PostScript
LETTER
Pediatric Emergency Research in the UK and Ireland (PERUKI): developing a collaborative for multicentre research Paediatric Emergency Medicine (PEM) has evolved significantly in the UK and Ireland. Recognition as a subspecialty by the Royal College of Paediatrics & Child Health (RCPCH) and the College of Emergency Medicine, and the existence of the Association of Pediatric Emergency Medicine (PEM), have resulted in structured training programmes and enhanced paediatric emergency care. However, the limited evidence base for a number of childhood conditions treated in Emergency Departments (EDs) leads to variability in practice.1 To further improve emergency care of children in our population, further evidence must be generated. This can only be achieved through cohesive multicentre PEM research. With presentations encompassing the full spectrum of childhood illness and injury, EDs theoretically provide an ideal research environment, yet there are a number of perceived challenges. These are resource, clinical, attitudinal, or system based, and impact on development, delivery and translation of findings. They include: ▸ Funding limitations; ▸ Rarity of serious outcomes and adverse events; ▸ Balancing service delivery targets against research delivery; ▸ Quality of emergency episode data; ▸ Difficulties tracking patients throughout the care episode; ▸ Providing sufficiently informed consent; ▸ Reluctance to approach families; ▸ Limited formal junior researcher training; ▸ Dominance of specialist centres, inhibiting generalisability of findings; ▸ Delay in translation of findings to effect change. National guidance on research involving children (including deferred consent) and investigation of human factors in the emergency setting have removed some barriers.2 3 Changes to national funding bodies and research infrastructure have also driven change. Coupled with the development of the Medicines for Children Research Network (MCRN, UK) and the National Children’s Research Centre (Ireland) paediatric research has increased, with further rises a priority of the RCPCH.4
602
While multicentre research adds complexities including coordination and data sharing,5 this approach is necessary to produce generalisable results in realistic timeframes. Many existing challenges have been overcome by PEM research networks in other countries, including the Pediatric Emergency Medicine Collaborative Research Committee and the Pediatric Emergency Care Applied Research Network (PEMCRC and PECARN, US), Paediatric Emergency Research Canada (PERC), Paediatric Research in Emergency Departments International Collaborative
Table 1
(PREDICT, Australia/New Zealand) and Research in European Paediatric Emergency Medicine (REPEM), which have generated practice changing evidence for conditions including bronchiolitis, traumatic brain injury, meningitis, diabetic ketoacidosis, abdominal trauma, status epilepticus and febrile illness. Pediatric Emergency Research Networks (PERN) is an initiative which brings these networks together with the vision of answering globally relevant PEM research questions.6 Pediatric Emergency Research in the UK and Ireland (PERUKI) was formed in
Pediatric Emergency Research in the UK and Ireland (PERUKI) founding member sites
England Royal United Hospital Birmingham Children’s Hospital Royal Alexandra Children’s Hospital Bristol Royal Hospital for Children Frenchay Hospital Royal Derby Hospital Royal Devon and Exeter Hospital Leicester Royal Infirmary Alder Hey Children’s Hospital Barts & The London Chelsea & Westminster Hospital Evelina Hospital King’s College Hospital Lewisham Hospital Royal Free Hospital St George’s Hospital St Mary’s Hospital North Manchester General Hospital Royal Manchester Children’s Hospital Nottingham Children’s Hospital Derriford Hospital Queen Alexandra Hospital Salford Royal Hospital Sheffield Children’s Hospital University Hospital Southampton Sunderland Royal Hospital Ireland Cork University Hospital Temple Street Children’s University Hospital Our Lady’s Children’s Hospital, Crumlin Tallaght Children’s Hospital, Tallaght Northern Ireland Royal Belfast Hospital for Sick Children Scotland Aberdeen Royal Infirmary Forth Valley Hospital Royal Hospital for Sick Children Royal Hospital for Sick Children (Yorkhill) Crosshouse Hospital Royal Alexandra Hospital Wales Children’s Hospital for Wales Morriston Hospital
