Fall 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 Fall 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

The Pediatric Emergency Research team has been diligent in adhering to Alberta Health Services (AHS) and University of Alberta Environment Health Services (EHS) guidelines to ensure safety to staff and participants while conducting research during COVID times. We have ensured that all research staff have had in-person PPE training and have completed the AHS infection control module prior to research resumption in the Stollery ED. Also, all research staff are required to complete the AHS fitness for work screening prior to every shift in the ED. We continue to adhere to the University of Alberta EHS guidelines and safety requirements, which include weekly inspections of the workplace to ensure adherence to COVID safety precautions. To ensure patients and families are aware of our efforts to practice safely, we have included in all of our consent forms the risks involved with participating in research in regards to the COVID context, but also ensuring families that our team have been diligent in ensuring that we are practicing as safely as possible.

Our current COVID-related studies are as follows:

COVID-19: what families think and do: To date, there is one publication available from this study, which is available here. Read more about this study under our Fall 2020 highlights.

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. Focus group interviews conducted with emergency healthcare providers from 8 emergency departments across Canada were conducted at three phases during the pandemic. Transcripts are currently being produced and data is being analyzed to help prepare for the second wave of COVID-19 and to develop future ways of improving staff well-being.

Highlight: Ongoing PEM Study

Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis (PRIMED) Study

Appendicitis is the most common non-traumatic surgical emergency in children. 

Children with appendicitis present to the ED with undifferentiated complaints (fever, abdominal pain) and atypical features. This lack of “classic” features makes it challenging to differentiate those with appendicitis from those with benign, self-limited illness. Delays in identifying appendicitis can have serious adverse outcomes Clinicians currently. identify appendicitis using clinical history, physical exam, basic laboratory tests and imaging studies. Each has its own limitations in accuracy, availability and/or adverse effects.

Bio-profiling is the next generation of diagnostics in appendicitis. In this prospective multi-centre cohort study, we will deliver a set of definitive sensitive and specific bio-profiles that will differentiate children with appendicitis from those with non-appendicitis abdominal pain, and those with perforated appendicitis from simple appendicitis. 

Comprehensive comparisons of these bio-profiles to traditional diagnostic strategies will be provided. Our results will be leveraged to support the future innovation of accurate, cost-effective, timely point-of-care diagnostic tools. 

This study is enrolling participants in 11 Canadian emergency departments. To date, we have enrolled 78 participants at the Stollery Emergency Department.

In Local Research

Fowler M, Ali S, Gouin S, Drendel AL, Poonai N, Yaskina M, Sivakumar M, et al. Knowledge, attitudes and practices of Canadian pediatric emergency physicians regarding short-term opioid use: a descriptive, cross-sectional survey. CMAJ Open 2020;8(1):E148-55. doi: 10.9778/cmajo.20190101

Up to 80% of children visiting an emergency department (ED) in North America experience pain, with inadequate analgesia for these children being common. The current opioid crisis and a lack of national guidelines in Canada for opioid prescribing in children has meant that emergency physicians must carefully balance existing fear and stigma around opioid use with the need to provide adequate analgesia for children. 

This descriptive, cross-sectional survey was provided in English and French to Canadian emergency physicians who were members of Pediatric Emergency Research Canada. The survey gathered information about physicians’ knowledge and attitudes regarding potential risks and safe practice with opioid use, current practice, and perceived barriers to and facilitators of prescribing opioids. Study participants were also presented with hypothetical scenarios of patients with mild, moderate, or severe pain, and were asked to describe which medications (as either monotherapy or combination therapy) they would prescribe for first- and second-line pain management.

The results of the study can be found in the infographic below.

SKIP: Solutions for Kids in Pain

Call for Innovations

The Canadian Foundation for Healthcare Improvement (CFHI) and Solutions for Kids in Pain (SKIP) are working together to identify evidence-based solutions for kids in pain. 

Together, with CFHI’s quality improvement knowledge and resources and SKIP’s innovative approach to knowledge mobilization, we’re supporting innovators and end-users identify and share solutions that work.

