Now showing 1 - 10 of 13
  • Publication
    CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol [version 1; peer review: 2 approved]
    Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify changes in attendances at emergency healthcare. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences. Keywords
  • Publication
    Understanding the Impact of Public Health Advice on Paediatric Healthcare Use During COVID-19: A Cross-sectional Survey of Parents
    Background: Hospital avoidance during the COVID-19 pandemic has been reported with a significant decrease in attendance at emergency departments among paediatric populations with potential increased morbidity and mortality outcomes. The present study sought to understand parents’ experiences of healthcare during the initial public health stages of the COVID-19 pandemic. Methods: A cross-sectional survey of parents of children under the age of 16 (N = 1044). The survey collected demographic information to profile parents and children, capture relevant health information such as pre-existing conditions and/or chronic illness or disability, and health service usage during the pandemic. Descriptive statistics, chi-square tests and regression analyses were used to determine the factors that influenced avoidance and hesitancy. Results: 23% of parents stated that they were much more hesitant to access health services upon implementation of the initial public health restrictions. Parents with a higher perception of risk of their children contracting COVID-19 ( χ2 (3) =33.8618, p < 0.000), and stronger levels of concern regarding the effects of COVID-19 ( χ2 (3) =23.9189, p < 0.000) were more likely to be hesitant. Stress also appeared to be a factor in hesitancy with higher than normal stress levels significantly associated with hesitancy (RRR= 2.31, CI: 1.54 - 3.47), while those with severe/extremely severe stress were over three times more likely to be hesitant (RRR:3.37, CI:1.81 - 6.27). Approximately one third of the sample required healthcare for their children during the public health restrictions to delay the spread of COVID-19, however, one in five of these parents avoided accessing such healthcare when needed. Of those that required healthcare, parents who avoided were more likely to report that the services were needed more by others ( χ2 (1) 20.3470, p <0.000). Those who felt that the government advice was to stay away from health services were 1.7 times more likely to be much more hesitant (RRR:1.71, CI; 1.10 – 2.67). Conclusion The misinterpretation of government public health advice, stress and the perception of risk each contributed to parental avoidance of or hesitancy to utilize healthcare services during the public health measures imposed to combat COVID-19.
  • Publication
    Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol
    There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents' and families' preferences and decision making when seeking unscheduled paediatric healthcare.  Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients' behaviour.
  • Publication
    Increased Mental Health Presentations by Children Aged 5-15 at Emergency Departments during the first 12 months of COVID-19
    Aims To determine changes in mental health (MH) attendance at Emergency Departments (ED) by children aged five to 15 during the COVID-19 pandemic. Methods Analysis of MH presentations during the first year of the pandemic compared with prior year for three public paediatric EDs serving the greater Dublin area with a paediatric population of 430,000. Results Overall, ED attendance during the 12 months to 28th February 2021 was 34.3% below prior year, while MH presentations were 8.9% above prior year. MH attendances initially decreased by 26.8% (2020: 303; 2019: 414) during the first four months of the pandemic (March to June), lower than the corresponding decrease of 47.9% for presentations for any reason (2020: 11,530; 2019: 22,128). However, MH presentations increased by 52.4% in July and August (2020: 218; 2019: 143), and by 45.6% in September to December (2020: 552 ;2019: 379), dropping 28.1% below prior year in January (2021: 87; 2020: 121) before returning to prior year levels in February 2021 (2021: 107; 2020: 106). Conclusion Following the initial COVID-19 lockdown, ED presentations by children for acute MH care increased significantly over prior year, with this increase sustained throughout 2020. Long-term stressors linked to the pandemic may be leading to chronic MH problems, warranting increased funding of MH services as part of the response to COVID-19.
  • Publication
    Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events
    The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates. Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed. This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes. PROSPERO registration number: CRD42013003851.
