109 results on '"Cheek JA"'
Search Results
2. PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study
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Bressan, S, Eapen, N, Phillips, N, Gilhotra, Y, Kochar, A, Dalton, S, Cheek, JA, Furyk, J, Neutze, J, Williams, A, Hearps, S, Donath, S, Oakley, E, Singh, S, Dalziel, SR, Borland, ML, Babl, FE, Bressan, S, Eapen, N, Phillips, N, Gilhotra, Y, Kochar, A, Dalton, S, Cheek, JA, Furyk, J, Neutze, J, Williams, A, Hearps, S, Donath, S, Oakley, E, Singh, S, Dalziel, SR, Borland, ML, and Babl, FE
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BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors. METHODS: This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables. RESULTS: Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%-11.6%), 0.2% (95% CI = 0.0%-0.6%), and 0.0% (95% CI = 0.0%-0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%-7.2%), 0.7% (95% CI = 0.5%-1.0%), and 0.0% (95% CI = 0.0%-0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was "signs of palpable skull fracture" for younger children (11.4%, 95% CI = 5.3%-20.5%) and "signs of basilar skull fracture" in children ≥2 years (11.1%, 95% CI = 3.7%-24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%-80.6%) followed by the combination of "severe mechanism of injury" and "severe headache" (7.7%, 95% CI = 0.2%-36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis. CONCLUSIONS: The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predi
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- 2021
3. Trends of paediatric head injury and acute care costs in Australia
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Singh, S, Babl, FE, Hearps, SJC, Hoch, JS, Dalziel, K, Cheek, JA, Singh, S, Babl, FE, Hearps, SJC, Hoch, JS, Dalziel, K, and Cheek, JA
- Abstract
AIM: Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs. METHODS: Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend. RESULTS: The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs. CONCLUSION: PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention.
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- 2021
4. Rapid Assessment, Planning, Investigations and Discharge: Piloting the introduction of a senior doctor at triage model in an Australian paediatric emergency department
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Andrews, SL, Lewena, S, Cheek, JA, Andrews, SL, Lewena, S, and Cheek, JA
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OBJECTIVE: We implemented a senior doctor at triage (SDT) pilot programme at The Royal Children's Hospital, Melbourne. We examined the impact on ED length of stay, seen on time and fail to wait (FTW) rates. METHODS: A SDT model was piloted on Monday and Tuesday afternoons (pilot period) for 10 weeks, and compared with equivalent shifts for the preceding 10 weeks (pre-pilot period). We determined the differences between the proportions of patients seen on time, length of stay in the ED of less than 4 h and FTW rate, as well as the medians of time to clinician and length of stay in ED. RESULTS: A total of 2736 patients presented in the pilot period, and 2889 in the pre-pilot. The percentage of patients who were seen on time improved from 52.3% to 68.7% (absolute difference 16.4%, 95% confidence interval [CI] 13.6-19.2%, P < 0.001), the percentage of patients who had an ED length of stay of <4 h improved from 58.2% to 72.0% (absolute difference 13.8%, 95% CI 11.1-16.5%, P < 0.001) and the FTW rate reduced from 12.5% to 7.1% (absolute difference 5.4%, 95% CI 3.8-7.0%, P < 0.001) when the SDT model was operational. CONCLUSION: Implementation of a SDT model in a tertiary paediatric ED resulted in an increased proportion of patients being seen on time, having shorter length of stays in the ED and reduced the number of patients who FTW. Further studies are required to determine whether these improvements are sustained over time.
