Results from PEAK team studies

Ahrari M, Ali S, Hartling L, Dong K, Drendel AL, Klassen TP, Schreiner K, Dyson MP. Nonmedical opioid use following short-term therapeutic exposure in children: a systematic review. Pediatrics 2021; 148(6): e2021051927. doi: 10.1542/peds.2021-051927

Many caregivers do not know when to give their child/teen prescription opioids, partly because they worry about whether using opioids for even a short time is associated with later misuse or abuse. Our team recently completed a review of research studies to answer this important question. We discovered that the existing research is not always clear and sometimes contradictory. For example, some studies showed an increased risk with short-term use, while others did not. However, it does seem that teens and young adults who receive any opioid prescription are at risk for later use of opioids for nonmedical reasons, but we are not completely sure if this is true, specifically for short-term opioid prescriptions. Before a child or teen receives a prescription for opioids, the healthcare provider should perform a screen for risk of opioid use disorder so that they can take extra precautions if need be. The healthcare provider should also make sure that the family knows how to safely dispose of any opioids that were not taken. It is very important that pain is properly treated, so if opioids are used as directed for a short time, it is okay to take them.

Ali S, Manaloor R, Ma K, et al. A randomized trial of robot-based distraction to reduce children’s distress and pain during intravenous insertion in the emergency department. Can J Emerg Med 2021;23:85-93. doi: 10.1007/s43678-020-00023-5

For children presenting to the emergency department, an IV insertion or bloodwork can cause much pain and anxiety. These negative experiences can result in a future needle fear or phobia for the child and can cause dissatisfaction with the child’s care experience for families and healthcare providers, alike. Recent research has shown that distraction can be useful in reducing children’s procedural pain and anxiety, with digital technology distraction emerging as a new option. This two-arm, open-label parallel randomized controlled trial sought to determine whether a less-commonly encountered technology—a humanoid robot—could effectively distract children during a painful procedure.

The robot was programmed using cognitive behavioural therapy-based strategies for children 6-11 years old. The control group (n=39) in the study received standard care, including a numbing cream and non-electronic physical and psychological pain management strategies such as physical comforting, verbal and emotional support. Children receiving the intervention (n=42) received standard care and interacted with the robot during their IV insertion. The primary outcomes of the study were patient distress, which was measured using the Observed Scale of Behavioural Distress-Revised, and pain using the Faces Pain Scale-Revised.

This clinical trial demonstrated that use of the robot moderately decreased children’s distress compared to standard of care but not children’s pain. Caregivers whose child received the robot intervention reported lower anxiety immediately following the procedure. They were also more satisfied with the IV insertion and their child’s pain management compared to caregivers of children in the control group.

Ali S, Moodley A, Bhattacharjee A, Chang E, Kabaroff A, Lobay K, Allain D (2018) Prehospital dexamethasone administration in children with croup: a medical record review. Open Access Emerg Med 10: 141-7. doi: 10.2147/OAEM.S168728

More than 80,000 Canadian children get sick with croup every year. If they need to take an ambulance to the hospital, one way to decrease the severity of croup is for the child to receive dexamethasone, which is an oral corticosteroid. It may reduce the likelihood of being admitted to hospital and can reduce the length of stay for those children who are admitted to hospital. 

Across Alberta, Emergency Medical Services (EMS) can administer dexamethasone to children with croup on the way to the hospital. This study was the first to examine the clinical impact of the policy which has been in place since 2009. The study sought to understand whether dexamethasone reduced hospital admission rates and lengths of stays when administered prior to arriving at the hospital. To do this, the authors conducted a retrospective medical record review of 188 patient records.

While this study did not find a significant association between dexamethasone administration and hospital admission and length of stay, the authors found that pre-hospital administration of dexamethasone decreased the amount of epinephrine used in the emergency department (ED). This means that patients and families spend less time in the ED, which may improve patient and family satisfaction, increase bed space, and possibly shorten waiting times for others.

