Winter 2021 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 Winter 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

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 have adapted to the new provincial restrictions that were initiated in December 2020. We are 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. 

We continue to ensure that all current and new research staff have in-person PPE training and completed the required COVID-19 modules. All research staff are required to complete the AHS fitness for work screening prior to every shift in the ED. We conduct weekly inspections of the research office to ensure we have adequate cleaning supplies, PPE and are maintaining a safe workplace environment. We are also adhering to work from home policies whenever possible. Lastly, to ensure patients and families are aware of our efforts to practice safely, we have included in all of our informed consent forms the risks involved with participating in research in regard to the COVID-19 context, but also assuring families that our team has been diligent in conducting research as safely as possible.

Our current COVID-related studies are as follows:

COVID-19: what families think and do: To date, there are three publications available from this study, and the results from all three of these publications were presented at this year's Pediatric Emergency Research Canada annual meeting. Dr. Ran Goldman from the University of British Columbia is the Principal Investigator for this project, and Dr. Samina Ali from the University of Alberta's PEM Division is the local site Principal Investigator. We have just recently launched phase 2 of the COVID-19 family survey study this January, which will continue to explore family perceptions and attitudes around the COVID-19 pandemic.

The publications available from this study to date include:

Goldman RD, et al. Caregiver willingness to vaccinate their children against COVID-19: cross sectional survey. Vaccine 2020;38:7668-73. doi: 10.1016/j.vaccine.2020.09.084.

Goldman RD, et al. Factors associated with parents' willingness to enrol their children in trials for COVID-19 vaccination. Hum Vaccin Immunother 2020. doi: 10.1080/21645515.2020.1834325.

Goldman RD, et al. Willingness to vaccinate children against influenza after the Coronavirus disease 2019 pandemic. J Pediatr 2021;228:87-93. doi:  10.1016/j.jpeds.2020.08.005.

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 for this study is currently ongoing.

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.

Highlight: Ongoing PEM Study

A randomized controlled trial of virtual reality-based distraction for venipuncture-related pain and distress in children

Intravenous (IV) insertions are a very common procedure among children who visit the emergency department. IV insertions, like other needle procedures, can often be a painful and stressful experience for both children and their families. Untreated pain and distress can further lead to a scared and uncooperative child, a need for repeated IV attempts, and overall dissatisfaction with care for the family. We are trying to find better ways to help children who need to have painful procedures such as IV insertions. One thing we can do to help a child is distraction. Distraction therapy aims to take a child's attention away from the source of the pain and anxiety and redirect it to more positive things. Some examples of distraction include watching videos, listening to music or stories, playing with toys or, in the case of this study, virtual reality (VR) googles. The VR goggles use computer technology to produce an artificial 3D video or game that the child can watch and interact with during the IV procedure. The purpose of this study is to determine whether distraction using virtual reality can help reduce a child's pain and distress related to having an IV insertion. This is a single-center randomized controlled trial recruiting children from the Stollery Children's Hospital Emergency Department. We have recruited 24 participants to date! A total of 80 children will be enrolled in this trial.

In Local Research

For children presenting to the emergency department, an IV insertion or bloodwork can cause much pain and anxiety. These negative experiences can result in a future needle fear or phobia for the child and can cause dissatisfaction with the child’s care experience for families and healthcare providers, alike. Recent research has shown that distraction can be useful in reducing children’s procedural pain and anxiety, with digital technology distraction emerging as a new option. This two-arm, open-label parallel randomized controlled trial sought to determine whether a less-commonly encountered technology—a humanoid robot—could effectively distract children during a painful procedure. 

The robot was programmed using cognitive behavioural therapy-based strategies for children 6-11 years old. The control group (n=39) in the study received standard care, including a numbing cream and non-electronic physical and psychological pain management strategies such as physical comforting, verbal and emotional support. Children receiving the intervention (n=42) received standard care and interacted with the robot during their IV insertion. The primary outcomes of the study were patient distress, which was measured using the Observed Scale of Behavioural Distress-Revised, and pain using the Faces Pain Scale-Revised. 

This clinical trial demonstrated that use of the robot moderately decreased children’s distress compared to standard of care but not children’s pain. Caregivers whose child received the robot intervention reported lower anxiety immediately following the procedure. They were also more satisfied with the IV insertion and their child’s pain management compared to caregivers of children in the control group. 

SKIP: Solutions for Kids in Pain

Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health  Commission

In late 2020, the Lancet Child & Adolescent Health Commission published an important report on pediatric pain. The Commission presents four transformative goals—to make pain matter, understood, visible, and better. It sets out priorities for clinicians, researchers, funders, and policy makers, and calls for cross-sector collaboration to deliver the action needed to improve the lives of children and adolescents with pain. Canadian authors include SKIP’s own Dr. Christine Chambers, Dr. Katie Birnie, patient partners Isabel Jordan and Zachary Jordan, and Dr. Paula Forgeron (University of Ottawa).

