Phillips N, Dalziel SR, Borland ML, Dalton S, Lyttle MD, Bressan S, Oakley E, Hearps SJ, Kochar A, Furyk J, Cheek JA, Gilhotra Y, Neutze J, Babl FE; Paediatric Research in Emergency Department International Collaborative (PREDICT) group. Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study.  Emerg Med Australas. 2019 Nov 26. doi: 10.1111/1742-6723.13396. [Epub ahead of print] [link]

Franklin D, Babl F, Gibbons K, Pham T, Hasan N, Schlapbach L, Oakley E, Craig S, Furyk J, Neutze J, Moloney S, Gavranich J, Shirkhedkar P, Kapoor V, Grew S, Fraser J, Dalziel S, Schibler A, and PARIS and PREDICT. Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants. Front. Pediatr., 25 October 2019, 7(426). https://doi.org/10.3389/fped.2019.00426. [link].

Eapen N, Davis GA, Borland ML, Phillips N, Oakley E, Hearps S, Kochar A, Dalton S, Cheek J, Furyk J, Lyttle MD, Bressan S, Crowe L, Dalziel S, Tavender E, Babl FE. Clinically important sport-related traumatic brain injuries in children. Med J Aust. 2019 Aug 16. doi: 10.5694/mja2.50311. [Epub ahead of print] [link].

Shavit I, Rimon A, Waisman Y, Borland ML, Phillips N, Kochar A, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Dalziel SR, Lyttle MD, Bressan S, Donath S, Hearps S, Oakley E, Crowe L, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Performance of Two Head Injury Decision Rules Evaluated on an External Cohort of 18,913 Children. J Surg Res. 2019 Aug 20;245:426-433. doi: 10.1016/j.jss.2019.07.090. [Epub ahead of print] [link]

Jamal A, Finkelstein Y, Kuppermann N, Freedman SB, Florin TA, Babl FE, Dalziel SR, Zemek R, Plint AC, Steele DW, Schnadower D, Johnson DW, Stephens D, Kharbanda A, Roland D, Lyttle MD, Macias CG, Fernandes RM, Benito J, Schuh S; Pediatric Emergency Research Networks. Pharmacotherapy in bronchiolitis at discharge from emergency departments within the Pediatric Emergency Research Networks: a retrospective analysis. Lancet Child Adolesc Health. 2019 Aug;3(8):539-547. doi: 10.1016/S2352-4642(19)30193-2. Epub 2019 Jun 7. [link]

Singh S, Cheek JA, Babl FE, Hoch JS. Letters to the Editor: Choosing the discount rate in an economic analysis. Emerg Med Australas. 2019 Aug 4. doi:10.1111/1742-6723.13369. [link].

Hopper SM, McKenna S, Williams A, Phillips N, Babl FE, Paediatric Research in Emergency Departments International Collaborative (PREDICT). Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study. Emerg Med Australas. 2019 Jul 17. doi: 10.1111/1742-6723.13351. [Epub ahead of print] [link].

O’Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network, Australasia, ‘Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?’ A Paediatric Research in Emergency Departments International Collaborative perspective, J Paediatr Child Health, 2019 Jul;55 (7) 746–752. doi:10.1111/jpc.14496. [link].

Babl FE, Mackay M, Dalziel SR. Letters to the Editor: Facial nerve palsy in children, J Paediatr Child Health, 55 (2019) 878-879. DOI: 10.1111/jpc.14494. [link].

Long E, Babl FE, Oakley E, Hopper S, Sheridan B, Duke T; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Does fluid bolus therapy increase blood pressure in children with sepsis? Emerg Med Australas. 2019 Jun 25. doi: 10.1111/1742-6723.13336. [Epub ahead of print]. [link]

Singh S, Cheek JA, Babl FE, Hoch JS. Review article: A primer for clinical researchers in the emergency department: Part X. Understanding economic evaluation alongside emergency medicine research. Emerg Med Australas. 2019 Jun 24. doi: 10.1111/1742-6723.13320. [Epub ahead of print]. [link].