      62Scopus© Citations 7
  • Publication
    One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures
    (British Editorial Society of Bone & Joint Surgery, 2021-06-01) ; ; ; ;
    Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service.Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referred for urgent operative treatment, referred back to emergency department for further evaluation, referred for face-to-face clinical assessment and all patients who re-presented on an unplanned basis for further management of the index injury) were compiled and collated. Cost analysis was performed using established costing for a virtual fracture clinic within the Irish Healthcare System.Results There were a total of 3961 patients referred to the virtual fracture clinic from the PED. Of these, 70% (n = 2776) were discharged. In all, 26% (n = 1033) were referred to a face-to-face appointment. Of discharged patients, 7.5% (n = 207) required an unplanned face-to-face evaluation. A total of 0.1% (n = 3) subsequently required operative treatment relating to their index injury. Implementation of the virtual fracture clinic model generated calculated savings of €254 120.Conclusion This prospective evaluation has demonstrated that a virtual fracture clinic pathway for minor paediatric trauma is safe, effective and brings significant cost savings.
  • Publication
    The utility of ketones at triage: a prospective cohort study
    Objective: To establish the relationship between serum point-of-care (POC) ketones at triage with clinical dehydration based on the validated Gorelick scales. Design, setting and patients: Prospective unblinded exploratory study fromApril 2016 to February 2017in a tertiary paediatric Emergency Department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of dehydration or clinical concern for hypoglycaemia were eligible. Main outcome measures: POC ketones were analysed at triage and 4-hours later or upon discharge if earlier.Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition. Results:Two-hundred and one attendances were included(198 patients); median age 1.8years. The median triage ketones were 4.4 (interquartile range (IQR) 2.8–5.6) mmol/L. Aweak correlation was identified between triage ketones and 10-point Gorelick scale (Pearson r=0.215), however the 4-point Gorelick scale was non-significant. Those admitted to hospital had median triage ketones of 5.2 (IQR 5-6) mmol/L and repeat ketones of 4.6 (IQR 3.3-5.7) mmol/L compared to 4.2 (IQR 2.4–5.2) mmol/Land 2.9 (IQR 1.6–4.2) mmol/L in those discharged home. Conclusion: Elevated POC ketones were demonstrated in non-diabetic childrenwith acute illness. A weak correlation was demonstrated between triage POC ketones and the 10-point Gorelick scale, however,this was not demonstrated with the 4-point Gorelick scale. The use of POC ketones, at triage and at 4-hours,to predict the patient’s disposition had poor and fair accuracy respectively. Ketosis and the potential impact of tailored treatments in paediatric acute illness warrants further research.
  • Publication
    Too old for a paediatric emergency department? It’s complex
    Background: In Ireland, the paediatric emergency department (PED) is tasked with acute healthcare provision to children and adolescents under 16 years of age. The population > 15 years attending the PED remains undescribed. Aims: The objective of the study is to describe the presentations of patients > 15 years to the PED of a national tertiary academic paediatric hospital. Methods: A retrospective review of electronic records identifying all patients (> 15 years) who presented from January 2014 to December 2015. Patient demographics, presenting complaint, diagnosis, treatment and disposition were recorded. Results: A total of 71,082 patients attended during the study period; of whom, 426 (0.6%) patients were aged 16 to 61 years. Over half were identified as having clearly defined chronic complex conditions. Three hundred and forty-five (89%) patients were known to the hospital paediatric services and under the care of specialist with 131 (34%) patients admitted locally, all of whom had chronic complex conditions (CCC). There was a total of 44 (11%) patients who presented to the PED with de novo issues and had a variety of acute presenting complaints with minor injuries, syncope and chest pain being most common. Conclusion: This is the first Irish study demonstrating a significant population (> 15 years) with medical complexity that requires a suite of services in a paediatric hospital which is accessed in an unscheduled manner through an emergency department. We recommend further research to describe paediatric CCC attending Irish emergency and hospital services.
