Acute hypoxic respiratory distress (AHRF) such as pneumonia, caused by an infection imposes the greatest health care burden on non-elective hospital admissions. The early use of non-invasive respiratory to facilitate respiratory support may avoid progression of the disease.

Nasal High Flow therapy (NHF) therapy has emerged as a new method to provide a form of positive pressure support with
titratable oxygen fraction. There is a lack of high-grade evidence on the use of NHF therapy in children with AHRF.

Eight in 1000 infants less than 12 months of age need hospital admission due to acute respiratory infection and represents the greatest number of non-elective intensive care admissions in the USA with a cost over U$ 1.7 billion per year.

This study at Gold Coast University Hospital aims to compare NHF therapy to standard subnasal oxygentherapy, in children 0-16 yrs of age with AHRF presenting to hospital. The primary outcome is treatment failure of NHF therapy or standard subnasal oxygen therapy.

Gold Coast University Hospital will be the first hospital in 2017, following the pilot trial at LCCH in 2016, to enrol patients on this much needed study.

The NHMRC awards Dr Donna Franklin (new member of our GCH ED research team) an Early Careers Researcher fellowship valued at $645,000 to continue the work on early respiratory support in children, following on from the PARIS studies GCH ED research has been involved in since 2014.
 

Medical and nursing staff experiences of working during COVID-19: An Emergency Department and Intensive Care Unit study to inform preparedness and response.

Bronchiolitis, a lower respiratory tract infection which causes inflammation of the small airways in infants, imposes the largest health care burden on hospital admissions worldwide, with up to 15 % of admissions to intensive care.

Nasal High Flow (NHF) therapy has emerged as a new method to support the breathing of these infants avoiding intensive care admission. We have shown in a previous large study that NHF therapy can be used in regional and metropolitan hospitals and reduces the need to transfer infants to a specialised children’s hospital. This new project entails working with six of the regional Queensland hospitals from the previous study to explore the optimal way to translate the new knowledge into practice.

We will compare three sites provided with structured educational support to three sites with no additional educational support. We suspect that the centres receiving the additional support will retain the knowledge and skill level to maintain and sustain optimal improved outcomes and have better uptake and adherence to evidence based NHF therapy guidelines for admitted infants with bronchiolitis.

Children present to emergency departments on a daily basis where sedation is required in order to conduct painful or distressing medically necessary procedures. Ketamine has been widely accepted as the preferred medication in which to achieve this sedation, however ongoing debate revolves around the best method of administration. Historically, intravenous ketamine has been the preferred method and this requires a cannula to be inserted into the vein. This procedure can be difficult to achieve with just one cannulation attempt and often takes multiple efforts to achieve intravenous access. Restraint of the child is necessary, often for a prolonged period of time - this can be significantly distressing for both the child and parent and can have long term psychological impacts. Delivering ketamine via the intramuscular route is significantly easier and quicker to achieve as a first pass success and has the potential to be much less distressful for the child. The hypothesis is that ketamine via one needle only, as an injection into the muscle, can provide adequate sedation for children – this proposed research trial will investigate this. This study will also look at the adverse effects, length of stay in the emergency department and length of sedation of intramuscular ketamine, when compared to intravenous ketamine.

Sepsis is devastating infection, leading to organ dysfunction. Sepsis kills more children in Australia than road traffic accidents. One out of three survivors will suffer from long-term health problems. Faster recognition of sepsis can save lives. However, recognising sepsis in children can be difficult, as children with sepsis initially present with symptoms similar to common infections. Currently, the recognition of sepsis is based on physician assessment of patients, and laboratory tests. Sadly, a common finding in Coroner`s investigations of sepsis deaths is that parents represented several times to health-care facilities, stating their concerns that “something is wrong” with their child. There is at present great debate as to what role parental concern should have in sepsis recognition.

We hypothesise that parents as experts of their child provide important information to recognise disease severity in their child. We will perform questionnaires with parents, and with medical and nursing staff when a child is evaluated for sepsis. We will compare the value of measuring parental concern in comparison to healthcare worker assessment, clinical signs and symptoms, and routine infection markers.

Bell’s palsy denotes the sudden onset of one-sided facial weakness of unknown cause. It is the third most common neurological reason for children to present acutely to hospital.

Patients with Bell’s palsy cannot properly close their eyes and mouths. This interferes with eating and speaking, causes eye problems and has a considerable cosmetic and social impact. In adults, there is conclusive evidence from two major recent trials that a short course of prednisolone, a cheap, widely available and safe steroid, can significantly increase the number of Bell’s palsy patients who completely recover.

While the medical problems associated with Bell’s palsy are similar, in children there is no good evidence that prednisolone is also an effective treatment.Many neurological conditions progress differently in children and treatment methods sometimes vary.
Children may react differently to prednisolone and without paediatric evidence; treatment guidelines for children with Bell’s palsy remain absent or vague, with variable and overall low rates of steroid use in children by physicians.

The lack of evidence and clinical uncertainty in the treatment of Bell’s palsy in children warrants a definitive trial to determine the efficacy of prednisolone as a treatment for Bell’s palsy in children.