This study addresses the critical need to improve pediatric sepsis outcomes by developing methods to accurately identify at-risk children presenting for emergency care. The project will capture electronic health record (EHR) data to create a multi-center registry with the ultimate goal of improving the detection and treatment of pediatric sepsis in the emergency department (ED) setting. To accomplish this, we will automate the determination of organ dysfunction in children with sepsis directly from structured and narrative data in an expanded multicenter EHR patient registry. That data will be used to derive and validate a prediction model of pediatric sepsis that predicts subsequent organ dysfunction within 48 hours using ED EHR data from the first 4 hours of care. Innovative deliverables from this project include the existence of a broad and rich EHR registry, an automated process of outcome determination, and a prediction model of risk of sepsis.
Archives: PECARN Studies
This study focused on pediatric patient safety in the emergency department (ED). The first phase involved surveys of pediatric ED staff to assess perceptions of safety. The manuscript for this phase was published in Pediatrics (2009). The second phase of the study involved transmitting incident reports to the data center and classifying and quantifying ED events using a consensus process. Analysis of over 3000 incidents reports was completed and various manuscripts discussing medication errors/events, radiology events, laboratory events, process variance events, and near-miss errors have been published. A newsletter summarizing findings from the medication error review has been distributed to share information on prevention of medication errors in the emergency departments that care for children.
This project is a cross-sectional study of all pediatric ED visits from all sites within the network. A database of electronic administrative data is compiled annually from 2002 to the present. This study has several aims:
- to identify the frequency and type of PECARN Emergency Department (ED) visits;
- to identify the availability of data elements from existing electronic databases and chart reviews at each HEDA;
- to identify the availability of clinical parameters collected during usual medical care of patients with selected diagnoses (asthma and long bone fractures);
- to measure the agreement between, and completeness of, data elements collected by electronic methods and chart review.
This study provides important epidemiological information regarding pediatric emergency department visits in the PECARN network. Data are collected annually from all hospital sites. The public use dataset is available on this website.
Children with sickle cell disease (SCD) are at risk for acute vasoocclusive crises, the most frequent of which are pain crises. The usual treatment for pain crises, intravenous (IV) fluids and pain medicine, has changed little over the past three decades. The purpose of this study was to determine the safety and efficacy of intravenous magnesium in shortening the duration of a pain crisis and to determine the health-related quality of life and short term outcomes of children treated with intravenous magnesium during an acute pain crisis. This was a multi-center, randomized, double-blind, placebo controlled trial. Patients were randomized to receive either the study drug or placebo every eight hours for a total of six doses, or until discharge, whichever occurred first. Patients were followed up by phone one week after discharge to assess rehospitalization rates, and returned to the sickle cell clinic for follow up within 3 months after discharge. Enrollment began in December 2010 and concluded Dec 2013. This project was co-funded by NICHD and NHLBI. Findings were published in Blood on July 31, 2015. The public use dataset is available on this website.
Blunt head trauma is a leading cause of mortality and morbidity in children. However, greater than 95% of the more than 450,000 children who present to US emergency departments annually with blunt head trauma have minor head trauma. Although important traumatic brain injuries (TBI) are infrequent, clinicians obtain cranial computed tomography (CT) in up to 50% of children with minor blunt head trauma, exposing them to radiation with its potential to induce malignancies. Given the substantial burden of blunt head trauma to families and society, as well as the importance of minimizing radiation exposure, this study will investigate whether implementation of the recently validated Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules using computerized clinical decision support can decrease unnecessary use of CT in children with minor blunt head trauma. The overall goal of this study is to promote the appropriate use of CT for children with blunt head trauma by creating a generalizable model to translate evidence into clinical practice.
The study objectives are:
- To rigorously develop an integrated electronic health record blunt head trauma data collection template and computer-based clinical decision support system to implement the PECARN TBI prediction rules for children; and,
- To assess whether implementing the prediction rules via computerized clinical decision support decreases the number of (unnecessary) cranial CTs in children with minor blunt head trauma at very low risk of traumatic brain injuries.
In order to meet study objective one, we will conduct focus groups of clinicians and perform emergency department workflow evaluations; develop an electronic health record blunt head trauma template that captures patient encounter data; and develop computerized clinical decision support to provide CT recommendations. Subsequently (in order to meet objective two), we will conduct a seven–center prospective, interrupted time series trial with concurrent controls that assesses CT use prior to and after the implementation of the electronic health record-clinical decision support (EHR-CDS) intervention system. We hypothesize that the EHR-CDS intervention system will safely decrease the use of CT compared to passive diffusion. This project is funded by the American Recovery and Reinvestment Act—Office of the Secretary (ARRA OS): Grant #S02MC19289-01-00.