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- 2020
5. Risk of traumatic intracranial haemorrhage in children with bleeding disorders
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Bressan, S, Monagle, P, Dalziel, SR, Borland, ML, Phillips, N, Kochar, A, Lyttle, MD, Cheek, JA, Neutze, J, Oakley, E, Dalton, S, Gilhotra, Y, Hearps, S, Furyk, J, Babl, FE, Bressan, S, Monagle, P, Dalziel, SR, Borland, ML, Phillips, N, Kochar, A, Lyttle, MD, Cheek, JA, Neutze, J, Oakley, E, Dalton, S, Gilhotra, Y, Hearps, S, Furyk, J, and Babl, FE
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AIM: To assess computerised tomography (CT) use and the risk of intracranial haemorrhage (ICH) in children with bleeding disorders following a head trauma. METHODS: Design: Multicentre prospective observational study. SETTING: 10 paediatric emergency departments (ED) in Australia and New Zealand. PATIENTS: Children <18 years with and without bleeding disorders assessed in ED following head trauma between April 2011 and November 2014. INTERVENTIONS: Data collection of patient characteristics, management and outcomes. MAIN OUTCOME MEASURES: Rate of CT use and frequency of ICH on CT. RESULTS: Of 20 137 patients overall, 103 (0.5%) had a congenital or acquired bleeding disorder. CT use was higher in these patients compared with children without bleeding disorders (30.1 vs. 10.4%; rate ratio 2.91 95% CI 2.16-3.91). Only one of 31 (3.2%) children who underwent CT in the ED had an ICH. This patient rapidly deteriorated in the ED on arrival and required neurosurgery. None of the patients with bleeding disorders who did not have a CT obtained in the ED or had an initial negative CT had evidence of ICH on follow up. CONCLUSIONS: Although children with a bleeding disorder and a head trauma more often received a CT scan in the ED, their risk of ICH seemed low and appeared associated with post-traumatic clinical findings. Selective CT use combined with observation may be cautiously considered in these children based on clinical presentation and severity of bleeding disorder.
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- 2020
6. Emergency department utilisation by vulnerable paediatric populations during theCOVID-19 pandemic
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Cheek, JA, Craig, SS, West, A, Lewena, S, Hiscock, H, Cheek, JA, Craig, SS, West, A, Lewena, S, and Hiscock, H
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OBJECTIVE: To determine if changes to community-based services have effected paediatric ED attendances for mental health issues and neonates during the COVID-19 pandemic. METHODS: Analysis of total presentations, presentations with a mental health diagnoses and presentation of neonates during the early stages of the pandemic compared with the previous year for four Victorian hospitals. RESULTS: There was a 47.2% decrease in total presentations compared with 2019, with a 35% increase in mental health diagnoses and a 2% increase in neonatal presentations. CONCLUSION: Vulnerable paediatric patients are seeking care elsewhere during the pandemic because of the closure of community services.
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- 2020
7. Understanding parent-reported factors that influence children and young people's anxiety and depression presentations to emergency departments: A multi-site study
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Hiscock, H, Connolly, A-S, Dunlop, K, Perera, P, O'Loughlin, R, Brown, SJ, Krieser, DM, West, A, Chapman, P, Lawford, R, Cheek, JA, Hiscock, H, Connolly, A-S, Dunlop, K, Perera, P, O'Loughlin, R, Brown, SJ, Krieser, DM, West, A, Chapman, P, Lawford, R, and Cheek, JA
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OBJECTIVE: Victorian ED data show increased presentations for anxiety and depression in children. We aimed to determine parent-reported factors contributing to these presentations. METHODS: Qualitative study with parents of children and young people aged 0-17 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression (excluding self-harm or suicide attempt). Eligible parents completed semi-structured phone interviews, which were audio-recorded and transcribed. Transcripts were coded and qualitatively analysed using thematic analysis. RESULTS: Seventy parents completed interviews. The average age of children and young people was 14 years (standard deviation 2.4) and 63% (n = 44) identified as female. Thirty (43%) children received a primary diagnosis of depression, compared to 40 (57%) children who received a primary diagnosis of anxiety. The majority of respondents were mothers (n = 59; 84%). Key themes as to why families presented to EDs included: listening to trusted professionals, desperation, a feeling of no alternative, respecting their child's need to feel safe and to rule out a potentially serious medical condition. CONCLUSIONS: Parents bring their children to the ED for many reasons. Policy makers, managers and clinicians should work with parents to develop alternative approaches that provide families with community-based support, particularly for younger children and after hours, in order to provide an appropriate source of care for children and young people with anxiety and depression.
