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Papers by Jason P Acworth

Research paper thumbnail of PRE-scripted debriefing for Paediatric simulation Associated with Resuscitation EDucation (PREPARED): A multicentre, cluster randomised controlled trial

Resuscitation Plus

Aim: Scripted debriefing tools may improve the performance of novices debriefing in resuscitation... more Aim: Scripted debriefing tools may improve the performance of novices debriefing in resuscitation courses, but this has not previously been measured. The aim of this study was to determine the impact of a script on the quality of debriefs in a statewide paediatric resuscitation course. Methods: This cluster-randomised controlled trial compared scripted debriefing (intervention) versus non-scripted debriefing (control) for participants in a paediatric resuscitation course. The trial was conducted across participating sites in Queensland, Australia, from November 2017 to February 2020. Debriefing quality was measured using the Observational Structured Assessment of Debriefing (OSAD) tool. The OSAD tool rates 8 domains that comprise the elements of an ideal debrief. OSAD scores between scripted and non-scripted groups were compared, overall and after stratification by debriefer experience and site size. Results: Seventy debriefings occurred across 19 sites (intervention, n = 34, control n = 36). There was a statistically significant increase in total OSAD scores in the scripted group, compared to non-scripted (mean difference (MD) = 3.5, 95% confidence interval (CI) 0.7-6.2, p = 0.01). The categories of 'reflection' and 'analysis' had the greatest difference in OSAD scores in the scripted group (MD = 0.8, 95%CI 0.2-1.3, p = 0.005; MD = 0.6, 95%CI 0.2-1.0, p = 0.007). After stratification, overall OSAD scores improved for novices (MD = 4.1, 95%CI 0.5-7.7, p = 0.03) and large centres (MD = 5.2, 95%CI 1.1-9.2, p = 0.01). Conclusion: Providing debriefing scripts to faculty facilitating simulated paediatric resuscitation scenarios improved the quality of debriefing, especially for novices and those at large sites. The development and provision of debriefing scripts for large-scale paediatric resuscitation courses should be considered.

Research paper thumbnail of Changing patterns in paediatric medical emergency team (MET) activations over 20 years in a single specialist paediatric hospital

Resuscitation Plus, 2020

Background: The Medical Emergency Team (MET) model was first introduced in the early 1990s and ai... more Background: The Medical Emergency Team (MET) model was first introduced in the early 1990s and aimed to intervene at an earlier stage of patient clinical deterioration. This study aimed to describe the changes in patient demographics, patterns of activation and clinical outcomes of MET activations at our specialist paediatric hospital across a 20-year period providing the longest duration Medical Emergency Team data set published to date. Methods: This single-centre observational study prospectively collected data about MET events at a single specialist paediatric hospital in Australia from 1995 to 2014. Patient demographics, activation patterns and clinical outcomes from MET activations were analysed for the 20-year period. Results: 771 MET events were included in analysis. Most MET events involved children aged <5 years (median age 36 months) with decreased incidence on weekends and night shift. The most frequent reasons stated for MET activation were seizure and respiratory compromise and the most commonly recorded MET interventions were bag-valve-mask ventilation and intravascular access. There was an increase in MET event frequency (MET events per 1000 hospital separations) in the second decade of the service compared to the first (3.25 vs 1.42, p < 0.001) with fewer events for cardiopulmonary arrest but more for respiratory, cardiovascular or neurological compromise. Conclusions: This study describes the longest duration MET data set published to date. The 20-year span of data demonstrates increased utilisation of the MET system and activation for patients earlier in their deterioration. The data should inform both health service planning and educational requirements for MET providers.

Research paper thumbnail of 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Ta...

Circulation

This is the sixth annual summary of the International Liaison Committee on Resuscitation Internat... more This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile...

Research paper thumbnail of Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis

Research paper thumbnail of Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review

Resuscitation, 2021

Context: Parent/family presence at pediatric resuscitations Q7 has been slow to become consistent... more Context: Parent/family presence at pediatric resuscitations Q7 has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. Objective: To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. Data sources: Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. Study selection: 3200 titles were retrieved in the initial search; 36 ultimately included for review. Data extraction: Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. Results: The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. Limitations: English language only; lack of randomized control trials; quality of the publications. Conclusions: Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes.