O’Brien S., Borland M. L., Cotterell E., Armstrong D., Babl F., Bauert P., Brabyn C., Garside L., Haskell L., Levitt D., McKay N., Neutze J., Schibler A., Sinn K., Spencer J., Stevens H., Thomas D., Zhang M., Oakley E., and Dalziel S. R., ‘Australasian Bronchiolitis Guideline’, J Paediatr Child Health, 55 (2019) 42-53 DOI 10.1111/jpc.14104. Epub 2018 Jul 15. [link]

O’Brien S, Borland ML, Oakley E. Dalziel S, Babl FE. Letters to the Editor: National guidelines for bronchiolitis. J. Paediatr. Child Health. 2019 June 2. 55(2019) 728–729, PMID: 31155791. DOI: 10.1111/jpc.14463. [link]

Tavender E, Babl FE, Middleton S. Review article: Review article: A primer for clinical researchers in the emergency department: Part VIII. Implementation science: An introduction. Emerg Med Australas. 2019 Jun;31(3):332-338. doi: 10.1111/1742-6723.13296. [EPub 2019 Apr 24] Review. PMID: 31016861 [link]

Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, Francis KL, Sharpe C, Harvey AS, Davidson A, Craig S, Phillips N, George S, Rao A, Cheng N, Zhang M, Kochar A, Brabyn C, Oakley E, Babl FE; PREDICT research network. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial.  Lancet. 2019 Apr 17. pii: S0140-6736(19)30722-6. doi: 10.1016/S0140-6736(19)30722-6. [Epub ahead of print] [link].

Long E, Craig S, Babl FE, Tavender E, Lunny C. Review article: A primer for clinical researchers in the emergency department: Part IX. How to conduct a systematic review in the field of emergency medicine. Emerg Med Australas. 2019 Apr 15. doi: 10.1111/1742-6723.13298. [Epub ahead of print] Review. PMID: 30989835 [link]

Bressan S, Kochar A, Oakley E, Borland M, Phillips N, Dalton S, Lyttle MD, Hearps S, Cheek JA, Furyk J, Neutze J, Dalziel S, Babl FE; Paediatric Research in Emergency Department International Collaborative (PREDICT) group. Traumatic brain injury in young children with isolated scalp haematoma. Arch Dis Child. 2019 Mar 4. pii: archdischild-2018-316066. doi: 10.1136/archdischild-2018-316066. [Epub ahead of print]. [link].

George S, Humphreys S, Williams T, Gelbart B, Chavan A, Rasmussen K, Ganeshalingham A, Erickson S, Ganu SS, Singhal N, Foster K, Gannon B, Gibbons K, Schlapbach LJ, Festa M, Dalziel S, Schibler A; Paediatric Critical Care Research Group (PCCRG), Paediatric Research in Emergency Departments International Collaborative (PREDICT) and the Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG). Transnasal humidified rapid insufflation ventilatory exchange in children requiring emergent intubation (Kids THRIVE): a protocoll for a randomised controlled trial.  BMJ Open. 2019 Feb 20;9(2):e025997. doi: 10.1136/bmjopen-2018-025997 [link].

Lee WH., O’Brien S., Skarin D., Cheek JA., Deitch J., Nataraja R., Craig S., Borland ML., on behalf of PREDICT. Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department. Emerg Med Australas. 2019 Jan 21. doi: 10.1111/1742-6723.13220. Epub ahead of print [link].

Borland ML, Dalziel SR, Phillips N, Lyttle MD, Bressan S, Oakley E, Hearps SJC, Kochar A, Furyk J, Cheek JA, Neutze J, Gilhotra Y, Dalton S, Babl FE; Paediatric Research in Emergency Department International Collaborative (PREDICT) Group. Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study, Ann Emerg Med. 2019 July, 74(1) pii: S0196-0644(18)31485-9. doi: 10.1016/j.annemergmed.2018.11.035. [link]

2019 Presentations (conference proceedings, posters, published abstracts)

Ibrahim L, Hopper S, Donath S, Salvin B, Babl FE, Bryant P. An ASSET for treatment: development and validation of a paediatric cellulitis risk score. International Conference on Emergency Medicine (ICEM), Seoul, South Korea, 12-15 June 2019. (Poster). More information

Aims: There are currently no standardised guidelines for treating cellulitis in children, specifically whether oral or intravenous (IV) antibiotics should be used. This potentially results in over treatment leading to unnecessary hospital admission or under treatment resulting in further complications. This study aimed to derive and validate a cellulitis risk assessment scoring system to guide which patients require IV antibiotics.

