Acute abdominal pain (tummy ache) accounts for 6-10% of all emergency department (ED) visits in children. Some of these children will be diagnosed with appendicitis, which is inflammation inside the gut that often requires surgery to fix. It takes time to diagnose appendicitis and kids may need treatment for their pain while they are waiting.

In this study we are trying to determine if ketorolac (a strong NSAID) works as well as morphine (an opioid) to help treat abdominal pain for kids in the ED. Both medications are already commonly used in Canadian EDs to help treat pain, but there has not been a study comparing the two for abdominal pain specifically. We also want to see if ketorolac has fewer side effects when compared to morphine. 

This study is being conducted in four children’s hospitals across Canada, and we will ask a total of over 500 children to be part of this study. Approximately 125 of these children will be recruited from the Stollery Emergency Department.

Site lead: Dr. Samina Ali

Research coordinator: Raymond Odsen

Study team: Dr. Mohamed Eltorki (PI), Dr. Waleed Alqurashi, Dr. Quang Ngo, Dr. Evelyne D. Trottier, Karen Beattie, Kathryn Birnie, Dr. Jason Busse,, Dr. Michael Livingstone, Dr. Naveen Poonai, Dr. Yaron Finkelstein, Dr. Stephen Freedman, Dr. Lehane Thabane, Dr. Graham Thompson. University of Alberta research nurses: Amanda Hack, Kevin Chung, Joy Ylagan, Ella Milne
Funding: CIHR 

Lacerations (or cuts) make up nearly half of all procedures done on kids who visit the emergency room. Research shows that children often feel a lot of stress and anxiety when they get stitches, even when a numbing cream, called LET (lidocaine-epinephrine-tetracaine), is used. If a child's stress and anxiety isn't treated, it can lead to fear of needles and fear of medical care later in life. The American Academy of Pediatrics recommends treating pain and distress as much as possible, but because there isn’t enough research, no single anxiolytic (calming medication) method is used regularly.

In the emergency department, medications like midazolam and nitrous oxide are often used as the calming medications during laceration repair. A newer medication, called dexmedetomidine, could be helpful for calming children during stitches. Right now, we just don’t know which of these three medicines is the best choice for kids getting stitches. This is important because many children get stitches and experience distress. Our results may be used to help such children have a better healthcare experience in the future. 

Site Investigator: Dr. Samina Ali
Research coordinator: Pat Candelaria
Study team members: Dr. Naveen Poonai (PI), Vinolia Arthur-Hayward (PM); University of Alberta Nurses: Kevin Chung, Amanda Hack, Taytem Syrnyk, Joy Ylagan
Funding: Accelerating Clinical Trials (ACT), Academic Medical Organization of South Western Ontario (AMOSO), Western Strategic Support for Success (WSSS), New Frontiers in Research Fund (NFRF)

Women’s achievements in medicine are often perceived differently than those of men. This is caused by implicit gender bias and leads to differences in opportunities. Literature suggests that men have higher research productivity, different career trajectories, and greater funding opportunities than women. Speaking with women in academic medicine, we have learned that biased hiring policies, informal social network and unprofessional behaviours are widely experienced. Few studies have examined gender differences in emergency medicine research productivity in Canada.

The field of emergency medicine research in Canada lacks a deep understanding of the role of gender within its professional networks. This study will provide Canadian data detailing the impact of gender on research productivity and researchers' personal opinions and experiences regarding the gender gap.

This study combines two projects: (1) an analysis of the research produced by our PERC's members, and (2) an analysis of PERC member's perceptions and experiences of how personal attributes have affected their research careers.

The results of this work will inform recommendations to support women researchers whose career progress is impacted by bias.