Research paper thumbnail of Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

Emergency Medicine Journal, 2001

Objectives-This study compared intranasal midazolam (INM) with a combination of intravenous ketam... more Objectives-This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department. Method-A single blinded randomised clinical trial was conducted in the emergency department of a major urban paediatric hospital. Subjects requiring sedation for minor procedures were randomised to receive either INM (0.4 mg/kg) or intravenous ketamine (1 mg/kg) plus intravenous midazolam (0.1 mg/kg). Physiological variables and two independent measures of sedation (Sedation Score and Visual Analogue Sedation Scale) were recorded before sedation and at regular intervals during the procedure and recovery period. Times to adequate level of sedation and to discharge were compared. Results-Fifty three patients were enrolled over a 10 month period. Sedation was suYcient to complete the procedures in all children receiving IVKM and in 24 of the 26 receiving INM. Onset of sedation was an average of 5.3 minutes quicker with IVKM than with INM (95%CI 3.2, 7.4 minutes, p<0.001). Children given INM were discharged an average of 19 minutes earlier than those given IVKM (95%CI 4, 33 minutes, p=0.02). Mean Sedation Scores and Visual Analogue Sedation Scale scores for the 30 minutes after drug administration were significantly better in children given IVKM compared with INM (2.4 and 1.8 versus 3.5 and 3.8, respectively). Both doctors and parents were more satisfied with sedation by intravenous ketamine and midazolam. Conclusions-Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of eVect. INM delivered via aerosol spray has a more variable eVect but may still be adequate for the completion of many of these procedures.

Research paper thumbnail of Pyloric stenosis: A retrospective study of an Australian population

Emergency Medicine Australasia, 2009

gery has been the traditional treatment of fenestrated duodenal membranes. A radial endoluminal i... more gery has been the traditional treatment of fenestrated duodenal membranes. A radial endoluminal incision of the membrane can widen its diameter and resolve the duodenal obstruction. OBJECTIVE: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes. METHODS: Under general anesthesia and endotracheal intubation, we introduced a flexible videopanendoscope into the second duodenal portion to visualize the membrane. Through the fenestration, we inserted a triplelumen stone extraction balloon of 15 mm. After insufflation, we performed gentle traction to expose the membrane and distinguish its border from the duodenal wall. We dilated the orifice and advanced the endoscope to localize Vater's ampoule. Using a sphincterotome, we performed 1 or 2 radial cuts of 1.5 to 2.0 cm in the membrane in an opposite direction to the ampoule. RESULTS: We performed this procedure on 10 patients. The mean duration of the procedure was 50 minutes. No patient had postoperative pain. Abdominal condition was normal, and all patients started oral intake 18 to 24 hours after the endoscopy. Patients were discharged asymptomatic. They completed 4 months to 4 years of follow-up. Eight continued to be asymptomatic. One had a double duodenal membrane and after 2 endoscopic cuts has occasional vomiting. Another 1 was lost to follow-up. CONCLUSIONS: Transluminal endoscopic treatment of fenestrated duodenal membranes has been a safe procedure that may be an effective and less invasive alternative to open or laparoscopic surgery.

Research paper thumbnail of Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-Spine and PECARN clinical decision rules in a prospective Australian cohort

Emergency Medicine Journal

BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical... more BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population.MethodsA single-centre prospective observational study on all aged under 16 years presenting for assessment of possible CSI to a tertiary paediatric emergency department over a year, commencing September 2015. CDR variables from the National Emergency X-Radiography Utilization Study (NEXUS) rule, Canadian C-Spine rule (CCR) and proposed Paediatric Emergency Care Applied Research Network (PECARN) rule were collected prospectively and applied post hoc.Results1010 children were enrolled; 973 had not received prior imaging. Of these, 40.7% received cervical spine imaging; 32...

Research paper thumbnail of Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

Journal of Clinical Medicine

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following h... more We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most c...

Research paper thumbnail of A Cochrane Systematic Review - Anticholinergic Therapy for Acute Asthma in Children

Research paper thumbnail of How does the Canadian Acute Respiratory Illness and Flu Scale relate to other scales in paediatric asthma exacerbations?

Paediatric asthma and allergy, 2021

Research paper thumbnail of Chronic cough following acute respiratory illness in children

Research paper thumbnail of How does the Canadian Acute Respiratory Illness and Flu Scale relate to other scales in pediatric asthma exacerbations?