Methods: A prospective cohort study of children presenting to the Emergency Department aged 6 months-18 years diagnosed with cellulitis, from January 2014-August 2017 for the derivation cohort and over a 14-month period from June 2015-August 2017 for the validation cohort. Demographics and clinical features of cellulitis were collected, and patients were divided into two groups based on route of antibiotic at 24 hours (the pre-determined gold standard). A comparison of demographics and clinical features were made between the two groups.  Clinicians were surveyed on which features they used to decide whether to start IV antibiotics. Combinations of differentiating features were plotted on receiver operating characteristic curves.

Results: There were 285 children in the derivation cohort to create the Melbourne ASSET (Area, Systemic features, Swelling, Eye, Tenderness) score out of 7. The area under the curve (AUC) was 0.86 [95% confidence interval (CI) 0.83-0.91]. Using a cutoff score of 4 to start IV antibiotics gave the highest correct classification of 80% of patients (sensitivity 60%, specificity of 93%). This score was validated in 251 children and maintained a robust AUC of 0.83 (95% CI 0.78-0.89), correctly classifying 76% of patients (sensitivity 85%, specificity 63%).

Conclusion: The Melbourne ASSET score is the first risk assessment scoring system for childhood cellulitis proposed to aid clinicians in deciding whether to treat with IV or oral antibiotics. It is simple, easy to use, applicable and reliable.

Singh S, Borland ML, Dalziel S, Neutze J, Hearps S, Donath S, Cheek JA, Kochar A, Gilhotra Y, Lyttle MD, Bressan S, Oakley E, Kuppermann N, Holmes JF, Babl FE. The effect of observation status on cranial computed tomography rates in children with minor head trauma: the Australasian Paediatric Head Injury Rules Study (APHIRST). International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (free paper session). More information

Aims: Management of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Objective:
We explored the relationship between planned observation and cranial CT use among children <18 years old with minor blunt head trauma.

Methods: This was a planned sub-analysis of a prospective observational study at 10 pediatric emergency departments (EDs) in Australia and New Zealand. Children <18 years old with Glasgow Coma Scale (GCS) scores ≥14 presenting within 24 hours of blunt head trauma were included. After the initial assessment, clinicians documented responses to two questions that were not mutually exclusive: if they planned to observe the patient, and if the planned to obtain neuroimaging. Based on the responses, the planned observation group included those with planned observation and no immediate plan for cranial CT. The no planned observation group included those with either planned immediate cranial CT or no planned observation. For patient outcomes we used the PECARN definition of a clinically important traumatic brain injury (ciTBI): either intubation for more than 24 hours, ≥2 day hospitalization, requiring neurosurgical intervention or death following head trauma. We estimated the association of cranial CT use with planned observation using a generalized linear model with mixed effects, adjusting for time from injury, patient characteristics, PECARN TBI risk group and hospital clustering.

Results: Of 20,137 children enrolled, 18,471 (92%) presented within 24 hours of sustaining blunt head trauma, had GCS scores ≥14 and documented plans for observation and neuroimaging. The cranial CT rate in the total cohort was 8.6%, and 0.8% had ciTBI. The planned observation group had 4,945 (27%) children compared to 13,526 (73%) in the no planned observation group. The cranial CT rate was lower in those with planned observation (4.2%) than those in the no planned observation group (10.1%), (rate difference 5.7%, [95% CI: 5.0 – 6.5%]). Similarly, the ciTBI rate in the planned observation group was lower (0.4% vs. 0.9%; rate difference 0.5%, [95%CI: 0.3-0.8%]). There was no difference in missed ciTBI rates between the groups with 1 patient (0.1% of patients with ED return visit) in each group. After adjusting for PECARN TBI risk groups, time from injury, patient characteristics, and hospital cluster effects, patients with planned observation had significantly lower cranial CT rates (adjusted odds ratio 0.2, [95% CI: 0.15-0.21]).

Conclusion: Even in a setting with low overall cranial CT rates in children with minor blunt head trauma, planned observation was associated with decreased cranial CT use.

Crellin D, Harrison D,  Santamaria N, Babl FE. Procedural pain assessment in infants and young children: a comparison of 3 behavioural scales. International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (Poster). More information

Aims: Infants and young children frequently experience painful procedures in the emergency department, the management of which is contingent on accurate assessment. The most suitable tool for this purpose is unclear. The aim of this study was to compare the reliability, validity, feasibility and utility of three observational pain scales to quantify procedural pain in infants and young children.

