Emergency Care for Children Growing Pains (2007) / Chapter Skim
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7 Building the Evidence Base for Pediatric Emergency Care
7 Building the Evidence Base for Pediatric Emergency Care
Pages 245-278
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From page 245... ...
The chapter begins with a review of pediatric emergency care research from the 1980s through the present day and continues with a discussion of why advancing the state of knowledge remains critical today. It then turns to some of the barriers to pediatric emergency care research that hinder progress and presents the committee's recommendations for overcoming those barriers.
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From page 246... ...
Report Emergency Medical Serices for Children called attention to the need for pediatric emergency care research by highlighting knowledge gaps in the field. These gaps encompassed the most basic questions about emergency care services for children: • What is the structure of the system?
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From page 247... ...
. Also in the 1990s, the first infrastructure for multicenter pediatric emergency care research was established when the American Academy of Pediatrics' Section on Emergency Medicine created the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC)
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Spandorfer and colleagues (2003) reviewed abstracts on pediatric emergency medicine research submitted to national scientific meetings of the American Psychological Association (APA)
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, part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ)
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The National Highway Traffic Safety Administration's (NHTSA) Emergency Medical Serices Agenda for the Future described five goals for an EMS information system: (1)
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is now widely used to evaluate the adequacy and safety of health care delivery. In Chapter 2, this framework was used to provide an overview of the state of pediatric emergency care under the current system.
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Basic research projects in pediatric emergency medicine could address the pathophysiology of acute respiratory failure, ways to minimize the risk of secondary ischemic brain injury during limited resuscitation from hemorrhagic shock and traumatic brain injury, and the pathophysiology and treatment of traumatic spinal cord injury.
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From page 253... ...
This is an important area that deserves special emphasis within emergency care research as well. Examples of pediatric translational research include the formulation of guidelines for the efficacy, safety, and dosage of medications for infants, children, and adolescents; the development of evidenced-based protocols for the treatment of common pediatric conditions (e.g., fever)
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From page 254... ...
. Although emergency care providers are not commonly linked to public health prevention activities, their potential role in such efforts has been recognized (Maclean, BOX 7-1 Airbags and Children Just as new medical technologies and information systems must be designed with pediatric patients in mind, prevention efforts must consider the potential implications for children.
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From page 255... ...
. Additionally, the National Highway Traffic Safety Administration enacted regulatory measures to address the problem, including labeling requirements for vehicles and child safety seats and specifications for airbag cutoff switches (CDC, 1995)
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Pediatric emergency care research meets all three of these criteria. First, utilization data from individual EMS agencies and national data from NHAMCS indicate heavy reliance on the emergency care system among pediatric patients.
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. To address these barriers, the committee recommends that the Secretary of Health and Human Services conduct a study to examine the gaps and opportunities in emergency care research, including pediatric emergency care, and recommend a strategy for the optimal organization and funding of the research effort.
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From page 258... ...
As recommendation 7.1 suggests, specific opportunities and funding streams for pediatric emergency care research should be identified and prioritized. This funding should target emergency medical and trauma care for both children and adults, including prehospital and ED care, disaster medicine, critical care, mental health emergencies, and prevention.
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From page 259... ...
In response to the 1993 IOM report on emergency care for children, which called for an increase in funding for pediatric emergency care research, a multiagency announcement was released in 2001 that focused on improving the quality and quantity of research in this area. The announcement included AHRQ, the Health Resources and Services Administration's (HRSA)
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From page 260... ...
Within the federal government, the fol lowing agencies can and should play an important role in pediatric emergency care research. National Institutes of Health (NIH)
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has a dedicated funding source for pediatric emergency services under its Emergency Medical Services for Children (EMS-C) program.
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IHS will conduct a national assessment of all Native Ameri can tribal EMS programs to obtain the information needed by MCHB to assess the state of readiness of tribes to serve children in emergency situations (EMS-C National Resource Center, 1999)
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. The National Highway Traffic Safety Administration (NHTSA)
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The organization is committed to trauma prevention and the delivery of quality medical services at each stage of trauma of EMTs represent opportunities for pediatric emergency care researchers to disseminate new information to emergency care providers. The Dearth of Well-Trained Pediatric Emergency Care Researchers Many authors have decried the lack of a sufficient pool of well-trained laboratory and patient-oriented investigators in emergency care and have identified it as a major barrier to emergency care research.
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From page 265... ...
. The Ambulatory Pediatric Association, an organization of academic pediatric health professionals, offers a young investigator grant that provides up to $10,000 per project to new investigators for research in a number of areas, including pediatric emergency medicine (Christakis et al., 2001)
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From page 266... ...
While existing foundation support has increased the number of well-trained emergency care investigators, a significant increase in the total research training support available will be required to substantially expand the nation's emergency care research capability. As discussed in Chapter 4, most pediatric emergency medicine physicians hold their primary board certification in pediatrics; moreover, most pediatric emergency medicine fellowships in the United States are organized under the pediatric residency review committee (RRC)
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From page 267... ...
Presently, midlevel research development grants are restricted to primary care specialties, thereby excluding emergency physicians and other providers of emergency care. There is a pressing need for access to training grants, including K23 and K08 applications, specifically targeting emergency and trauma care researchers.
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From page 268... ...
The network is currently working on a variety of projects, including studies on how practitioners diagnose child abuse in primary care settings, on a new way to help parents prevent child violence, and on how to improve practice/clinic immunization rates. The Vermont Oxford Network (VON)
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From page 269... ...
Recognizing the importance of research networks to the knowledge base and the research infrastructure, the committee formulated recommendation 7.1 -- that the Secretary of Health and Human Services conduct a study to examine research gaps and opportunities in emergency care, including pediatric emergency care, encompassing a focused look at the development of multicenter research networks. Ideally, such networks should address issues including prevention, trauma, and pediatric emergency medicine.
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From page 270... ...
0 EMERGENCY CARE FOR CHILDREN center research networks is not new. In fact, at both the 1995 Emergency Medicine Research Directors Conference and the 1997 Future of Emergency Medicine Research Conference, participants encouraged the growth of such networks (Pollack et al., 2003)
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trauma centers that would provide data on trauma patients for the NTDB. Those data will allow researchers to compute national estimates with high confidence.
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EMERGENCY CARE FOR CHILDREN hospitals. The project has not yet developed a stratum for pediatric patients, but this is intended for the future.
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From page 273... ...
SUMMARY OF RECOMMENDATIONS 7.1 The Secretary of Health and Human Services should conduct a study to examine the gaps and opportunities in emergency care research, including pediatric emergency care, and recommend a strategy for the optimal organization and funding of the research effort. This study should include consideration of the training of new investigators, development of multicenter research networks, involvement of emergency and trauma care researchers in the grant review and research advisory processes, and improved research coordination through a dedicated center or institute.
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. AHRQ (Agency for Healthcare Research and Quality)
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1989b. Pediatric deaths and emergency medical services (EMS)
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2004a. Emergency Medical Serices for Children: A 0-Year Retrospectie Based on the Recommendations of the Committee on Pediatric Emergency Medical Serices of the National Academy of Sciences Institute of Medicine.
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. NHTSA (National Highway Traffic Safety Administration)
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From page 278... ...
2003. Pediatric emergency medicine research: A critical evaluation.
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