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- 2020
8. The Effect of Patient Observation on Cranial Computed Tomography Rates in Children With Minor Head Trauma
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Cloutier, R, Singh, S, Hearps, SJC, Borland, ML, Dalziel, SR, Neutze, J, Donath, S, Cheek, JA, Kochar, A, Gilhotra, Y, Phillips, N, Williams, A, Lyttle, MD, Bressan, S, Hoch, JS, Oakley, E, Holmes, JF, Kuppermann, N, Babl, FE, Cloutier, R, Singh, S, Hearps, SJC, Borland, ML, Dalziel, SR, Neutze, J, Donath, S, Cheek, JA, Kochar, A, Gilhotra, Y, Phillips, N, Williams, A, Lyttle, MD, Bressan, S, Hoch, JS, Oakley, E, Holmes, JF, Kuppermann, N, and Babl, FE
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BACKGROUND: Management of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Our objective was to estimate the effect of planned observation on CT use for each Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk group among children with minor head trauma. METHODS: This was a secondary analysis of a prospective observational study at 10 emergency departments (EDs) in Australia and New Zealand, including 18,471 children < 18 years old, presenting within 24 hours of blunt head trauma, with Glasgow Coma Scale scores of 14 to 15. The planned observation cohort was defined by those with planned observation and no immediate plan for cranial CT. The comparison cohort included the rest of the patients who were either not observed or for whom a decision to obtain a cranial CT was made immediately after ED assessment. The outcome clinically important TBI (ciTBI) was defined as death due to head trauma, neurosurgery, intubation for > 24 hours for head trauma, or hospitalization for ≥ 2 nights in association with a positive cranial CT scan. We estimated the odds of cranial CT use with planned observation, adjusting for patient characteristics, PECARN TBI risk group, history of seizure, time from injury, and hospital clustering, using a generalized linear model with mixed effects. RESULTS: The cranial CT rate in the total cohort was 8.6%, and 0.8% had ciTBI. The planned observation group had 4,945 (27%) children compared to 13,526 (73%) in the no planned observation group. Cranial CT use was significantly lower with planned observation (adjusted odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.1 to 0.1), with no difference in missed ciTBI rates. There was no difference in the odds of cranial CT use with planned observation for the group at very low risk for ciTBI (adjusted OR = 0.9, 95% CI = 0.5 to 1.4). Planned observation was associated with sig
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- 2020
9. Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study
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Hiscock, H, Connolly, A-S, Dunlop, K, Perera, P, O'Loughlin, R, Brown, SJ, Krieser, DM, West, A, Chapman, P, Lawford, R, Cheek, JA, Hiscock, H, Connolly, A-S, Dunlop, K, Perera, P, O'Loughlin, R, Brown, SJ, Krieser, DM, West, A, Chapman, P, Lawford, R, and Cheek, JA
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AIM: The number of children and young people presenting to emergency departments (EDs) with anxiety and depression is increasing. We aimed to determine parent perspectives on: (i) barriers to accessing non-ED mental health services; and (ii) improving access in the paediatric mental health service system. METHODS: Qualitative study with parents of children and young people aged 0-19 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression. EXCLUSION CRITERIA: child or young person without a parent/guardian, or presented with self-harm or suicide attempt. Eligible participants completed semi-structured phone interviews. Interviews were recorded and transcripts were coded and analysed using content analysis. RESULTS: A total of 72 parents completed interviews. The average child age was 14 years (standard deviation 2.5) and two thirds identified as female (64%). A total of 57% of children and young people presented with a primary diagnosis of anxiety. Parents reported barriers in accessing care including: service shortages and inaccessibility, underresourced schools, lack of clinician mental health expertise, lack of child-clinician rapport, inconsistent care, financial constraints, lack of mental health awareness among parents, and stigma. Parents want expanded and improved access to services, more respite and support services, supportive schools, and improved mental health education for parents. CONCLUSIONS: Parents of children and young people attending the ED for anxiety and depression are generally dissatisfied with services for child mental health. Solutions that enable parents to better care for their child in the community are needed to improve care.