Methods: A convenience sample of twenty-six clinicians used the Face, Legs, Activity, Cry & Consolability (FLACC) scale, the Modified Behavioural Pain Scale (MBPS) and the Visual Analogue Scale applied by an observer (VASobs) to segments of video from 100 children aged six to 42 months undergoing a procedure.

Results: Inter-rater reliability was poorest for VASobs pain scores (ICC – 0.55). VASobs pain scores were lower than FLACC and MBS scores during the procedure but MBPS scores were higher during non-painful phases (p < 0.001). The FLACC scale provided the best sensitivity (94.9%) and specificity (72.5%) for the lowest cut-off score (pain score 2). Correlations between FLACC and VASobs (distress) were strongest (r = 0.89). The FLACC scale resulted in more incomplete scores (p < 0.000) than the other scales. Finally, reviewers liked the VASobs (pain) most, considered it quickest and easiest to apply but all scales were considered of limited use for procedural pain assessment.

Conclusion: This study supported the reliability and sensitivity of the FLACC and MBPS. There were practical concerns for application of the FLACC scale and the MBPS and doubt about the capacity of both scales to differentiate between pain- and non-pain related distress exist. The VASobs, although practical, was less reliable than either the FLACC scale or the MBPS. The results of this study demonstrated that the FLACC scale may be best suited for procedural pain assessment.

Wilson CL, Tavender E, Phillips N, Oakley E, O’Brien S, Dalziel SR, Babl FE, for PREDICT.. Variation in Head Computed Tomography Use for Paediatric Head Injury Across Different Types of Emergency Departments: Do We Have a Problem? International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (Poster).  More information

Aims: Computed tomography of the brain (CTB) for paediatric head injury is used at low rates at tertiary paediatric Emergency Departments (EDs) in Australia and New Zealand. However, most paediatric patients are seen in mixed, non-tertiary EDs. International studies have found large variation in CTB rates across hospital types. We aimed to assess variation in CTB use for paediatric head injury in Australia and New Zealand across tertiary, urban/suburban and regional/rural EDs.

Methods: A retrospective observational study of medical and neuroimaging records of presentations to 30 tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016.  Case inclusion criteria; 1) Primary ED diagnosis of head injury; 2)Age <16 years. Data extraction was undertaken on 100 sequential eligible cases per site for head injury severity by Glasgow Coma Scale (GCS) scores, CTB rate and clinical management.

Results: 2472 eligible presentations from 25 of 32 EDs recruited have been analysed, 9 tertiary (n=900), 9 urban/suburban (n=872) and 7 regional/rural EDs (n=700). Proportion of children <2 years; tertiary 54.6%; urban/suburban 42.9%; regional/rural 36%, p<.001. Proportion of children presenting with a known GCS of 15/14/13/12-9/3-8; tertiary 95.2%/2.4%/0.4%/0.6%/0.22%, urban/suburban 93.7%/4.6%/0.57%/0.8%/0.1%, regional/rural 93.6%/2.57%/0.3%/0.71%/0.1%, p=0.001. CTB imaging rates were; tertiary 8.2%, urban/suburban 7.2%, regional/rural 4.14%, p=0.004. Median length of stay was; tertiary 2.6 hours, urban/suburban 2.7 hours, regional/rural 1.7 hours, p=<0.001. Full data are expected to be analysed by January 2019, when severity weighted analysis will occur.

Conclusion: Neuroimaging rates for paediatric head injury in Australia and New Zealand are not higher in mixed urban/suburban or regional/rural EDs when compared with tertiary paediatric EDs.  Lower imaging rates do not seem to be offset by increased length of observation.  Assessing variation in CTB rates across hospital types is an important consideration in strategies to improve care.