Bath Birmingham Brighton Bristol Bristol Derby Exeter Leicester Liverpool London London London London London London London London Manchester Manchester Nottingham Plymouth Portsmouth Salford Sheffield Southampton Sunderland Cork Dublin Dublin Dublin Belfast Aberdeen Dumbarton Edinburgh Glasgow Kilmarnock Paisley Cardiff Swansea
Arch Dis Child June 2014 Vol 99 No 6
PostScript August 2012 as a collaborative clinical studies group to develop and deliver high quality PEM research for our population. It consists of 39 member sites from England, Ireland, Northern Ireland, Scotland and Wales (table 1), comprising 15 paediatricspecific and 24 mixed adult/paediatric EDs, with a total annual census of 1.1 million childhood ED encounters. PERUKI’s guiding vision is to improve emergency care for children through rigorous multicentre research by: ▸ Facilitating collaboration and coordinating research activities of participating institutions; ▸ Developing a research agenda to produce high-quality studies in the short, medium and long term; ▸ Creating an environment for communication between academics and clinicians with translation of findings; ▸ Promoting sharing of expertise within the UK and Ireland, and the rest of the world; ▸ Mentoring junior PEM researchers to create sustainability. Individual membership is open to anyone with this vision including doctors, nurses and allied health professionals. Site membership is conditional on participation in PERUKI studies. A representative from each site sits on the Research Steering Committee, which contributes to studies to ensure they are realistic, deliverable, and likely to produce meaningful results. Proposals for potential PERUKI studies are presented at bi-annual meetings, and collaborations are formed to further develop and seek funding for adopted studies. To develop a robust research agenda, PERUKI undertakes an annual research prioritisation exercise. Results are disseminated and shared with funding bodies in order to facilitate study development. Initial studies include determination of the epidemiology of PERUKI, analysis of prehospital triage tools for injured children and a programme of research into childhood asthma.
Arch Dis Child June 2014 Vol 99 No 6
PERUKI’s infrastructure functions synergistically with established research bodies to enhance the development and delivery of multicentre PEM research throughout the UK and Ireland and will enable involvement with international PEM research networks and engagement in global studies. To ensure sustainability, PERUKI provides a framework which individuals and sites can use to develop research capabilities. By taking a collaborative approach PERUKI will generate a body of high quality studies to answer key research questions—only in doing so can we continue to improve the emergency care of children in the UK and Ireland. Further information can be found at http://www.peruki.org or by request at [email protected].
acknowledge the financial support of the Association of Paediatric Emergency Medicine, which has provided funding for our initial infrastructure. Collaborators PERUKI site representatives: R Alcock, J Barling, J Bayreuther, C Bevan, C Blackburn, T Bolger, A Brown, D Burke, V Choudhery, J Criddle, F Davies, K Dickson-Jardine, C Dieppe, E Gilby, S Hartshorn, P Leonard, K Lenton, M Lyttle, I Maconochie, J Maney, O Marzouk, R McNamara, M Mitchelson, N Mullen, J Mulligan, R O’Sullivan, A Parikh, K Potier, C Powell, A Reuben, G Robinson, J Ross, A Rowland, J Smith, E Sutherland, J Thiagarajan, L Thomas, C Vorwerk, S Wong, P Younge. Contributors MDL conceived and designed the article, drafted it and approved the final version. ROS, SH, CB, and FC appraised and assisted in drafting the article, and approved the final version. IKM assisted in the conception, drafting, appraisal and final approval of the article. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
Mark D Lyttle,1,2 Ronan O’Sullivan,3,4 Stuart Hartshorn,5 Catherine Bevan,6 Francesca Cleugh,7 Ian Maconochie,8 on behalf of PERUKI 1