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- 2020
10. Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study
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Borland, ML, Dalziel, SR, Phillips, N, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, Jeremy, Cheek, JA, Neutze, J, Gilhotra, Y, Dalton, S, Babl, FE, Borland, ML, Dalziel, SR, Phillips, N, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, Jeremy, Cheek, JA, Neutze, J, Gilhotra, Y, Dalton, S, and Babl, FE
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- 2019
11. A Cost-Effectiveness Analysis Comparing Clinical Decision Rules PECARN, CATCH, and CHALICE With Usual Care for the Management of Pediatric Head Injury
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Dalziel, K, Cheek, JA, Fanning, L, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Furyk, Jeremy, Neutze, J, Dalziel, SR, Lyttle, MD, Bressan, S, Donath, S, Molesworth, C, Hearps, SJC, Oakley, E, Babl, FE, Dalziel, K, Cheek, JA, Fanning, L, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Furyk, Jeremy, Neutze, J, Dalziel, SR, Lyttle, MD, Bressan, S, Donath, S, Molesworth, C, Hearps, SJC, Oakley, E, and Babl, FE
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- 2019
12. Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study
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Babl, FE, Pfeiffer, H, Dalziel, SR, Oakley, E, Anderson, V, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Lyttle, MD, Bressan, S, Donath, S, Hearps, SJC, Crowe, L, Babl, FE, Pfeiffer, H, Dalziel, SR, Oakley, E, Anderson, V, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Lyttle, MD, Bressan, S, Donath, S, Hearps, SJC, and Crowe, L
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OBJECTIVE: Although there is a large body of research on head injury (HI) inflicted by caregivers in young children, little is known about intentional HI in older children and inflicted HI by perpetrators other than carers. Therefore, we set out to describe epidemiology, demographics and severity of intentional HIs in childhood. METHODS: A planned secondary analysis of a prospective multicentre cohort study was conducted in 10 EDs in Australia and New Zealand, including children aged <18 years with HIs. Epidemiology codes were used to prospectively code the injuries. Demographic and clinical information including the rate of clinically important traumatic brain injury (ciTBI: HI leading to death, neurosurgery, intubation >1 day or admission ≥2 days with abnormal computed tomography [CT]) was descriptively analysed. RESULTS: Intentional injuries were identified in 372 of 20 137 (1.8%) head-injured children. Injuries were caused by caregivers (103, 27.7%), by peers (97, 26.1%), by siblings (47, 12.6%), by strangers (35, 9.4%), by persons with unknown relation to the patient (21, 5.6%), other intentional injuries (8, 2.2%) or undetermined intent (61, 16.4%). About 75.7% of victims of assault by caregivers were <2 years, whereas in other categories, only 4.9% were <2 years. Overall, 66.9% of victims were male. Rates of CT performance and abnormal CT varied: assault by caregivers 68.9%/47.6%, by peers 18.6%/27.8%, by strangers 37.1%/5.7%. ciTBI rate was 22.3% in assault by caregivers, 3.1% when caused by peers and 0.0% with other perpetrators. CONCLUSIONS: Intentional HI is infrequent in children. The most frequently identified perpetrators are caregivers and peers. Caregiver injuries are particularly severe.
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- 2019
13. Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study
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Phillips, N, Dalziel, SR, Borland, ML, Dalton, S, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, J, Cheek, JA, Gilhotra, Y, Neutze, J, Babl, FE, Phillips, N, Dalziel, SR, Borland, ML, Dalton, S, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, J, Cheek, JA, Gilhotra, Y, Neutze, J, and Babl, FE
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OBJECTIVES: Variation in the management of paediatric head injury has been identified worldwide. This prospective study describes imaging and admission practices of children presenting with head injury across 10 hospital EDs in Australia and New Zealand. METHODS: Prospective observational multicentre study of 20 137 children (under 18 years) as a planned secondary analysis of the Australasian Paediatric Head Injury Rules Study. All presentations with head injury without prior imaging were eligible for inclusion. Variations in rates of computed tomography of the brain (CTB) and admission practices between sites, ED type and country were investigated, as were clinically important traumatic brain injuries (ciTBIs) and abnormal CTBs within CTBs. RESULTS: Among the 20 137 enrolled patients, the site adjusted CTB rate was 11.2% (95% confidence interval [CI] 7.8-14.6); individual sites ranged from 2.6 to 18.6%. ciTBI was found in 0.4-2.2%, with abnormal scans documented in 0.7-6.5%. As a percentage of CTBs undertaken, ciTBIs were found in 12.8% (95% CI 10.8-14.7) with individual site variation of 8.8-16.9%, and no statistically significant difference noted, and traumatic abnormalities in 29.3% (95% CI 26.2-32.3) with individual site variation between 19.4 and 35.6%. Among those under 2 years,traumatic abnormalities were found in greater than 50% of CTBs at 90% of sites. Admission rate overall was 24.0% (site adjusted) with wide variation between sites (5.0-48.9%). CONCLUSION: Across the 10 largely tertiary EDs included in this study, the overall CTB rate was low with no significant variation between sites when adjusted for ciTBIs.
