Research priorities for European paediatric emergency medicine

Bressan, Silvia; Titomanlio, Luigi; Gómez, Borja; Mintegi, Santiago; Gervaix, Alain; Parri, Niccolò; Dalt, Liviana Da; Moll, Henriëtte A.; Waisman, Yehezkel; Maconochie, Ian; Oostenbrink, Rianne

doi:10.1136/archdischild-2019-316918

Cited by 22 publications

(29 citation statements)

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“…Even though most participating centres mentioned that their guidelines were based on the NICE guideline, in the process of translation from the UK to another setting, the evidence probably is weighed according to the local setting and practice. This may induce further practice variation across centres [18].…”

Section: Interpretation and Comparison To Existing Literaturementioning

confidence: 99%

“…Future research should focus on identifying reasons for noncompliance, including cultural and healthcare factors at the individual, organizational and national level [18]. Qualitative research could provide more in-depth information on the reasons for the observed discrepancies in vital sign measurements across Europe.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

“…This problem may be even larger in Europe, given the diversity of the countries, cultures and healthcare systems. However, international data on recording of vital signs across Europe in children are lacking [18]. Information on the measurement of vital signs is crucial in order to fuel research on serious illness and to target quality improvement initiatives in paediatric emergency medicine.…”

Section: Introductionmentioning

confidence: 99%

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Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

et al. 2020

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Vital signs can help clinicians identify children at risk of serious illness. The NICE guideline for fever in under-fives recommends a routine measurement of temperature, heart rate, capillary refill and respiratory rate in all febrile children visiting the emergency department (ED). This study aims to evaluate the measurement of paediatric vital signs in European EDs, with specific attention to adherence to this NICE guideline recommendation. In a prospective observational study, we included 4560 febrile children under 16 years from the ED of 28 hospitals in 11 European countries (2014-2016). Hospitals were academic (n = 17), teaching (n = 10) and non-teaching (n = 1) and ranged in annual paediatric ED visits from 2700 to 88,000. Fifty-four percent were male, their median age was 2.4 years (IQR 1.1-4.7). Temperature was measured most frequently (97%), followed by capillary refill (86%), heart rate (73%), saturation (56%) and respiratory rate (51%). In children under five (n = 3505), a complete measurement of the four NICE-recommended vital signs was performed in 48% of patients. Children under 1 year of age, those with an urgent triage level and with respiratory infections had a higher likelihood of undergoing complete measurements. After adjustment for these factors, variability between countries remained.

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Section: Interpretation and Comparison To Existing Literaturementioning

confidence: 99%

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

et al. 2020

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“…The Delphi process is a formalised method for obtaining consensus, whereby participants respond to successive questionnaires that aim to identify common principles or proposals 9 10. It is used for multiple purposes, including determining common priorities for research 11–14. Responses are qualitative (free text comments) and quantitative (assigning ranks/scores).…”

Section: Methodsmentioning

confidence: 99%

Priorities for collaborative research using very preterm birth cohorts

Zeitlin

Sentenac

Morgan

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectivesTo develop research priorities on the consequences of very preterm (VPT) birth for the RECAP Preterm platform which brings together data from 23 European VPT birth cohorts.Design and settingThis study used a two-round modified Delphi consensus process. Round 1 was based on 28 research themes related to childhood outcomes (<12 years) derived from consultations with cohort researchers. An external panel of multidisciplinary stakeholders then ranked their top 10 themes and provided comments. In round 2, panel members provided feedback on rankings and on new themes suggested in round 1.ResultsOf 71 individuals contacted, 64 (90%) participated as panel members comprising obstetricians, neonatologists, nurses, general and specialist paediatricians, psychologists, physiotherapists, parents, adults born preterm, policy makers and epidemiologists from 17 countries. All 28 initial themes were ranked in the top 10 by at least six panel members. Highest ranking themes were: education (73% of panel members' top 10 choices); care and outcomes of extremely preterm births, including ethical decisions (63%); growth and nutrition (60%); emotional well-being and social inclusion (55%); parental stress (55%) and impact of social circumstances on outcomes (52%). Highest ranking themes were robust across panel members classified by background. 15 new themes had at least 6 top 10 endorsements in round 2.ConclusionsThis study elicited a broad range of research priorities on the consequences of VPT birth, with good consensus on highest ranks between stakeholder groups. Several highly ranked themes focused on the socioemotional needs of children and parents, which have been less studied.

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“…This need is well recognized by pediatric emergency medicine physicians; a recent survey conducted by the Research in European Paediatric Emergency Medicine network found that fever and risk stratification are research priorities. 6 Lillitos and colleagues assessed the performance of the Brighton and Children's Observation and Severity Tool (COAST) pediatric early warning scores to predict serious medical and surgical illness and requirement for hospital admission in pediatric patients presenting to the emergency department. 7 A high score was specific but not sensitive for predicting the need for hospital admission and serious medical illness, and performed poorly at predicting serious surgical illness.…”

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confidence: 99%

Demand, overcrowding and the pediatric emergency department

Moylan¹,

Maconochie²

2019

CMAJ

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CMAJ | JUNE 10, 2019 | VOLUME 191 | ISSUE 23 E625 D emand on pediatric emergency departments is increasing. A linked study provides evidence that overcrowding in Canadian pediatric emergency departments negatively affects the care of both those triaged as requiring urgent care and those requiring less urgent care, by an increased rate of hospital admission and an increased rate of reattendance after discharge, respectively. 1 Doan and colleagues conducted a retrospective cohort study looking at more than 1.9 million attendances to 8 Canadian pediatric emergency departments over 5 years to determine whether overcrowding in the emergency department is associated with adverse outcomes -defined as hospital admission at the index visit, return to the department or hospital admission within 7 days of discharge from the emergency department, and mortality within 14 days.For policy-makers in the United Kingdom, this question has already been answered. The first evidence-based principle of the Keogh review of urgent and emergency care services -that "preventing crowding in emergency departments improves patient outcomes" 2 -drove a national effort to reduce emergency department attendances through the reconfiguration and promotion of community services. Although the authors of the linked research found no significant association between emergency department crowding and either hospital admission or mortality after discharge, they did not consider the full range of outcomes examined in other studies, which indicate that quality of treatment, provision of analgesia and patient experience are all negatively affected by overcrowding in the pediatric emergency department. 3,4 The lack of an increase in hospital admission within 7 days or mortality within 14 days shows an element of resilience among Canadian clinicians and emergency departments. However, Doan and colleagues did observe "an increase in the odds of hospital admission at the index visit with increasing departmental length of stay among the sickest children (Canadian Triage and Acuity Scale [CTAS]) 1-3)." This lowering of the threshold of admission may imply that decision-making became more risk averse during busy periods.Doan and colleagues' finding that the number of emergency department attendances increased by 27% over the 5-year study period is similar to the experience in England, where attendances by those younger than 15 years to emergency departments has increased by 60% over the past 10 years. 5 Increasing attendances at pediatric emergency departments pose a challenge to clinicians, emergency departments and health systems. Adjusting to overcrowding by lowering the threshold of admission is not a sustainable response. This need is well recognized by pediatric emergency medicine physicians; a recent survey conducted by the Research in European Paediatric Emergency Medicine network found that fever and risk stratification are research priorities. 6 Lillitos and colleagues assessed the performance of the Brighton and Children's Observation and Severity Tool...

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Research priorities for European paediatric emergency medicine

Cited by 22 publications

References 13 publications

Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

Priorities for collaborative research using very preterm birth cohorts

Demand, overcrowding and the pediatric emergency department

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