Principal investigators: Dr. Stevi Golden-Plotnik (co-PI), Dr. Gabrielle Freire (co-PI)

Study team: Dr. Samina Ali (mentor), Dr. Nathalie Gaucher, Dr. Angela Jarman, Dr. Kelly Cobey, Dr. Amy Plint, Dr. Roger Zemek, Rebecca Emerton, Kelly Kim, Ally Suarez, Tayte Syrnyk
Funding: Canadian Association of Emergency Physicians 

Hemolytic Uremic Syndrome (HUS) is a serious complication of high-risk Shiga toxin-producing Escherichia coli (STEC) infection and the most common cause of acquired acute kidney injury in otherwise healthy children. STEC is commonly aquired from tainted meat, but there are other ways to get it.  HUS develops in up to 1 in 5  children after a STEC infection, 60% of whom require temporary kidney dialysis; and about 3-5% of children die from HUS.

The primary objective of the study is to determine if early intravenous fluids (hyperhydration) in children diagnosed with STEC infection improves clinical outcomes compared with drinking fluid only, which is the current practice.

Site lead: Dr. Andrew Dixon
Research coordinator: Raymond Odsen
Study team: Dr. Stephen Freedman, Dr. David Schnadower, Dr. Phillip Tarr
Funding: NIAID

Sepsis is a medical emergency caused by infection. More than 25 million children worldwide are diagnosed with sepsis every year. Sepsis is the most expensive hospital condition in North America and for critically ill children it is the most common cause of hospital death.

Children with sepsis need treatment in the Emergency Department (ED) with IV fluids to improve blood supply to vital organs in the body.  Two types of IV fluids are commonly available and used in EDs and hospital wards for treating children with sepsis: balanced fluids (BF) and 0.9% “normal” saline (NS).  However, there is currently no research that clearly shows which IV fluid is the most effective and safest type to use.

The purpose of this large, international study is to compare the effectiveness (how well the fluids work) and safety of the two most commonly used types of IV fluid (BF vs NS) to improve clinical outcomes in children treated for sepsis.  We will also determine whether one type of fluid is more cost-effective. 

The PRoMPT BOLUS study is a multi-national clinical trial that includes 3 large pediatric emergency medicine research networks: Pediatric Emergency Research Canada (PERC), Pediatric Emergency Care Applied Research Network (PECARN – United States) and Paediatric Research in Emergency Departments International Collaborative (PREDICT – Australia/New Zealand). This study is being conducted in thirteen children’s hospitals across Canada, and we will ask between 1400 and 2700 Canadian children to be part of this study. Approximately 350 of these children will be recruited from the Stollery Emergency Department.

Site lead: Dr. Sarah Curtis

Research coordinator: Raymond Odsen

Study team: Dr. Graham Thompson (PI), Beata Mickiewicz (PM), Dr. Fran Balalmuth, Dr. Scott Weiss, Dr. Stephen Freedman, Dr. Pavan Judge, Dr. Ahmed Mater, Dr. Karen Gripp, Dr. April Kam, Dr. Gurinder Sangha, Dr. Gary Joubert, Dr. Adrienne Davis, Dr. Anupam Sehgal, Dr. Waleed Alqurashi, Dr. Fuad Alnaji, Dr. Yasaman Shayan, Dr. Simon Berthelot, Dr. Jason Emsley, Dr. Myla Moretti, Dr. Tex Kissoon, Dr. Bram Rochwerg, Dr. Suzette Cooke
Funding: CIHR 

Publications:

Weiss SL, Balamuth F, Long E, Thompson GC, Hayes KL, Katcoff H, Cook M, Tsemberis E, Hickey CP, Williams A, Williamson-Urquhart S, Borland ML, Dalziel SR, Gelbart B, Freedman SB, Babl FE, Huang J, Kuppermann N; Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) Investigators of the PECARN, PERC, and PREDICT Networks. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials. 2021 Nov 6;22(1):776. doi: 10.1186/s13063-021-05717-4. PMID: 34742327; PMCID: PMC8572061. 

Emergency research is needed to advance clinical knowledge and evidence, and to find new therapies for patients requiring urgent and life-threatening care. Ethical research conducted on humans must be done with participants’ approval, through the procedure known as ‘informed consent’. In this process, a participant voluntarily confirms their willingness to participate in a particular trial after understanding the potential risks and benefits of participation in the trial. This is an integral part of Good Clinical Practice guidelines.