Journal of Asthma, 2021

Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian... more Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores and (a) Asthma Diary Scale (ADS) scores for 14 days; (b) Pediatric Asthma Caregiver's Quality of Life (QoL) Questionnaire (PACQLQ) scores on days 1, 7 and 14; (c) viral detection. We hypothesized that in children with acute asthma, CARIFS scores correlate with ADS and PACQLQ scores over time and that viruses have little impact on CARIFS scores.Methods: In children aged 2-16 years who presented with acute asthma to the Emergency Departments of 2 hospitals, we documented the clinical history, examination, asthma severity at baseline and on presentation. Eighteen respiratory pathogens were determined by PCR on nasopharyngeal aspirate (NPA) collected on recruitment. The parent(s) recorded their child's daily CARIFS and ADS and weekly PACQLQ for 14 days. We used Spearman's correlation to relate the scores of 108 children.Results: CARIFS scores correlated well with ADS scores throughout 14 days (rs ranged 0.30-0.67). CARIFS and PACQLQ scores correlated -0.28, -0.14 and -0.44 on days 1, 7 and 14 respectively. There was no significant difference in CARIFS scores between children whose NPAs were PCR virus-positive or -negative over 14 days.Conclusions: CARIFS and ADS scores correlated well as a disease severity measure during the recovery period in children with acute asthma and this was not influenced by the virus state. The ADS may be used as an alternative in selected situations. The CARIFS reflects different aspects to acute asthma severity and QoL.

Research paper thumbnail of Where are children seen in Australian emergency departments? Implications for research efforts

Emergency Medicine Australasia, 2021

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Research paper thumbnail of A 5‐ versus 3‐day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial

Medical Journal of Australia, 2008

Flow of participants through the study 3-day group = 3-day course of oral prednisolone plus 2-day... more Flow of participants through the study 3-day group = 3-day course of oral prednisolone plus 2-day course of placebo. 5-day group = 5-day course of prednisolone. CS = corticosteroid. ◆ Assessed for eligibility (n = 535) Enrolment Excluded (n = 334) Did not meet inclusion criteria (n = 258) Refused to participate (n = 76) Other reasons (n = 0) Allocated to 3-day group (n = 101) Received allocated intervention (n = 101) Did not receive allocated intervention (n = 0) Allocated to 5-day group (n = 100)

Research paper thumbnail of Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial

The Lancet. Respiratory Medicine, 2013

Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cau... more Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospital admission. Hydration is a mainstay of treatment, but insufficient evidence exists to guide clinical practice. We aimed to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants. In this multicentre, open, randomised trial, we enrolled infants aged 2-12 months admitted to hospitals in Australia and New Zealand with a clinical diagnosis of bronchiolitis during three bronchiolitis seasons (April 1-Oct 31, in 2009, 2010, and 2011). We randomly allocated infants to nasogastric hydration or intravenous hydration by use of a computer-generated sequence and opaque sealed envelopes, with three randomly assigned block sizes and stratified by hospital site and age group (2-&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6 months vs 6-12 months). The primary outcome was length of hospital stay, assessed in all randomly assigned infants. Secondary outcomes included rates of intensive-care unit admission, adverse events, and success of insertion. This trial is registered with the Australian and New Zealand clinical trials registry, ACTRN12605000033640. Mean length of stay for 381 infants assigned nasogastric hydration was 86·6 h (SD 58·9) compared with 82·2 h (58·8) for 378 infants assigned intravenous hydration (absolute difference 4·5 h [95% CI -3·9 to 12·9]; p=0·30). Rates of admission to intensive-care units, need for ventilatory support, and adverse events did not differ between groups. At randomisation, seven infants assigned nasogastric hydration were switched to intravenous hydration and 56 infants assigned intravenous hydration were switched to nasogastric hydration because the study-assigned method was unable to be inserted. For those infants who had data available for successful insertion, 275 (85%) of 323 infants in the nasogastric hydration group and 165 (56%) of 294 infants in the intravenous hydration group required only one attempt for successful insertion. Intravenous hydration and nasogastric hydration are appropriate means to hydrate infants with bronchiolitis. Nasogastric insertion might require fewer attempts and have a higher success rate of insertion than intravenous hydration. Australian National Health and Medical Research Council, Samuel Nissen Charitable Foundation (Perpetual), Murdoch Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Research Institute, Victorian Government.