Department of Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK 2 University of the West of England, Bristol 3 Department of Emergency Medicine, Cork University Hospital, Cork, Ireland 4 Paediatric Emergency Research Unit (PERU), National Children’s Research Centre, Dublin, Ireland 5 Department of Paediatric Emergency Medicine, Birmingham Children’s Hospital, Birmingham, UK 6 Department of Paediatric Emergency Medicine, Royal Alexandra Children’s Hospital, Brighton, UK 7 Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK 8 Department of Paediatric Emergency Medicine, St Mary’s Hospital, Imperial College NHS Healthcare Trust, London, UK Correspondence to Dr Mark D Lyttle, Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK; [email protected] Acknowledgements We thank a number of individuals and organisations for their support in the development of PERUKI. In particular we thank Associate Professor Franz Babl (PREDICT), Professor Nathan Kuppermann (PECARN), Dr Santi Mintegi (REPEM), Professor Martin Osmond (PERC), Professor Tim Coats (NIHR Injuries & Emergencies Specialty Group), Dr Kevin Morris (Paediatric Intensive Care Society Study Group) and Dr Colin Powell (MCRN) for their invaluable advice and start-up support. We also
To cite Lyttle MD, O’Sullivan R, Hartshorn S, et al. Arch Dis Child 2014;99:602–603. Accepted 11 February 2014 Published Online First 10 March 2014 Arch Dis Child 2014;99:602–603. doi:10.1136/archdischild-2013-304998
REFERENCES 1
2
3
4
5
6
Cheung CRLH, Gray JAM. Unwarranted variation in health care for children and young people. Arch Dis Child 2013;98:60–5. Gamble C, Nadel S, Snape D, et al. What parents of children who have received emergency care think about deferring consent in randomised trials of emergency treatments: postal survey. PLoS ONE 2012;7:e35982. General Medical Council. Good practice in research and consent to research. http://www.gmc-uk.org/ Research_guidance_FINAL.pdf_31379258.pdf (accessed 1 May 2013). Royal College of Paediatrics and Child Health. Turning the tide: Harnessing the power of child health research. November 2012. http://www.rcpch.ac.uk/ harnessing-the-power-of-child-health-research (accessed 1 May 2013). Oakley E, Taylor DMcD, Coats T, et al. A primer for clinical researchers in the emergency department: Part IV: Multicentre research. Emerg Med Australas 2012;24:482–91. Klassen TP, Acworth J, Bialy L, et al. Pediatric Emergency Research Networks: a global initiative in pediatric emergency medicine. Pediatr Emerg Care 2010;26:541–3.
603
LETTER
Pediatric Emergency Research in the UK and Ireland (PERUKI): developing a collaborative for multicentre research Paediatric Emergency Medicine (PEM) has evolved significantly in the UK and Ireland. Recognition as a subspecialty by the Royal College of Paediatrics & Child Health (RCPCH) and the College of Emergency Medicine, and the existence of the Association of Pediatric Emergency Medicine (PEM), have resulted in structured training programmes and enhanced paediatric emergency care. However, the limited evidence base for a number of childhood conditions treated in Emergency Departments (EDs) leads to variability in practice.1 To further improve emergency care of children in our population, further evidence must be generated. This can only be achieved through cohesive multicentre PEM research. With presentations encompassing the full spectrum of childhood illness and injury, EDs theoretically provide an ideal research environment, yet there are a number of perceived challenges. These are resource, clinical, attitudinal, or system based, and impact on development, delivery and translation of findings. They include: ▸ Funding limitations; ▸ Rarity of serious outcomes and adverse events; ▸ Balancing service delivery targets against research delivery; ▸ Quality of emergency episode data; ▸ Difficulties tracking patients throughout the care episode; ▸ Providing sufficiently informed consent; ▸ Reluctance to approach families; ▸ Limited formal junior researcher training; ▸ Dominance of specialist centres, inhibiting generalisability of findings; ▸ Delay in translation of findings to effect change. National guidance on research involving children (including deferred consent) and investigation of human factors in the emergency setting have removed some barriers.2 3 Changes to national funding bodies and research infrastructure have also driven change. Coupled with the development of the Medicines for Children Research Network (MCRN, UK) and the National Children’s Research Centre (Ireland) paediatric research has increased, with further rises a priority of the RCPCH.4
602
