Pediatric Emergency Medicine Current Research

Nursing Research Council

The Nursing Research Council (NRC) within the Division of Emergency Medicine at Lurie Children’s is a critical part of our research operations. Meeting monthly, the NRC is composed of Lurie Children's emergeny department nurses, the Director of Research for Emergency Medicine, the Emergency Medicine Clinical Research Manager, and the Director of Patient Care Services. The NRC is engaged for all actively enrolling studies occurring in the emergency department space to incorporate nursing feedback and participation, foster nursing education regarding emergency department research, and provide an opportunity for nurse-initiated scientific inquiry.

Tiny Cargo, Big Deal! An ED-Based Study of Child Passenger Safety Behaviors

Investigator: Michelle Macy, MD

This clinical trial will be used to test the efficacy of the Tiny Cargo, Big Deal (TCBD) intervention. The study team will test the precision prevention intervention with an adaptive trial design to determine the balance between too much and too little intervention and realize optimal outcomes at decreased costs. Adaptive designs recognize the existence of sample heterogeneity and cost differences of various intervention strategies, allowing for more efficient allocation of resources to the participants who need them the most. Adaptive designs have been applied to studies of behavioral interventions aimed at improving mental health and achieving weight loss but have not previously been applied to child passenger safety.

The Effect of Emergency Department and After-Emergency Department Analgesic Treatment on Pediatric Long Bone Fracture Outcomes

Site Investigator: Elizabeth Alpern, MD, MSCE (Study Principal Investigator: Amy Drendel, DO, Medical College of Wisconsin)

This novel study will evaluate the full patient pain experience from ED visit to home. During this era of opioid abuse and misuse, the direct comparison of existing pain management strategies and their associated short-term patient outcomes is necessary to determine the most effective acute pain management practice. This study, carried out in the Pediatric Emergency Care Applied Research Network (PECARN), will assess the differential impact of recommended analgesic regimens for after ED care by comparing the pain-related function during the first week after ED discharge and determine if reduced pain during ED care is associated with better pain-related function.

BEdside Exclusion of Pulmonary Embolism in Children without Radiation (BEEPER)

Site Investigator: Elizabeth Powell, MD, MPH (Study Principal Investigator: Jeffrey Kline, MD, Indiana University School of Medicine)

This PECARN study is a prospective, observational cohort study of children ages 4 to 17 years old who have sufficiently high probability of pulmonary embolism (PE) to warrant objective diagnostic testing with a D-dimer or pulmonary vascular imaging. The goal is to measure the diagnostic accuracy of a prediction rule for exclusion of PE and the D-dimer.

The Epigenetic Impact of Abusive vs Accidental Head Trauma in Young Children: A Pilot Study

Investigator: Mary Clyde Pierce, MD

Traumatic brain injury (TBI) is the leading cause of pediatric morbidity and mortality, affecting nearly 500,000 children annually in the United States alone. Often a result of blunt trauma or shaking, these injuries have the potential to result in death or permanent neurologic impairment, including static encephalopathy, cerebral palsy, cortical blindness, seizure disorders, and intellectual disabilities. Research in pediatric TBI has consistently demonstrated poorer outcomes among children exposed to early life adversity, including child maltreatment. The underlying biological pathways that translate these risk factors into worse outcomes are not yet known. The objective of this project is to elucidate the epigenetic responses to abuse in infants with head injuries, and to explore whether those epigenetic features are risk factors for suboptimal neurodevelopmental outcomes.

Improving Detection of Sexually Transmitted Infections in Pediatric Emergency Department: A Pragmatic Trial

Site Investigator: Erin Augustine, MD (Study Principal Investigator: Monika Goyal, MD, MSCE; Children's National Hospital and Jennifer Reed, MD; Cincinnati Children's Hospital Medical Center)

Sexually transmitted infections (STIs) are highly prevalent among adolescents. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescents are suboptimal. There is an urgent need to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare, and to determine the most efficient and cost-effective method for providing this screening. This PECARN study will compare the effectiveness of usual care, targeted screening and universally-offered screening in EDs through a pragmatic trial that applies a human factors systems approach to implement GC/CT screening into routine clinical care.

Balanced Fluid Resuscitation to Decrease Kidney Injury in Children with Septic Shock

Site Investigator: Elizabeth Alpern, MD, MSCE (Study Principal Investigator: Frances Balamuth, MD, PhD, Children’s Hospital of Philadelphia)

PRoMPT BOLUS is a clinical trial comparing two intravenous (IV) fluid treatments, normal saline vs balanced fluids, for pediatric sepsis conducted through PECARN. Although both fluid types are commonly used and both are helpful to treat pediatric sepsis, we do not know which fluid type is most effective. PRoMPT BOLUS will enroll children over 6 months and less than 18 years of age with possible sepsis during an emergency department visit.

Development of a Probability Model to Predict Head Injury Risk in Pediatric Falls

Investigator: Mary Clyde Pierce, MD

The research goal is to develop evidence-based statistical models capable of predicting the probability of head injury in young children involved in falls to improve accuracy in forensic biomechanical investigations. Our high-fidelity probability model will be based on falls and injury data gathered from children presenting to a pediatric emergency department (ED) with a history of fall and head injury. We will develop and validate an innovative 3D computer model that will be used to reconstruct injurious ED falls to determine associated head acceleration. This ED dataset containing children with head injuries due to falls will be combined with a previously collected dataset of children involved in daycare setting falls without head injuries to develop a robust pediatric head injury probability model that will address a major gap in the forensic biomechanical investigation of falls, which are commonly conducted in suspected child abuse cases. The outcomes of our project will facilitate improved accuracy in forensic biomechanical investigations to aid in determination of biomechanical compatibility between a child’s injuries and stated fall history.

An Injury Plausibility Assessment Model for Differentiating Abusive from Accidental Fractures in Young Children

Investigator: Mary Clyde Pierce, MD

Fractures are the most common serious injury from physical abuse, occurring more often than abuse-related traumatic brain injury and abdominal injury combined. Each year in the United States there are more than 90,000 emergency department visits for fractures in children age 0-5 years with abuse-related fractures peaking in the first 3 years of life. This study will collect a comprehensive dataset from previously healthy children diagnosed with a long bone fracture and apply the FxIPAM model.

Quality Improvement to Improve Pediatric Acute Agitation Management in the Emergency Department

Investigator: Jennifer Hoffmann, MD

This study will develop and implement quality measures for acute agitation management in the emergency department that are informed by multidisciplinary perspectives including patients and families. Investigators will determine whether a quality improvement initiative driven by clinical decision support improves the quality of care for acute agitation management.