Individuals and teams from across Canada are invited to tell us about a virtual innovation they have created or experienced to prevent and manage pain in children and youth (age 18 years and under). 

Healthcare organizations (both public and private), community, government, and social service sectors in Canada that have implemented and evaluated a relevant innovation to support an improved virtual approach to chronic pain prevention and management for children/youth (18 years and younger) are eligible to apply.​

Applications are due September 30, 2020 at 11:59pm ET.

University of Alberta Pediatric Grand Rounds

On June 18, 2020, Stollery Hub Lead Dr. Samina Ali and Knowledge Broker Dr. Elise Reiter presented at Pediatric Grand Rounds with patient partner Mr. Joshua Eszczuk and parent partner Ms. Shannon Schmidt. 

Mr. Eszczuk and Ms. Schmidt shared some of their experiences at the Stollery and highlighted how important clear communication and compassion are for children and their families when visiting the hospital. Drs. Ali and Reiter then discussed some of the initiatives to manage children's pain and improve their comfort that SKIP has been working to implement not only at the Stollery, but across Western Canada.

TREKK: Translating Knowledge for Kids 

What to expect when visiting the emergency department during the COVID-19 pandemic

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 video was created through a collaboration between ECHO Research and ARCHE with support from TREKK. Funding was provided by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute. 

Ali S, Ma K, Dow N ... Curtis S ... Hartling L. A randomized trial of iPad distraction to reduce children's pain and distress during intravenous cannulation in the paediatric emergency department. Pediatr Child Health 2020. doi: 10.1093/pch/pxaa089.

Ali S, Rajagopal M, Klassen T, et al. Study protocol for two complementary trials of non-steroidal or opioid analgesia use for children aged 6 to 17 years with musculoskeletal injuries (the No OUCH study). BMJ Open 2020;10(6):e035177. doi: 10.1136/bmjopen-2019-035177.

Goldman RD, McGregor S, Marneni SR ... Ali S, et al. Willingness to vaccinate children against influenza after the Coronavirus disease 2019 pandemic. J Pediatr 2020; doi: 10.1016/j.jpeds.2020.08.005.

Gravel J, Ledoux AA, Tang K ... Craig W, et al. 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 J 2020;37(6):338-343. doi: 10.1136/emermed-2019-209054.

Heath A, Rios JD, Williamson-Urquhart S ... Dixon A, et al. A pragmatic randomized controlled trial of multi-dose oral ondansetron for pediatric gastroenteritis (the DOSE-AGE study): statistical analysis plan. Trials 2020;21(1):735. doi: 10.1186/s13063-020-04651-1.

Heath A, Yaskina M, Hopkin G ... Ali S, et al. Non-steroidal or opioid analgesia use for children with musculoskeletal injuries (the No OUCH study): statistical analysis plan. Trials 2020;21(1):759. doi: 10.1186/s13063-020-04503-y.

Tarr GAM, Pang XL, Zhuo R ... Ali S, et al. Attribution of pediatric acute gastroenteritis episodes and emergency department visits to Norovirus GI and GII. J Infect Dis 2020;. doi: 10.1093/infdis/jiaa391.

Rajagopal M, Kundra M, Mabood N ... Ali S ... Craig W. Pediatric injuries due to falls from windows and balconies: an 8-year prospective and retrospective review. Pediatr Child Health 2020. doi: 10.1093/pch/pxaa090.

Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev 2020;8:CD004370. doi: 10.1002/14651858.CD004370.pub4.

van Ierssel J, Ledoux AA, Tang K ... Craig W, et al. Symptom burden, school function, and physical activity one-year following pediatric concussion [published online ahead of print]. J Pediatr 2020;S0022-3476(20)31097-0. doi: 10.1016/j.jpeds.2020.08.061.

Xie J, Pang XL, Tarr GAM ... Ali S, et al. Influenza virus detection in the stool of children with acute gastroenteritis. J Clin Virol 2020;131:104565. doi: 10.1016/j.jcv.2020.104565.

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