Research paper thumbnail of Anticholinergic therapy for acute asthma in children

Reviews, 2012

Background Inhaled anticholinergics as single agent bronchodilators (or in combination with beta ... more Background Inhaled anticholinergics as single agent bronchodilators (or in combination with beta 2-agonists) are one of the several medications available for the treatment of acute asthma in children. Objectives To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma. Search methods The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011. Selection criteria We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma. Data collection and analysis Two authors independently selected trials, extracted data and assessed trial quality. Main results Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta 2-agonists from four trials on 171 1 Anticholinergic therapy for acute asthma in children (Review)

Research paper thumbnail of Patterns of presentation to the Australian and New Zealand Paediatric Emergency Research Network

Emergency Medicine Australasia, 2009

To describe epidemiological data concerning paediatric ED visits to an Australian and New Zealand... more To describe epidemiological data concerning paediatric ED visits to an Australian and New Zealand research network. We conducted a cross-sectional study of paediatric ED visits to all Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in 2004. Epidemiological data, including demographics, admission rates and diagnostic grouping, were examined and analysed using descriptive and comparative statistical methods. We compared the data, if possible, with published data from a US paediatric emergency research network (Pediatric Emergency Care Applied Research Network). A total of 351 440 ED presentations were analysed from 11 PREDICT sites. Mean patient age was 4.6 years and 55% were boys. Presentations were identified as 3% Aboriginal at Australian sites and 44% Maori/Pacific in New Zealand locations. According to Australasian Triage Scale (ATS), 5% were ATS 1 or 2 (to be seen immediately or within 10 min), 27% ATS 3 (to be seen within 30 min) and 67% ATS 4 or 5. Although ED visits peaked in late winter and early spring, admission rates remained unchanged throughout the year with an overall admission rate of 24%. Most frequent diagnoses were acute gastroenteritis, acute viral illness and upper respiratory tract infection. Asthma was the next most common. Pediatric Emergency Care Applied Research Network and PREDICT data showed differences in terms of ethnicity descriptions/distribution and admission rates. This is the first description of the epidemiology of patient presentations to major paediatric ED in Australia and New Zealand. It details baseline data important to future collaborative studies and for planning health services for children.

Research paper thumbnail of A prospective randomised trial comparing nasogastric with intravenous hydration in children with bronchiolitis (protocol) The comparative rehydration in bronchiolitis study (CRIB)

BMC Pediatrics, 2010

Background Bronchiolitis is the most common reason for admission of infants to hospital in develo... more Background Bronchiolitis is the most common reason for admission of infants to hospital in developed countries. Fluid replacement therapy is required in about 30% of children admitted with bronchiolitis. There are currently two techniques of fluid replacement therapy that are used with the same frequency-intravenous (IV) or nasogastric (NG). The evidence to determine the optimum route of hydration therapy for infants with bronchiolitis is inadequate. This randomised trial will be the first to provide good quality evidence of whether nasogastric rehydration (NGR) offers benefits over intravenous rehydration (IVR) using the clinically relevant continuous outcome measure of duration of hospital admission. Methods/Design A prospective randomised multi-centre trial in Australia and New Zealand where children between 2 and 12 months of age with bronchiolitis, needing non oral fluid replacement, are randomised to receive either intravenous (IV) or nasogastric (NG) rehydration. 750 patients...

Research paper thumbnail of The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness: study protocol for a prospective cohort study

BMC Pediatrics, 2013

Background Acute respiratory illness, a leading cause of cough in children, accounts for a substa... more Background Acute respiratory illness, a leading cause of cough in children, accounts for a substantial proportion of childhood morbidity and mortality worldwide. In some children acute cough progresses to chronic cough (>4 weeks duration), impacting on morbidity and decreasing quality of life. Despite the importance of chronic cough as a cause of substantial childhood morbidity and associated economic, family and social costs, data on the prevalence, predictors, aetiology and natural history of the symptom are scarce. This study aims to comprehensively describe the epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children presenting to a tertiary paediatric emergency department. Methods/design A prospective cohort study of children aged <15 years attending the Royal Children’s Hospital Emergency Department, Brisbane, for a respiratory illness that includes parent reported cough (wet or dry) as a symptom. The primary objective is to de...