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- 2019
14. Review article: A primer for clinical researchers in the emergency department: Part X. Understanding economic evaluation alongside emergency medicine research
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Singh, S, Cheek, JA, Babl, FE, Hoch, JS, Singh, S, Cheek, JA, Babl, FE, and Hoch, JS
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In this series we address research topics in emergency medicine. While traditionally there was an almost exclusive focus on the efficacy and effectiveness of interventions in emergency research, analysis of the costs and the societal impact of different approaches and pathways have become increasingly important. In this paper we will address what health economics means and discuss the different types and key features of economic evaluation relevant for clinical researchers.
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- 2019
15. Neonatal head injuries: A prospective Paediatric Research in Emergency Departments International Collaborative cohort study
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Eapen, N, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Neutze, J, Lyttle, MD, Donath, S, Crowe, L, Dalziel, SR, Oakley, E, Williams, A, Hearps, S, Bressan, S, Babl, FE, Eapen, N, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Neutze, J, Lyttle, MD, Donath, S, Crowe, L, Dalziel, SR, Oakley, E, Williams, A, Hearps, S, Bressan, S, and Babl, FE
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AIM: To characterise the causes, clinical characteristics and short-term outcomes of neonates who presented to paediatric emergency departments with a head injury. METHODS: Secondary analysis of a prospective data set of paediatric head injuries at 10 emergency departments in Australia and New Zealand. Patients without neuroimaging were followed up by telephone call. We extracted epidemiological information, clinical findings and outcomes in neonates (≤28 days). RESULTS: Of 20 137 children with head injuries, 93 (0.5%) occurred in neonates. These were mostly fall-related (75.2%), commonly from a care giver's arms, or due to being accidentally struck by a person/object (20.4%). There were three cases of non-accidental head injuries (3.2%). Most neonates were asymptomatic (67.7%) and many had no findings on examination (47.3%). Most neonates had a Glasgow Coma Scale 15 (89.2%) or 14 (7.5%). A total of 15.1% presented with vomiting and 5.4% were abnormally drowsy. None had experienced a loss of consciousness. The most common findings on examination were scalp haematoma (28.0%) and possible palpable skull fracture (6.5%); 8.6% underwent computed tomography brain scan and 4.3% received an ultrasound. Five of eight computed tomography scan (5.4% of neonates overall) showed traumatic brain injury and two of four (2.2% overall) had traumatic brain injury on ultrasound. Thirty-seven percent were admitted, one patient was intubated and none had neurosurgery or died. CONCLUSIONS: Neonatal head injuries are rare with a mostly benign short-term outcome and are appropriate for observation. However, non-accidental injuries need to be considered.
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- 2019
16. Re: Choosing the discount rate in an economic analysis
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Singh, S, Cheek, JA, Babl, FE, Hoch, JS, Singh, S, Cheek, JA, Babl, FE, and Hoch, JS
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- 2019
17. Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study
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Babl, FE, Pfeiffer, H, Kelly, P, Dalziel, SR, Oakley, E, Borland, ML, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Lyttle, MD, Bressan, S, Donath, S, Hearps, SJC, Smith, A, Crowe, L, Babl, FE, Pfeiffer, H, Kelly, P, Dalziel, SR, Oakley, E, Borland, ML, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Lyttle, MD, Bressan, S, Donath, S, Hearps, SJC, Smith, A, and Crowe, L
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AIM: Abusive head trauma (AHT) is associated with high morbidity and mortality. We aimed to describe characteristics of cases where clinicians suspected AHT and confirmed AHT cases and describe how they differed. METHODS: This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged <18 years across five centres in Australia and New Zealand. We identified cases of suspected AHT when emergency department clinicians raised suspicion on a clinical report form or based on research assistant-assigned epidemiology codes. Cases were categorised as AHT positive, negative and indeterminate after multidisciplinary review. Suspected and confirmed AHT and non-AHT cases were compared using odds ratios with 95% confidence intervals. RESULTS: AHT was suspected in 70 of 13 371 (0.5%) head-injured children. Of these, 23 (32.9%) were categorised AHT positive, 18 (25.7%) AHT indeterminate and 29 (27.1%) AHT negative. Median age was 0.8 years in suspected, 1.4 years in confirmed AHT and 4.1 years in non-AHT cases. Odds ratios (95% confidence interval) for presenting features and outcomes in confirmed AHT versus non-AHT were: loss of consciousness 2.8 (1.2-6.9), scalp haematoma 3.9 (1.7-9.0), seizures 12.0 (4.0-35.5), Glasgow coma scale ≤12 30.3 (11.8-78.0), abnormal neuroimaging 38.3 (16.8-87.5), intensive care admission 53.4 (21.6-132.5) and mortality 105.5 (22.2-500.4). CONCLUSIONS: Emergency department presentations of children with suspected and confirmed AHT had higher rates of loss of consciousness, scalp haematomas, seizures and low Glasgow coma scale. These cases were at increased risk of abnormal computed tomography scans, need for intensive care and death.