The report can be accessed for free here.

SKIP's first annual report to the community and year 1 video

TREKK: Translating Knowledge for Kids 

Fact sheet for healthcare professionals: Pediatric COVID-19

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 COVID-19 in pediatric populations for emergency department professionals covers current knowledge on COVID-19, treatment, and a link to a discharge resource for families.

Ali S, Maki C, Xie J ... Rajagopal M, et al. Characterizing pain in children with acute gastroenteritis who present for emergency care. J Pediatr 2020. doi: 10.1016/j.jpeds.2020.12.029.

Bhavanam S, Freedman SB, Lee BE ... Ali S, et al. Differences in illness severity among circulating norovirus genotypes in a large pediatric cohort with acute gastroenteritis. Microorganisms 2020;8(12):1873. doi: 10.3390/microorganisms8121873.

Campbell A, Hartling L, Louie-Poon S, Scott SD. Parent experiences caring for a child with bronchiolitis: a qualitative study. J Patient Exp 2020;7(6):1362-1368. doi: 10.1177/2374373520924526.

Florin TA, Tancredi DJ, Ambroggio L ... Pediatric Emergency Research Networks (PERN) Pneumonia Investigators. Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN) study protocol. BMJ Open 2020;10(12):e041093. doi: 10.1136/bmjopen-2020-041093.

Freedman S, Thull-Freedman J, Lightbody T ... Wright B, et al. Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study. BMJ Open Qual 2020;9(4):e001106. doi: 10.1136/bmjoq-2020-001106.

Gates A, Gates M, DaRosa D ... Hartling L. Decoding semi-automated title-abstract screening: findings from a convenience sample of reviews. Syst Rev 2020;9(1):272. doi: 10.1186/s13643-020-01528-x.

Gates M, Gates A, Guitard S, Pollock M, Hartling L. Guidance for overviews of reviews continues to accumulate, but important challenges remain: a scoping review. Syst Rev 2020;9(1):254. doi: 10.1186/s13643-020-01509-0.

Goldman RD, Marneni SR, Seiler M ... Ali S, et al. Caregivers' willingness to accept expedited vaccine research during the COVID-19 pandemic: a cross-sectional survey. Clin Ther 2020;42(11):2124-2133. doi: 10.1016/j.clinthera.2020.09.012.

Goldman RD, Staubli G, Cotanda CP ... Ali S, et al. Factors associated with parents' willingness to enrol their children in trials for COVID-19 vaccination. Hum Vaccin Immunother 2020. doi: 10.1080/21645515.2020.1834325.

Goldman RD, Yan TD, Seiler M ... Ali S, et al. Caregiver willingness to vaccinate their children against COVID-19: cross sectional survey. Vaccine 2020;38(48):7668-7673. doi: 10.1016/j.vaccine.2020.09.084.

Hodapp JW, Ali S, Drendel AL. Bringing it all together: a review of the challenges in measuring children's satisfaction as a key component of acute pain management. Children 2020;7(11):243. doi: 10.3390/children7110243.

Nagler J, Auerbach M, Monuteax MC ... Dixon A, et al. Exposure and confidence across critical airway procedures in pediatric emergency medicine: an international survey study. Am J Emerg Med 2020;42:70-77. doi: 10.1016/j.ajem.2020.12.075.

Pabbaraju K, Tellier R, Pang XL ... Ali S, et al. A clinical epidemiology and molecular attribution evaluation of adenoviruses in pediatric acute gastroenteritis: a case-control study. J Clin Microbiol 2020;59(1):e02287-20. doi: 10.1128/JCM.02287-20.

Pohlman KA, Carroll L, Tsuyuki RT, Hartling L, Vohra S. Comparison of active versus passive surveillance adverse event reporting in a paediatric ambulatory chiropractic care setting: a cluster randomised controlled trial. BMJ Open Qual 2020;9(4):e000972. doi: 10.1136/bmjoq-2020-000972.

Poonai N, Coriolano K, Klassen T ... Ali S, et al. Adaptive randomised controlled non-inferiority multicentre trial (the Ketodex Trial) on intranasal dexmedetomidine plus ketamine for procedural sedation in children: study protocol. BMJ Open 2020;10(12):e041319. doi: 10.1136/bmjopen-2020-041319.

Poonai N, Kumar K, Coriolano K ... Ali S, et al. Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial. CMAJ 2020;192(48):E1612-E1619. doi: 10.1503/cmaj.201055.

Schuh S, Sweeny J, Rumantir M ... Curtis S, et al. Effect of nebulized magnesium vs placebo added to albuterol on hospitalization among children with refractory acute asthma treated in the emergency department: a randomized clinical trial. JAMA 2020;324(20):2038-2047. doi: 10.1001/jama.2020.19839.

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