfield D. Comparative Effectiveness of Pediatric Integrative Medicine: A Pragmatic Cluster-Controlled Trial. Children (Basel). 2021 Apr 20;8(4):311. doi: 10.3390/children8040311.

Zhuo R, Ding X, Freedman SB, Lee BE, Ali S, et al. Molecular Epidemiology of Human Sapovirus Among Children with Acute Gastroenteritis in Western Canada. J Clin Microbiol. 2021 Jul 21:JCM0098621. doi: 10.1128/JCM.00986-21.

Questions, feedback, or comments? Contact pemres@ualberta.ca.