Research paper thumbnail of PRE-scripted debriefing for Paediatric simulation Associated with Resuscitation EDucation (PREPARED): A multicentre, cluster randomised controlled trial

Resuscitation Plus

Aim: Scripted debriefing tools may improve the performance of novices debriefing in resuscitation... more Aim: Scripted debriefing tools may improve the performance of novices debriefing in resuscitation courses, but this has not previously been measured. The aim of this study was to determine the impact of a script on the quality of debriefs in a statewide paediatric resuscitation course. Methods: This cluster-randomised controlled trial compared scripted debriefing (intervention) versus non-scripted debriefing (control) for participants in a paediatric resuscitation course. The trial was conducted across participating sites in Queensland, Australia, from November 2017 to February 2020. Debriefing quality was measured using the Observational Structured Assessment of Debriefing (OSAD) tool. The OSAD tool rates 8 domains that comprise the elements of an ideal debrief. OSAD scores between scripted and non-scripted groups were compared, overall and after stratification by debriefer experience and site size. Results: Seventy debriefings occurred across 19 sites (intervention, n = 34, control n = 36). There was a statistically significant increase in total OSAD scores in the scripted group, compared to non-scripted (mean difference (MD) = 3.5, 95% confidence interval (CI) 0.7-6.2, p = 0.01). The categories of 'reflection' and 'analysis' had the greatest difference in OSAD scores in the scripted group (MD = 0.8, 95%CI 0.2-1.3, p = 0.005; MD = 0.6, 95%CI 0.2-1.0, p = 0.007). After stratification, overall OSAD scores improved for novices (MD = 4.1, 95%CI 0.5-7.7, p = 0.03) and large centres (MD = 5.2, 95%CI 1.1-9.2, p = 0.01). Conclusion: Providing debriefing scripts to faculty facilitating simulated paediatric resuscitation scenarios improved the quality of debriefing, especially for novices and those at large sites. The development and provision of debriefing scripts for large-scale paediatric resuscitation courses should be considered.

Research paper thumbnail of Changing patterns in paediatric medical emergency team (MET) activations over 20 years in a single specialist paediatric hospital

Resuscitation Plus, 2020

Background: The Medical Emergency Team (MET) model was first introduced in the early 1990s and ai... more Background: The Medical Emergency Team (MET) model was first introduced in the early 1990s and aimed to intervene at an earlier stage of patient clinical deterioration. This study aimed to describe the changes in patient demographics, patterns of activation and clinical outcomes of MET activations at our specialist paediatric hospital across a 20-year period providing the longest duration Medical Emergency Team data set published to date. Methods: This single-centre observational study prospectively collected data about MET events at a single specialist paediatric hospital in Australia from 1995 to 2014. Patient demographics, activation patterns and clinical outcomes from MET activations were analysed for the 20-year period. Results: 771 MET events were included in analysis. Most MET events involved children aged <5 years (median age 36 months) with decreased incidence on weekends and night shift. The most frequent reasons stated for MET activation were seizure and respiratory compromise and the most commonly recorded MET interventions were bag-valve-mask ventilation and intravascular access. There was an increase in MET event frequency (MET events per 1000 hospital separations) in the second decade of the service compared to the first (3.25 vs 1.42, p < 0.001) with fewer events for cardiopulmonary arrest but more for respiratory, cardiovascular or neurological compromise. Conclusions: This study describes the longest duration MET data set published to date. The 20-year span of data demonstrates increased utilisation of the MET system and activation for patients earlier in their deterioration. The data should inform both health service planning and educational requirements for MET providers.

Research paper thumbnail of 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Ta...

Circulation

This is the sixth annual summary of the International Liaison Committee on Resuscitation Internat... more This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile...

Research paper thumbnail of Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis

Research paper thumbnail of Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review

Resuscitation, 2021

Context: Parent/family presence at pediatric resuscitations Q7 has been slow to become consistent... more Context: Parent/family presence at pediatric resuscitations Q7 has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. Objective: To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. Data sources: Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. Study selection: 3200 titles were retrieved in the initial search; 36 ultimately included for review. Data extraction: Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. Results: The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. Limitations: English language only; lack of randomized control trials; quality of the publications. Conclusions: Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes.