While multicentre research adds complexities including coordination and data sharing,5 this approach is necessary to produce generalisable results in realistic timeframes. Many existing challenges have been overcome by PEM research networks in other countries, including the Pediatric Emergency Medicine Collaborative Research Committee and the Pediatric Emergency Care Applied Research Network (PEMCRC and PECARN, US), Paediatric Emergency Research Canada (PERC), Paediatric Research in Emergency Departments International Collaborative
Table 1
(PREDICT, Australia/New Zealand) and Research in European Paediatric Emergency Medicine (REPEM), which have generated practice changing evidence for conditions including bronchiolitis, traumatic brain injury, meningitis, diabetic ketoacidosis, abdominal trauma, status epilepticus and febrile illness. Pediatric Emergency Research Networks (PERN) is an initiative which brings these networks together with the vision of answering globally relevant PEM research questions.6 Pediatric Emergency Research in the UK and Ireland (PERUKI) was formed in
Pediatric Emergency Research in the UK and Ireland (PERUKI) founding member sites
England Royal United Hospital Birmingham Children’s Hospital Royal Alexandra Children’s Hospital Bristol Royal Hospital for Children Frenchay Hospital Royal Derby Hospital Royal Devon and Exeter Hospital Leicester Royal Infirmary Alder Hey Children’s Hospital Barts & The London Chelsea & Westminster Hospital Evelina Hospital King’s College Hospital Lewisham Hospital Royal Free Hospital St George’s Hospital St Mary’s Hospital North Manchester General Hospital Royal Manchester Children’s Hospital Nottingham Children’s Hospital Derriford Hospital Queen Alexandra Hospital Salford Royal Hospital Sheffield Children’s Hospital University Hospital Southampton Sunderland Royal Hospital Ireland Cork University Hospital Temple Street Children’s University Hospital Our Lady’s Children’s Hospital, Crumlin Tallaght Children’s Hospital, Tallaght Northern Ireland Royal Belfast Hospital for Sick Children Scotland Aberdeen Royal Infirmary Forth Valley Hospital Royal Hospital for Sick Children Royal Hospital for Sick Children (Yorkhill) Crosshouse Hospital Royal Alexandra Hospital Wales Children’s Hospital for Wales Morriston Hospital
Bath Birmingham Brighton Bristol Bristol Derby Exeter Leicester Liverpool London London London London London London London London Manchester Manchester Nottingham Plymouth Portsmouth Salford Sheffield Southampton Sunderland Cork Dublin Dublin Dublin Belfast Aberdeen Dumbarton Edinburgh Glasgow Kilmarnock Paisley Cardiff Swansea
Arch Dis Child June 2014 Vol 99 No 6
PostScript August 2012 as a collaborative clinical studies group to develop and deliver high quality PEM research for our population. It consists of 39 member sites from England, Ireland, Northern Ireland, Scotland and Wales (table 1), comprising 15 paediatricspecific and 24 mixed adult/paediatric EDs, with a total annual census of 1.1 million childhood ED encounters. PERUKI’s guiding vision is to improve emergency care for children through rigorous multicentre research by: ▸ Facilitating collaboration and coordinating research activities of participating institutions; ▸ Developing a research agenda to produce high-quality studies in the short, medium and long term; ▸ Creating an environment for communication between academics and clinicians with translation of findings; ▸ Promoting sharing of expertise within the UK and Ireland, and the rest of the world; ▸ Mentoring junior PEM researchers to create sustainability. Individual membership is open to anyone with this vision including doctors, nurses and allied health professionals. Site membership is conditional on participation in PERUKI studies. A representative from each site sits on the Research Steering Committee, which contributes to studies to ensure they are realistic, deliverable, and likely to produce meaningful results. Proposals for potential PERUKI studies are presented at bi-annual meetings, and collaborations are formed to further develop and seek funding for adopted studies. To develop a robust research agenda, PERUKI undertakes an annual research prioritisation exercise. Results are disseminated and shared with funding bodies in order to facilitate study development. Initial studies include determination of the epidemiology of PERUKI, analysis of prehospital triage tools for injured children and a programme of research into childhood asthma.
