2015

Background: The aetiology and clinical course of Bell’s palsy is different in paediatric and adult patients. There is no placebo controlled, blinded, randomised controlled trial (RCT) to show effectiveness of prednisolone for Bell’s palsy in children.
Objective: To assess current practice in paediatric Bell’s palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT).
Methods: A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell’s palsy during between January 1, 2012 and December 31, 2013 was performed. Potential participants were identified from ED information systems using Bell’s palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management was entered into REDCap.
Results: 304 presentations were included from 13 PREDICT sites. Mean age at presentation was 9.2(SD 5.0) years with 173(56.9%) females. Most (225, 74.0%) presented to ED within 72 hours of symptoms, 163(53.6%) had seen a doctor prior. In ED, 211(69.4%) were treated with steroids, usually prednisolone, for a mean of 8.8days at a mean starting dose of 1.1mg/kg/day, with 36% prescribed tapering. 29(9.5%) received antiviral treatment.
Conclusion: Treatment of Bell’s palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the need for and feasibility of a planned PREDICT RCT on prednisolone for Bell’s palsy in children.

Background: The capacity to generate new evidence is only the first step in improving emergency care outcomes for children. The second and arguably harder step is to translate new knowledge into practice. How to most effectively shorten the time period between discovery of new knowledge and its routine wide spread use in the emergency department (ED), is a critically important goal.
Objectives: To systematically review clinical knowledge translation studies carried out in the ‘ED’ setting and focused on paediatric emergency care. To describe and assess the study design, interventions used and impact on work process and clinical care.
Method: Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies.
Results: From 1305 publications identified, 15 studies of varied design were included. Four were cluster controlled trials, two patient-level randomized controlled trials; two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6 to 12 months in before and after studies, and 3 to 28 months in cluster or patient level controlled trials. Changes in clinical practice were variable.
Conclusion: Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting.

Introduction: The Paediatric Research in Emergency Departments International Collaborative (PREDICT), was established in 2004 to perform multicentre paediatric research in Australia and New Zealand (ANZ). Research priorities are difficult to determine, often relying on individual interests or evolving from prior work.
Objectives: To identify the research priorities of Paediatric Emergency Medicine (PEM) specialists working in ANZ. Secondary objectives included the identification of geographical and subgroup differences amongst PEM specialists.
Methods: An online database was used to administer surveys in a two-stage, modified Delphi study. Fourteen PREDICT sites in ANZ were included. Eligible participants were consultants or senior advanced trainees in PEM. In survey one participants submitted up to three of their most important research questions. Responses are being collated and refined. A short list will be returned to the participants for ranking in survey two.
Results: 107/254 participants responded to survey one, (response rate 42.5%). 89.7% [96/107] worked in tertiary sites, 5.6% [6/107] at secondary sites and 4.7% [5/107] across both. 87.9% [94/107] were consultants and 12.1% [13/107] were trainees. 247 individual research questions were submitted. The areas generating most questions were respiratory diseases, 19.4% (48/247), infectious diseases 10.9% (27/247), trauma 7.3% (18/247), analgesia and sedation 6.9% (17/247) and critical care 5.7% (14/247). Priority topics include intravenous therapy in asthma, steroid use in wheeze, diagnosis of serious bacterial infection and choices of procedural sedation.
Conclusion: Survey one established a broad range of research questions for review. Results of the completed Delphi study will inform paediatric emergency research priorities in ANZ.