Research paper thumbnail of Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

Emergency Medicine Journal, 2001

Objectives-This study compared intranasal midazolam (INM) with a combination of intravenous ketam... more Objectives-This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department. Method-A single blinded randomised clinical trial was conducted in the emergency department of a major urban paediatric hospital. Subjects requiring sedation for minor procedures were randomised to receive either INM (0.4 mg/kg) or intravenous ketamine (1 mg/kg) plus intravenous midazolam (0.1 mg/kg). Physiological variables and two independent measures of sedation (Sedation Score and Visual Analogue Sedation Scale) were recorded before sedation and at regular intervals during the procedure and recovery period. Times to adequate level of sedation and to discharge were compared. Results-Fifty three patients were enrolled over a 10 month period. Sedation was suYcient to complete the procedures in all children receiving IVKM and in 24 of the 26 receiving INM. Onset of sedation was an average of 5.3 minutes quicker with IVKM than with INM (95%CI 3.2, 7.4 minutes, p<0.001). Children given INM were discharged an average of 19 minutes earlier than those given IVKM (95%CI 4, 33 minutes, p=0.02). Mean Sedation Scores and Visual Analogue Sedation Scale scores for the 30 minutes after drug administration were significantly better in children given IVKM compared with INM (2.4 and 1.8 versus 3.5 and 3.8, respectively). Both doctors and parents were more satisfied with sedation by intravenous ketamine and midazolam. Conclusions-Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of eVect. INM delivered via aerosol spray has a more variable eVect but may still be adequate for the completion of many of these procedures.

Research paper thumbnail of Pyloric stenosis: A retrospective study of an Australian population

Emergency Medicine Australasia, 2009

gery has been the traditional treatment of fenestrated duodenal membranes. A radial endoluminal i... more gery has been the traditional treatment of fenestrated duodenal membranes. A radial endoluminal incision of the membrane can widen its diameter and resolve the duodenal obstruction. OBJECTIVE: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes. METHODS: Under general anesthesia and endotracheal intubation, we introduced a flexible videopanendoscope into the second duodenal portion to visualize the membrane. Through the fenestration, we inserted a triplelumen stone extraction balloon of 15 mm. After insufflation, we performed gentle traction to expose the membrane and distinguish its border from the duodenal wall. We dilated the orifice and advanced the endoscope to localize Vater's ampoule. Using a sphincterotome, we performed 1 or 2 radial cuts of 1.5 to 2.0 cm in the membrane in an opposite direction to the ampoule. RESULTS: We performed this procedure on 10 patients. The mean duration of the procedure was 50 minutes. No patient had postoperative pain. Abdominal condition was normal, and all patients started oral intake 18 to 24 hours after the endoscopy. Patients were discharged asymptomatic. They completed 4 months to 4 years of follow-up. Eight continued to be asymptomatic. One had a double duodenal membrane and after 2 endoscopic cuts has occasional vomiting. Another 1 was lost to follow-up. CONCLUSIONS: Transluminal endoscopic treatment of fenestrated duodenal membranes has been a safe procedure that may be an effective and less invasive alternative to open or laparoscopic surgery.

Research paper thumbnail of Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-Spine and PECARN clinical decision rules in a prospective Australian cohort

Emergency Medicine Journal

BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical... more BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population.MethodsA single-centre prospective observational study on all aged under 16 years presenting for assessment of possible CSI to a tertiary paediatric emergency department over a year, commencing September 2015. CDR variables from the National Emergency X-Radiography Utilization Study (NEXUS) rule, Canadian C-Spine rule (CCR) and proposed Paediatric Emergency Care Applied Research Network (PECARN) rule were collected prospectively and applied post hoc.Results1010 children were enrolled; 973 had not received prior imaging. Of these, 40.7% received cervical spine imaging; 32...

Research paper thumbnail of Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

Journal of Clinical Medicine

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following h... more We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most c...

Research paper thumbnail of A Cochrane Systematic Review - Anticholinergic Therapy for Acute Asthma in Children

Research paper thumbnail of How does the Canadian Acute Respiratory Illness and Flu Scale relate to other scales in paediatric asthma exacerbations?

Paediatric asthma and allergy, 2021

Research paper thumbnail of Chronic cough following acute respiratory illness in children

Research paper thumbnail of How does the Canadian Acute Respiratory Illness and Flu Scale relate to other scales in pediatric asthma exacerbations?