Haskell L, Tavender EJ, Wilson C, O’Brien S, Borland ML, Cotterell E, Babl FE, Orsini F, Schembri R, Sheridan N, Johnson D, Oakley E, Dalziel SR, for PREDICT. Improving the management of infants with bronchiolitis: a cluster randomised controlled trial of tailored knowledge translation in paediatric acute care. International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (Poster). More information

Aims: Bronchiolitis is the most common reason for infants to be hospitalised following presentation to emergency departments (EDs). Management is supportive with high-level evidence of no efficacy for salbutamol, glucocorticoids, chest x-rays, antibiotics, or adrenaline. Despite all international guidelines recommending against the use of these therapies, significant practice variation exists, with the use of inappropriate therapy a worldwide problem. Knowledge translation (KT) interventions that are tailored to the factors that influence practice can improve care; however there is little high-level evidence in acute paediatrics. The primary objective was to establish whether tailored, theory informed KT interventions, compared to passive guideline dissemination, reduces the use of salbutamol, glucocorticoids, chest x-rays, antibiotics, and adrenaline, in infants. 

Methods: Tailored KT interventions were developed, following qualitative interviews using the Theoretical Domains Framework, to target key identified factors influencing bronchiolitis management. We then compared the tailored KT interventions versus passive dissemination in a cluster randomised controlled trial of 26 hospitals in Australia and New Zealand during the 2017 Australasian bronchiolitis season. The primary outcome was compliance with the Australasian Bronchiolitis Guideline during the first 24 hours of care (no use of salbutamol, glucocorticoids, chest x-rays, antibiotics, or adrenaline). Secondary outcomes included length of stay, median medication doses, health costs and process evaluation.

Results: Data was collected on 3,727 infants. Compliance with the Australasian Bronchiolitis Guideline was 86.1% (95%CI 82.6-89.7%) in the intervention sites and 72.0% (95%CI 65.3-78.8%) in the control sites, risk difference 14.1% (95%CI 6.5%-21.7%), p<0.0001.

Conclusion: The use of tailored KT interventions substantially reduces the use of inappropriate therapies in the management of infants with bronchiolitis. As bronchiolitis is the most common reason for infants to be admitted to hospital this study has important implications for future management of bronchiolitis and for KT in general in EDs.

Babl FE, Franklin D, Schlapbach L, Oakley E, Craig S, Neutze J, Furyk J, Fraser F, Dalziel S, Schibler A. Enteral Feeding in High-flow Therapy for Infants with Bronchiolitis: Secondary Analysis of a Randomized Trial. International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (Poster).  More information

Aims: Nasal high-flow oxygen therapy is increasingly used for respiratory failure in infants with bronchiolitis.  It is unclear if children receiving high flow can be safely fed enterally.

Methods: We performed a preplanned secondary analysis of a multi-center, randomised controlled trial of 1,472 infants <aged ,12 months with bronchiolitis and an oxygen requirement.  Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow.  For a subgroup we assessed how children on high-flow therapy were hydrated and fed; intravenously (IV), via bolus or continuous naso-gastric tube (NGT) or orally.  Secondary outcomes included adverse events while receiving enteral feeding.

Results: 505 patients (mean age 5.8 months, female 186 [36.8%]) on high-flow via primary study assignment (n=408) or as rescue therapy (n=97) were included.  While on high-flow, 15 of 505 (3%) received only IV fluids, 360 (71.3%) received only enteral feeds, and 93 (18.4%) received both IV and enteral feeds.  453 infants were enterally fed at some stage during their treatment on high-flow.  Of these, 80 (15.8%) received NGT bolus, 217 (43%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral feeds and 171 (33.9%) a mix of NGT and oral feeds.  None of the patients receiving oral or NGT feeding on high-flow sustained pulmonary aspiration (0%; 95% CI 0% to 0.8%); one patient had a pneumothorax (0.2%; 95% CI 0% to 1.2%).

Conclusion: In children with bronchiolitis treated with HF, enteral feeding using either oral or NGT route was safe.

Scanlan B, Ibrahim L, Hopper S, McNab S, Donath S, Davidson A, Babl FE, Bryant P. Development of a Clinical Score, an Aid For Deciding Between Intravenous and Oral Antibiotics For Urinary Tract Infection/pyelonephritis in Children. International Congress on Emergency Medicine (ICEM), Seoul, South Korea. 12-15 June 2019. (Poster).More information

Aims: Using intravenous (IV) antibiotics to treat urinary tract infection(UTI)/pyelonephritis places a significant burden on patients and health care resources. Despite a recent Cochrane review, guidelines do not clearly state the criteria for IV antibiotics in children with UTI/pyelonephritis. We aimed to derive and validate a clinical score that incorporates clinical features and patient complexity to guide the decision on the route of antibiotics.