      67Scopus© Citations 1
  • Publication
    Inhaled methoxyflurane (Penthrox®) versus placebo for injury-associated analgesia in children - The MAGPIE trial (MEOF-002): Study protocol for a randomised controlled trial
    Background: Pain from injuries is one of the commonest symptoms in children attending emergency departments (EDs), and this is often inadequately treated in both the pre-hospital and ED settings, in part due to challenges of continual assessment and availability of easily administered analgesic options. Pain practices are therefore a key research priority, including within the field of paediatric emergency medicine. Methoxyflurane, delivered via a self-administered Penthrox® inhaler, belongs to the fluorinated hydrocarbon group of volatile anaesthetics and is unique among the group in having analgesic properties at low doses. Despite over 30 years of clinical acute analgesia use, and a large volume of evidence supporting its safety and efficacy, there is a paucity of randomised controlled trial data for Penthrox®. Methods: This is an international multi-centre randomised, double-blind, placebo-controlled phase III trial assessing the efficacy and safety of methoxyflurane delivered via the Penthrox® inhaler for the management of moderate to severe acute traumatic pain in children and young people aged 6-17 years. Following written informed consent, eligible participants are randomised to self-administer either inhaled methoxyflurane (maximum dose of 2 × 3 ml) or normal saline placebo (maximum dose 2 × 5 ml). Patients, treating clinicians and research nurses are blinded to the treatment. The primary outcome is the change in pain intensity at 15 min after the commencement of treatment, as measured by the Visual Analogue Scale (VAS) or the Wong-Baker FACES® Pain Rating scale, with the latter converted to VAS values. Secondary outcome measures include the number and proportion of responders who achieve a 30% reduction in VAS score compared to baseline, rescue medication requested, time and number of inhalations to first pain relief, global medication performance assessment by the patient, clinician and research nurse, and evaluation of adverse events experienced during treatment and during the subsequent 14 ± 2 days. The primary analysis will be by intention to treat. The total sample size is 110 randomised and treated patients per treatment arm. Discussion: The Methoxyflurane AnalGesia for Paediatric InjuriEs (MAGPIE) trial will provide efficacy and safety data for methoxyflurane administered via the Penthrox® inhaler, in children and adolescents who present to EDs with moderate to severe injury-related pain. Trial registration: EudraCT, 2016-004290-41. Registered on 11 April 2017., NCT03215056. Registered on 12 July 2017.
      103Scopus© Citations 4
  • Publication
    Intranasal fentanyl versus intravenous morphine in the emergency department treatment of severe painful sickle cell crises in children: Study protocol for a randomised controlled trial
    Background: Children with sickle cell disease (SCD) frequently and unpredictably present to the emergency department (ED) with pain. The painful event is the hallmark acute clinical manifestation of SCD, characterised by sudden onset and is usually bony in origin. This study aims to establish if 1.5mcg/kg of intranasal fentanyl (INF; administered via a Mucosal Atomiser Device, MAD™) is non-inferior to intravenous morphine 0.1 mg/kg in severe SCD-associated pain.Methods/design: This study is a randomised,double-blind, double-dummy active control trial of children (weighing more than 10 kg) between 1 year and 21 years of age with severe painful sickle cell crisis. Severe pain is defined as rated seven or greater on a 0 to 10 age-appropriate numeric pain scale or equivalent. The trial will be conducted in a single tertiary urban paediatric ED in Dublin, Ireland. Each patient will receive a single active agent and a single placebo via the intravenous and intranasal routes. All clinical and research staff, patients and parents will be blinded to the treatment allocation. The primary endpoint is severity of pain scored at 10 min from administration of the study medications. Secondary endpoints include pain severity measured at 0, 5, 15, 20, 30, 60 and 120 min after the administration of analgesia, proportion of patients requiring rescue analgesia and incidence of adverse events. The trial ends at 120 min after the administration of the study drugs. A clinically meaningful difference in validated pain scores has been defined as 13 mm. Setting the permitted threshold to 50% of this limit (6 mm) and assuming both treatments are on average equal, a sample size of 30 patients (15 per group) will provide at least 80% power to demonstrate that INF is non-inferior to IV morphine with a level of significance of 0.05.Discussion: This clinical trial will inform of the role of INF 1.5mcg/kg via MAD in the acute treatment of severe painful sickle cell crisis in children in the ED setting.Trial registration: Current Controlled Trials ISRCTN67469672 and EudraCT no. 2011-005161-20. © 2012 Barrett et al.; licensee BioMed Central Ltd.
      91Scopus© Citations 15