Currently we don't have enough information / research on children and / or caregiver perception on studies that don't allow us to have informed consent prior to enrolling in studies. We say that these types of studies require "Research without prior consent (RWPC)" or "Exception from informed consent (EFIC)"

RWPC / EFIC was primarily introduced as a response to the difficulty of obtaining informed consent from patients or their proxies in the setting of immediately life-threatening injuries or illnesses, especially in cases where the patient is incapacitated.

The purpose of this study is to identify factors associated with supporting research when we can't have informed consent before the intervention in the study happens. This is an international study involving over 40 countries. 

Site lead: Dr. Samina Ali
Research coordinator: Patricia Candelaria
Lead site: Dr. Ran Goldman (PI), Jasleen Saini (national RC)
Research assistants: Neelam Mabood, Taytem Syrnyk, Joshua Eszczuk
Funding: CIHR

Understanding and remembering important health information during an emergency department (ED) visit can be challenging for patients and caregivers. ED-PATCH is a new tool designed to help. Given to patients early in their ED visit, it allows them to track key information—like diagnosis, tests, treatments, medications, and follow-up instructions—in real time.

Before leaving the ED, patients review their notes with a care provider to confirm accuracy. The final summary can be printed or sent electronically, supporting better understanding and ongoing care.

Over five years, our team will evaluate how ED-PATCH affects patient recall, experience, and communication. We will also explore how best to implement it in real-world emergency settings across Canada.

Site Investigator: Dr. Bruce Wright
Research coordinator: Andrea Eaton & Nadia Shular
Study PI: Dr. Janet Curran, IWK Halifax
Funding: CIHR

Children experience pain and distress in clinical settings every day. The negative consequences of unaddressed pain can be both short-term (e.g. fear, distress, inability to perform procedures) and long-term (e.g. needle phobia, anxiety). Working with stakeholders, we will develop a robust, adaptive, socially intelligent robot designed to distract children during painful clinical procedures, thereby reducing pain and distress. We interviewed health care professionals, caregivers and children about how they feel a robot can help children better manage painful procedures. We are currently developing this robot with the information we learned from these interviews. Our final step will be to test the robot's effectiveness through a clinical trial. It is a collaborative effort spanning six universities in Canada, two universities in the United Kingdom, and three branches of science (healthcare and biomedical sciences, social science and humanities, and natural sciences and engineering). 

National Principal Investigators: Dr. Samina Ali (Canada), Dr. Mary Ellen Foster (UK)
Canadian Project Manager: Patricia Candelaria
Healthcare and Biomedical Sciences: Dr. Sasha Litwin, Dr. Jennifer Stinson, Dr. Jennifer Parker, Dr. Christine Chambers, Summer Hudson, Cynthia Nguyen, Lauren Harris, Fareha Nishtat,
Social Sciences and Humanities: Dr. David Harris, Dr. Frauke Zeller, Lauren Dwyer
Natural Sciences and Engineering: Dr. Ron Petrick, Dr. Andres Ramirez-Duque, Dr. Alan Lindsay
University of Alberta Research Assistants: Neelam Mabood, Taytem Syrnyk, Joshua Eszczuk

Publications:
Foster ME, Ali S,  Litwin S, Parker J,  Petrick R, Smith D, Stinson J, Zeller F. (2020). Using AI-Enhanced Social Robots to Improve Children’s Healthcare Experiences. 10.1007/978-3-030-62056-1_45. 

Food allergy impacts 1-in-2 Canadian households, and up to 80% of severe allergic reactions in children are triggered by food. In Canada, approximately every 10 minutes, there is an Emergency Room (ER) visit for food-induced allergic reaction. In the event of an allergic reaction, treatment guidelines recommend that children be transported by an ambulance to an ER for observation, even if symptoms are mild or have stopped. The rationale behind the need for observation in the ER is that some patients are at risk of delayed reactions which can be life-threatening. Unfortunately, research data on the frequency, timing, severity, and predictors of delayed allergic reactions are very limited. As a result, many children are also admitted to the hospital or observed in the ER for long hours to increase the chance of detecting delayed reactions.