Journal of Asthma, 2021

Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian... more Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores and (a) Asthma Diary Scale (ADS) scores for 14 days; (b) Pediatric Asthma Caregiver's Quality of Life (QoL) Questionnaire (PACQLQ) scores on days 1, 7 and 14; (c) viral detection. We hypothesized that in children with acute asthma, CARIFS scores correlate with ADS and PACQLQ scores over time and that viruses have little impact on CARIFS scores.Methods: In children aged 2-16 years who presented with acute asthma to the Emergency Departments of 2 hospitals, we documented the clinical history, examination, asthma severity at baseline and on presentation. Eighteen respiratory pathogens were determined by PCR on nasopharyngeal aspirate (NPA) collected on recruitment. The parent(s) recorded their child's daily CARIFS and ADS and weekly PACQLQ for 14 days. We used Spearman's correlation to relate the scores of 108 children.Results: CARIFS scores correlated well with ADS scores throughout 14 days (rs ranged 0.30-0.67). CARIFS and PACQLQ scores correlated -0.28, -0.14 and -0.44 on days 1, 7 and 14 respectively. There was no significant difference in CARIFS scores between children whose NPAs were PCR virus-positive or -negative over 14 days.Conclusions: CARIFS and ADS scores correlated well as a disease severity measure during the recovery period in children with acute asthma and this was not influenced by the virus state. The ADS may be used as an alternative in selected situations. The CARIFS reflects different aspects to acute asthma severity and QoL.

Research paper thumbnail of Where are children seen in Australian emergency departments? Implications for research efforts

Emergency Medicine Australasia, 2021

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Research paper thumbnail of A 5‐ versus 3‐day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial

Medical Journal of Australia, 2008

Flow of participants through the study 3-day group = 3-day course of oral prednisolone plus 2-day... more Flow of participants through the study 3-day group = 3-day course of oral prednisolone plus 2-day course of placebo. 5-day group = 5-day course of prednisolone. CS = corticosteroid. ◆ Assessed for eligibility (n = 535) Enrolment Excluded (n = 334) Did not meet inclusion criteria (n = 258) Refused to participate (n = 76) Other reasons (n = 0) Allocated to 3-day group (n = 101) Received allocated intervention (n = 101) Did not receive allocated intervention (n = 0) Allocated to 5-day group (n = 100)

Research paper thumbnail of Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial

The Lancet. Respiratory Medicine, 2013

Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cau... more Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospital admission. Hydration is a mainstay of treatment, but insufficient evidence exists to guide clinical practice. We aimed to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants. In this multicentre, open, randomised trial, we enrolled infants aged 2-12 months admitted to hospitals in Australia and New Zealand with a clinical diagnosis of bronchiolitis during three bronchiolitis seasons (April 1-Oct 31, in 2009, 2010, and 2011). We randomly allocated infants to nasogastric hydration or intravenous hydration by use of a computer-generated sequence and opaque sealed envelopes, with three randomly assigned block sizes and stratified by hospital site and age group (2-&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6 months vs 6-12 months). The primary outcome was length of hospital stay, assessed in all randomly assigned infants. Secondary outcomes included rates of intensive-care unit admission, adverse events, and success of insertion. This trial is registered with the Australian and New Zealand clinical trials registry, ACTRN12605000033640. Mean length of stay for 381 infants assigned nasogastric hydration was 86·6 h (SD 58·9) compared with 82·2 h (58·8) for 378 infants assigned intravenous hydration (absolute difference 4·5 h [95% CI -3·9 to 12·9]; p=0·30). Rates of admission to intensive-care units, need for ventilatory support, and adverse events did not differ between groups. At randomisation, seven infants assigned nasogastric hydration were switched to intravenous hydration and 56 infants assigned intravenous hydration were switched to nasogastric hydration because the study-assigned method was unable to be inserted. For those infants who had data available for successful insertion, 275 (85%) of 323 infants in the nasogastric hydration group and 165 (56%) of 294 infants in the intravenous hydration group required only one attempt for successful insertion. Intravenous hydration and nasogastric hydration are appropriate means to hydrate infants with bronchiolitis. Nasogastric insertion might require fewer attempts and have a higher success rate of insertion than intravenous hydration. Australian National Health and Medical Research Council, Samuel Nissen Charitable Foundation (Perpetual), Murdoch Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Research Institute, Victorian Government.