Methods: This was an observational study (May’16-March’18) of all children (3m-18y) diagnosed in ED with UTI/pyelonephritis and subsequently confirmed on urine culture. To derive the score, half the cohort was used (aged 12m-12y) who met criteria from a recent systematic review. Patients were defined those with and without a ‘true’ need for IV antibiotics using the pre-determined gold standard based on the Cochrane review and route of antibiotic used at 24 hours. Features which were significantly different between the groups were identified. Combinations of these differentiating features were used to generate receiver operating characteristics(ROC) curves. The score was validated on the second half of the cohort and additional cohorts.

Results: 1,240 patients had a confirmed UTI/pyelonephritis: 831 (67%) aged 12m-12y, 276 (22%) aged 3-12m and 133(11%) aged 12-18y. Of those aged 12m-12y, 335 (40%) met the definition for inclusion, 167 were used to derive the RUPERT score (Rigors, Urological abnormality, Pyrexia(≥38◦C), Emesis, Tachycardia, Recurrent(>2) UTI – one point each – maximum 6), area under curve(AUC) of 0.85. A score of ≥3 to commence IV antibiotics resulted in correct classification of 80% of patients(sensitivity 77%, specificity 81%). In the validation cohort the AUC was 0.8, those not meeting full systematic review criteria AUC 0.82, and those age 12-18y AUC 0.86. It was not reliable in those age 3-12m AUC 0.58.

Conclusion: The RUPERT score can aid clinicians in deciding an appropriate route of antibiotics for UTI/pyelonephritis in children aged 12m-18y.

Wilson CL, Tavender E, Phillips N, Oakley E, O’Brien S, Dalziel SR, Babl FE, for PREDICT.. Variation in Head Computed Tomography Use for Paediatric Head Injury Across Different Types of Emergency Departments: Do We Have a Problem? Pediatric Academic Societies Meeting 2019 (PAS), Baltimore, USA. April 24-May 1 2019. (Poster).  More information

Aims: Computed tomography of the brain (CTB) for paediatric head injury is used at low rates at tertiary paediatric Emergency Departments (EDs) in Australia and New Zealand. However, most paediatric patients are seen in mixed, non-tertiary EDs. International studies have found large variation in CTB rates across hospital types. We aimed to assess variation in CTB use for paediatric head injury in Australia and New Zealand across tertiary, urban/suburban and regional/rural EDs.

Methods: A retrospective observational study of medical and neuroimaging records of presentations to 30 tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016.  Case inclusion criteria; 1) Primary ED diagnosis of head injury; 2)Age <16 years. Data extraction was undertaken on 100 sequential eligible cases per site for head injury severity by Glasgow Coma Scale (GCS) scores, CTB rate and clinical management.

Results: 2472 eligible presentations from 25 of 32 EDs recruited have been analysed, 9 tertiary (n=900), 9 urban/suburban (n=872) and 7 regional/rural EDs (n=700). Proportion of children <2 years; tertiary 54.6%; urban/suburban 42.9%; regional/rural 36%, p<.001. Proportion of children presenting with a known GCS of 15/14/13/12-9/3-8; tertiary 95.2%/2.4%/0.4%/0.6%/0.22%, urban/suburban 93.7%/4.6%/0.57%/0.8%/0.1%, regional/rural 93.6%/2.57%/0.3%/0.71%/0.1%, p=0.001. CTB imaging rates were; tertiary 8.2%, urban/suburban 7.2%, regional/rural 4.14%, p=0.004. Median length of stay was; tertiary 2.6 hours, urban/suburban 2.7 hours, regional/rural 1.7 hours, p=<0.001. Full data are expected to be analysed by January 2019, when severity weighted analysis will occur.

Conclusion: Neuroimaging rates for paediatric head injury in Australia and New Zealand are not higher in mixed urban/suburban or regional/rural EDs when compared with tertiary paediatric EDs.  Lower imaging rates do not seem to be offset by increased length of observation.  Assessing variation in CTB rates across hospital types is an important consideration in strategies to improve care.

Teo SSS, Oakley E, Stanford J, Cichero J.  Paediatric acute care: Highlights from the Paediatric Acute Care-Advanced Paediatric Life Support Conference, Hobart, 2018.  Emerg Med Australas. 2019 Mar 27. doi: 10.1111/1742-6723.13285. [Epub ahead of print] [link].