Arch Dis Child June 2014 Vol 99 No 6
PERUKI’s infrastructure functions synergistically with established research bodies to enhance the development and delivery of multicentre PEM research throughout the UK and Ireland and will enable involvement with international PEM research networks and engagement in global studies. To ensure sustainability, PERUKI provides a framework which individuals and sites can use to develop research capabilities. By taking a collaborative approach PERUKI will generate a body of high quality studies to answer key research questions—only in doing so can we continue to improve the emergency care of children in the UK and Ireland. Further information can be found at http://www.peruki.org or by request at [email protected].
acknowledge the financial support of the Association of Paediatric Emergency Medicine, which has provided funding for our initial infrastructure. Collaborators PERUKI site representatives: R Alcock, J Barling, J Bayreuther, C Bevan, C Blackburn, T Bolger, A Brown, D Burke, V Choudhery, J Criddle, F Davies, K Dickson-Jardine, C Dieppe, E Gilby, S Hartshorn, P Leonard, K Lenton, M Lyttle, I Maconochie, J Maney, O Marzouk, R McNamara, M Mitchelson, N Mullen, J Mulligan, R O’Sullivan, A Parikh, K Potier, C Powell, A Reuben, G Robinson, J Ross, A Rowland, J Smith, E Sutherland, J Thiagarajan, L Thomas, C Vorwerk, S Wong, P Younge. Contributors MDL conceived and designed the article, drafted it and approved the final version. ROS, SH, CB, and FC appraised and assisted in drafting the article, and approved the final version. IKM assisted in the conception, drafting, appraisal and final approval of the article. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
Mark D Lyttle,1,2 Ronan O’Sullivan,3,4 Stuart Hartshorn,5 Catherine Bevan,6 Francesca Cleugh,7 Ian Maconochie,8 on behalf of PERUKI 1
Department of Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK 2 University of the West of England, Bristol 3 Department of Emergency Medicine, Cork University Hospital, Cork, Ireland 4 Paediatric Emergency Research Unit (PERU), National Children’s Research Centre, Dublin, Ireland 5 Department of Paediatric Emergency Medicine, Birmingham Children’s Hospital, Birmingham, UK 6 Department of Paediatric Emergency Medicine, Royal Alexandra Children’s Hospital, Brighton, UK 7 Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK 8 Department of Paediatric Emergency Medicine, St Mary’s Hospital, Imperial College NHS Healthcare Trust, London, UK Correspondence to Dr Mark D Lyttle, Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK; [email protected] Acknowledgements We thank a number of individuals and organisations for their support in the development of PERUKI. In particular we thank Associate Professor Franz Babl (PREDICT), Professor Nathan Kuppermann (PECARN), Dr Santi Mintegi (REPEM), Professor Martin Osmond (PERC), Professor Tim Coats (NIHR Injuries & Emergencies Specialty Group), Dr Kevin Morris (Paediatric Intensive Care Society Study Group) and Dr Colin Powell (MCRN) for their invaluable advice and start-up support. We also
To cite Lyttle MD, O’Sullivan R, Hartshorn S, et al. Arch Dis Child 2014;99:602–603. Accepted 11 February 2014 Published Online First 10 March 2014 Arch Dis Child 2014;99:602–603. doi:10.1136/archdischild-2013-304998
REFERENCES 1
2
3
4
5
6
Cheung CRLH, Gray JAM. Unwarranted variation in health care for children and young people. Arch Dis Child 2013;98:60–5. Gamble C, Nadel S, Snape D, et al. What parents of children who have received emergency care think about deferring consent in randomised trials of emergency treatments: postal survey. PLoS ONE 2012;7:e35982. General Medical Council. Good practice in research and consent to research. http://www.gmc-uk.org/ Research_guidance_FINAL.pdf_31379258.pdf (accessed 1 May 2013). Royal College of Paediatrics and Child Health. Turning the tide: Harnessing the power of child health research. November 2012. http://www.rcpch.ac.uk/ harnessing-the-power-of-child-health-research (accessed 1 May 2013). Oakley E, Taylor DMcD, Coats T, et al. A primer for clinical researchers in the emergency department: Part IV: Multicentre research. Emerg Med Australas 2012;24:482–91. Klassen TP, Acworth J, Bialy L, et al. Pediatric Emergency Research Networks: a global initiative in pediatric emergency medicine. Pediatr Emerg Care 2010;26:541–3.
603