Research paper thumbnail of Anticholinergic therapy for acute asthma in children

Reviews, 2012

Background Inhaled anticholinergics as single agent bronchodilators (or in combination with beta ... more Background Inhaled anticholinergics as single agent bronchodilators (or in combination with beta 2-agonists) are one of the several medications available for the treatment of acute asthma in children. Objectives To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma. Search methods The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011. Selection criteria We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma. Data collection and analysis Two authors independently selected trials, extracted data and assessed trial quality. Main results Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta 2-agonists from four trials on 171 1 Anticholinergic therapy for acute asthma in children (Review)

Research paper thumbnail of Patterns of presentation to the Australian and New Zealand Paediatric Emergency Research Network

Emergency Medicine Australasia, 2009

To describe epidemiological data concerning paediatric ED visits to an Australian and New Zealand... more To describe epidemiological data concerning paediatric ED visits to an Australian and New Zealand research network. We conducted a cross-sectional study of paediatric ED visits to all Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in 2004. Epidemiological data, including demographics, admission rates and diagnostic grouping, were examined and analysed using descriptive and comparative statistical methods. We compared the data, if possible, with published data from a US paediatric emergency research network (Pediatric Emergency Care Applied Research Network). A total of 351 440 ED presentations were analysed from 11 PREDICT sites. Mean patient age was 4.6 years and 55% were boys. Presentations were identified as 3% Aboriginal at Australian sites and 44% Maori/Pacific in New Zealand locations. According to Australasian Triage Scale (ATS), 5% were ATS 1 or 2 (to be seen immediately or within 10 min), 27% ATS 3 (to be seen within 30 min) and 67% ATS 4 or 5. Although ED visits peaked in late winter and early spring, admission rates remained unchanged throughout the year with an overall admission rate of 24%. Most frequent diagnoses were acute gastroenteritis, acute viral illness and upper respiratory tract infection. Asthma was the next most common. Pediatric Emergency Care Applied Research Network and PREDICT data showed differences in terms of ethnicity descriptions/distribution and admission rates. This is the first description of the epidemiology of patient presentations to major paediatric ED in Australia and New Zealand. It details baseline data important to future collaborative studies and for planning health services for children.

Research paper thumbnail of A prospective randomised trial comparing nasogastric with intravenous hydration in children with bronchiolitis (protocol) The comparative rehydration in bronchiolitis study (CRIB)

BMC Pediatrics, 2010

Background Bronchiolitis is the most common reason for admission of infants to hospital in develo... more Background Bronchiolitis is the most common reason for admission of infants to hospital in developed countries. Fluid replacement therapy is required in about 30% of children admitted with bronchiolitis. There are currently two techniques of fluid replacement therapy that are used with the same frequency-intravenous (IV) or nasogastric (NG). The evidence to determine the optimum route of hydration therapy for infants with bronchiolitis is inadequate. This randomised trial will be the first to provide good quality evidence of whether nasogastric rehydration (NGR) offers benefits over intravenous rehydration (IVR) using the clinically relevant continuous outcome measure of duration of hospital admission. Methods/Design A prospective randomised multi-centre trial in Australia and New Zealand where children between 2 and 12 months of age with bronchiolitis, needing non oral fluid replacement, are randomised to receive either intravenous (IV) or nasogastric (NG) rehydration. 750 patients...

Research paper thumbnail of The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness: study protocol for a prospective cohort study

BMC Pediatrics, 2013

Background Acute respiratory illness, a leading cause of cough in children, accounts for a substa... more Background Acute respiratory illness, a leading cause of cough in children, accounts for a substantial proportion of childhood morbidity and mortality worldwide. In some children acute cough progresses to chronic cough (>4 weeks duration), impacting on morbidity and decreasing quality of life. Despite the importance of chronic cough as a cause of substantial childhood morbidity and associated economic, family and social costs, data on the prevalence, predictors, aetiology and natural history of the symptom are scarce. This study aims to comprehensively describe the epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children presenting to a tertiary paediatric emergency department. Methods/design A prospective cohort study of children aged <15 years attending the Royal Children’s Hospital Emergency Department, Brisbane, for a respiratory illness that includes parent reported cough (wet or dry) as a symptom. The primary objective is to de...