Canadian families described feelings of ambiguity about the severity of a reaction and hesitance to treat with epinephrine along with perceptions that ER visits often involve a long post-treatment wait time. The unpredictability of reactions and anticipation of ER visits can have a significant psychosocial impact on children and their caregivers. In fact, surveys of Canadian families showed that almost half of respondents described their anxiety level as 8 out of 10 or higher.

The main objective of this study is to determine which combination of risk factors identify children with allergic reactions who are at risk of developing delayed reactions. From this knowledge, we can develop guidelines so that children at high risk are monitored appropriately, whereas those at no or low risk can be discharged from the ER once they have no symptoms.

Site lead: Dr. Andrew Dixon

Research coordinator: Raymond Odsen

Study team: Dr. Waleed Alqurashi (PI), Dr. Amy C. Plint, Dr. Jocelyn Gravel, Dr. Grace Bravo, Dr. Stephen Freedman, Dr. Suzanne Schuh, Dr. Mohamed Eltorki
Research assistants: Neelam Mabood, Taytem Syrnyk, Joshua Eszczuk

Funding: CIHR

Caregivers play a pivotal role in making health decisions for their children, drawing on factors such as their knowledge, values, beliefs, and cultural background. An important aspect influencing their decision-making is health literacy, which is the ability to gather, understand, and apply health information within a healthcare context. Low health literacy is associated with increased healthcare visits and poorer overall health outcomes. Caregivers with limited health literacy may overestimate the seriousness of their child's illness, leading to overuse of pediatric emergency departments for non-urgent issues. This project aims to understand the motivations behind caregivers seeking care for non-urgent conditions in Alberta pediatric emergency departments, with a focus on the impact of health literacy on their decision-making. By gaining insights into the factors influencing caregivers decision-making when seeking non-urgent medical care, we aim to develop strategies to better support caregivers at home, ultimately reducing unnecessary visits to the pediatric emergency department. 

Principal Investigators:  Dr. Katharine Jensen (trainee), Dr. Samina Ali (supervisor)
Co-investigators: Dr. Michael Van Manen, Dr. Keon Ma, Dr. Graham Thompson
Patient Partner: Julie Leung
Decision-maker Partner:  Dr. Tania Principi, Dr. Andrew Dixon
Research Assistants: Neelam Mabood, Taytem Syrnyk, Joshua Eszczuk
Funding: TRIP, AMA

Children and their caregivers often have high levels of stress, fear, frustration, and uncertainty while waiting for medical care in the emergency department (ED) waiting room. Our team’s earlier research has shown that using robots to provide distraction during medical procedures, such as IV insertions, lessens child distress. We have also shown that robots providing caregiver education and distraction in ED waiting rooms reduces caregiver anxiety and improves their satisfaction with care, but there is little research specifically directed at decreasing child fear and stress in the waiting room. A positive waiting room experience can shape a family’s entire medical journey, as it is often their first point of contact with the healthcare system.

In this study, we plan to employ a humanoid robot, specially programmed to deliver brief, psychology-based interventions and distraction, to improve children’s experiences in the ED waiting room. The robot will distract children with music and dance and engage the child in guided relaxation techniques without any direct touch (minimizing infection risks). Robot interaction will be provided on certain days and on other days, children will have a ‘typical’ waiting room experience without robot presence. Through surveys, we will determine if the robot interaction helps lessen child fear and pain, and improve child (as well as caregiver and triage nurse) satisfaction with the waiting room experience. We will compare children’s experiences on days with and without a robot. We expect that children who experience robot interaction in the waiting room will report less fear, compared to those children who have a ‘typical’ no-robot waiting room experience.

Principal Investigators: Patricia Candelaria, Dr. Samina Ali

Co-Investigators: Dr. Summer Hudson, Dr. Elise Kammerer, Stephanie Smook, Julie Leung, Rebecca Liedtke, Jennifer Woods, Dr. Maryna Yaskina

Research Assistants: Neelam Mabood, Taytem Syrnyk, Joshua Eszczuk
Funding: ARNET