Hartling L, Elliott SA, Buckreus K, Leung J, Scott SD. Development and evaluation of a parent advisory group to inform a research program for knowledge translation in child health. Res Involv Engagem. 2021 Jun 7;7(1):38. doi: 10.1186/s40900-021-00280-3.

In 2016, ARCHE and ECHO developed a parent advisory group to inform their research program in knowledge translation (i.e., sharing research in accessible ways to inform decision-making) for child health. The group provides input from a parent perspective. An  online baseline survey of parent members and a follow-up online survey 16 months after the group had started was conducted. The surveys helped the team understand reasons for parents’ participation, what they thought was working well with the group, and areas for improvement. Parents valued the opportunity to provide constructive feedback on research processes and outputs. They felt the meetings were well-organized and the group was open and welcoming. Parents felt that regular and ongoing communication with the researchers was critical for meaningful engagement. To this end, funding to support a dedicated coordinator was considered essential. Parents appreciated that the researchers organized the group around parents’ needs in terms of timing of meetings (evenings) and reimbursement for expenses to attend meetings (travel, childcare). Parents considered this type of group to be unique, particularly as it supports a research program over the long-term rather than for specific projects, and because of the relative maturity in terms of clearly defining group purpose, structure, and engagement approach. The ongoing involvement allows for benefits in terms of building relationships, providing many and varied opportunities to interact, and allowing parents to see how their input is implemented. Finally, an evaluation mechanism with communication of results and a commitment to implement findings is considered critical. This parent advisory group can provide a model for other researchers or research organizations.

Virk P, Atwal A, Wright B, Doan Q. Exploring parental perceptions of psychosocial screening in paediatric emergency departments. Clin Child Psychol Psychiatry. 2022:13591045211070922. doi: 10.1177/13591045211070922

Since approximately one-third of youth who visit an emergency department (ED) may have underlying psychosocial concerns, it can be beneficial to screen these youth during their ED visit. Healthcare professionals may not always have the time or resources to screen youth for any potential mental health concerns, so self-administered screening can be an option. Self-administered screening, such as with a tool called MyHEARTSMAP, can give patients the necessary privacy and time to share their concerns. This was a qualitative study to find out whether using the MyHEARTSMAP tool was an acceptable way to screen for mental health concerns among caregivers and youth. Caregivers reported that they felt the MyHEARTSMAP tool helped to start more in-depth mental health discussions with their children. Although most youth (66%, n=124) who did have identified mental health concerns did not seek intervention for these concerns during their ED visit, approximately half of caregivers noted that they would help their child seek care for these concerns in the future. This study found that mental health screening in the ED setting was acceptable to most families and the MyHEARTSMAP tool may be one way that youth can be screened during an ED visit.

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M … Craig W, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA 2016;315(10):1014-1025. doi: 10.1001/jama.2016.1203

Thousands of children visit the emergency department (ED) every year due to an acute concussion. While most children recover within 2 weeks, approximately one-third of children continue to have somatic, cognitive, psychological, and/or behavioural symptoms beyond this time. Persistent postconcussion symptoms (PPCS) last longer than 28 days and may result in children missing school, performing poorly at school, experiencing a depressed mood, and engaging in fewer social activities.

Prior to this study, no validated tools existed to assess children’s risk of developing PPCS, although adolescence, being female, and having a physician-diagnosed history of migraines had been associated with higher risk in some studies. This study aimed to derive and validate a clinical risk score to determine a child’s risk of developing PPCS following a concussion.

The study team was able to determine 9 predictor variables that can be used to derive a clinical risk score of PPCS. This score was demonstrated to be significantly better than physician judgment when determining a child’s risk of developing PPCS. Predictor variables included adolescence, being female, having a prior concussion with symptoms lasting 1 week or more, having a physician-diagnosed history of migraine, answering questions slowly, being physically unable to undergo balance testing, having a headache, being sensitive to noise, and experiencing fatigue.

While this tool must be externally validated before being adopted into routine practice, this clinical risk score may be of future benefit when determining a child’s risk of developing PPCS when presenting to the ED for acute concussion.