Preliminary data strongly support the concept that diabetic ketoacidosis (DKA) related cerebral injury and subsequent edema may occur as a spectrum of severity. Although only a minority of children develop clinically-overt DKA-related cerebral injury of sufficient severity for obvious, profound neurological dysfunction, a much larger percentage may have subtle cerebral injury. The impact of variation in DKA treatment protocols on this cerebral injury is unknown and arguments for either slower or faster fluid treatment protocols can be made.
This study is a factorial-design, randomized controlled trial comparing four fluid treatment protocols for pediatric DKA. Two rates of rehydration will be compared; a more rapid rate, designed to promote faster reperfusion of brain tissue and a slower rate, geared toward more gradual reperfusion. Within each of these two basic rehydration schemes, we will vary the type of rehydration fluid used (0.9% saline or 0.45% saline). We will compare treatment arms using a comprehensive set of assessments for neurological injury including measurements of subtle neurological dysfunction during DKA treatment (in addition to recording the frequency of acute, clinically-overt cerebral edema) and measures of long-term neurocognitive function. These studies will not only allow us to determine whether variations in fluid treatment protocols affect acute neurological outcomes of DKA, but also will provide important additional data regarding the impact of DKA and DKA treatment on long-term neurocognitive function in children. In this way, we hope to identify a more ideal fluid management strategy for children with DKA. The anticipated enrollment period is from Fall 2010-2015. This project is cco-funded by NICHD
This study assesses the effectiveness and safety of the administration of oral dexamethasone for acute moderate to severe bronchiolitis in children seen in the ED, both with regard to the need for hospitalization (primary outcome), and severity and duration of disease (secondary outcomes). The study hypothesized that dexamethasone would be more effective than placebo in preventing hospital admission of infants with bronchiolitis.
This study was was conducted at selected sites within PECARN for a three-year period (during Bronchiolitis seasons). The study was co-funded by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) Emergency Medical Services for Children (EMSC) Program and the Research Program. Data collection began in January, 2004. The study concluded in Spring, 2006. We successfully enrolled 600 patients in this study, and we determined that there was no reduction in hospitalizations or improvement in respiratory scores associated with the administration of oral dexamethasone. Findings were published in the New England Journal of Medicine on July 26th, 2007. The public use data set can be requested here.
The ED-STARS study will develop and test a brief, personalized, computer-based suicide risk screening tool for teenagers. During the first study, over 6,000 youth were screened, and researchers followed up on a subsample of 12-17 year-olds who scored high on suicide risk factors – as well as those who scored low. Their experiences over a 6-month period were used to develop a computerized adaptive screen (CAS) for predicting suicide attempts that adjusts its line of questioning depending on responses to previous questions. The researchers will then compare the sensitivity, specificity, and predictive value of the CAS with the Ask Suicide-Screening Questions (ASQ), a standardized ED youth suicide prevention screening tool. Study Two began the summer of 2017 and will validate the CAS and associated risk stratification algorithm, determining the measure’s ability to predict suicide attempts in a new sample of 4,000 youth. The potential benefit of including a behavioral test of suicidal thoughts, the Implicit Association Test (IAT), as part of the screening process will also be evaluated. This study is funded by the National Institute for Mental Health (NIMH).
The objective of this protocol was to study pediatric emergency medical services (EMS) within the PECARN network and establish the network’s capability to collect pre-hospital data. This descriptive study initiated data collection from EMS agencies. The project aimed to demonstrate that data transmission from EMS agencies to the data center is feasible. This study established research relationships between PECARN sites and respective EMS agencies and gather data to understand the demographics and disease/injury patterns of the sample that is available to the PECARN network. The data collected will be invaluable in the future for generating hypotheses for pediatric EMS studies and providing preliminary data for grant applications. Data collection and analyses are complete. The main manuscript, Characteristics of the Pediatric Patients Treated by the Pediatric Emergency Care Applied Research Network’s Affiliated EMS Agencies,was published in Pediatric Emergency Care, October 2013.
This was a prospective study of children with minor-to-moderate blunt head trauma with a goal of identifying high-risk and low-risk indicators of traumatic brain injury (TBI). The goal was to derive the evidence on which to base appropriate use of head computerized tomography (CT) in children with acute head injury, which will hopefully reduce the number of unnecessary CT scans for children at very low risk for TBI. This will minimize the exposure of these children to the significant drawbacks related to CT (ionizing radiation, transport of children away from the direct observation of the emergency department, pharmacological sedation, and additional health care costs).
The study was co-funded by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) Emergency Medical Services for Children (EMSC) Program and the Research Program. Data collection began in June, 2004 at all PECARN sites, and concluded in September, 2006. The network successfully enrolled 34,000 patients for the derivation of two clinical decision rules (one for children < 2 years and one for children > 2 years), and an additional 9,000 patients to validate the decision rules. Multiple abstracts from this study have been presented at national emergency medicine and pediatric meetings to date. Several manuscripts have been published including the main prediction rule manuscript which was published in Lancet (October 3, 2009). The public use data set can be requested here.