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- 2019
18. Vomiting with head trauma and risk of traumatic brain injury
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Borland, ML, Dalziel, SR, Phillips, N, Dalton, S, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, Jeremy, Cheek, JA, Neutze, J, Babl, FE, Borland, ML, Dalziel, SR, Phillips, N, Dalton, S, Lyttle, MD, Bressan, S, Oakley, E, Hearps, SJC, Kochar, A, Furyk, Jeremy, Cheek, JA, Neutze, J, and Babl, FE
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- 2018
19. Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand: A PREDICT prospective study
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Babl, FE, Lyttle, MD, Bressan, S, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Donath, S, Hearps, S, Arpone, M, Crowe, L, Dalziel, SR, Barker, R, Oakley, E, Babl, FE, Lyttle, MD, Bressan, S, Borland, ML, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Donath, S, Hearps, S, Arpone, M, Crowe, L, Dalziel, SR, Barker, R, and Oakley, E
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AIM: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. METHODS: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography). RESULTS: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died. CONCLUSIONS: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations.
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- 2018
20. External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children
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Unden, J, Dalziel, SR, Borland, ML, Phillips, N, Kochar, A, Lyttle, MD, Bressan, S, Cheek, JA, Neutze, J, Donath, S, Hearps, S, Oakley, E, Dalton, S, Gilhotra, Y, Babl, FE, Unden, J, Dalziel, SR, Borland, ML, Phillips, N, Kochar, A, Lyttle, MD, Bressan, S, Cheek, JA, Neutze, J, Donath, S, Hearps, S, Oakley, E, Dalton, S, Gilhotra, Y, and Babl, FE
- Abstract
BACKGROUND: Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9-15. This study aims to validate these guidelines and to compare them with other CDRs. METHODS: A large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13-15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT. RESULTS: The SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1-100.0; 32/32), 97.8% (94.5-99.4; 179/183) and 95% (95% CI 91.6-97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs. CONCLUSION: The SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI.
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- 2018
21. Bell's Palsy in Children (BellPIC): Protocol for a multicentre, placebo-controlled randomized trial
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Babl, FE, Mackay, MT, Borland, ML, Herd, DW, Kochar, A, Hort, J, Rao, A, Cheek, JA, Furyk, Jeremy, Barrow, L, George, S, Zhang, M, Gardiner, K, Lee, KJ, Davidson, A, Berkowitz, R, Sullivan, F, Porrello, E, Dalziel, KM, Anderson, V, Oakley, E, Hopper, S, Williams, F, Wilson, C, Williams, A, Dalziel, SR, Babl, FE, Mackay, MT, Borland, ML, Herd, DW, Kochar, A, Hort, J, Rao, A, Cheek, JA, Furyk, Jeremy, Barrow, L, George, S, Zhang, M, Gardiner, K, Lee, KJ, Davidson, A, Berkowitz, R, Sullivan, F, Porrello, E, Dalziel, KM, Anderson, V, Oakley, E, Hopper, S, Williams, F, Wilson, C, Williams, A, and Dalziel, SR
- Abstract
Background: Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. Methods/Design: We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to
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- 2017
22. Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department
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Cheek, JA, Braitberg, G, Craig, S, West, A, Cheek, JA, Braitberg, G, Craig, S, and West, A
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AIM: To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. METHODS: A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. RESULTS: There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). CONCLUSIONS: We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs.
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- 2017
23. Bell's palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study
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Babl, FE, Gardiner, KK, Kochar, A, Wilson, CL, George, SA, Zhang, M, Furyk, J, Thosar, D, Cheek, JA, Krieser, D, Rao, AS, Borland, ML, Cheng, N, Phillips, NT, Sinn, KK, Neutze, JM, Dalziel, SR, Babl, FE, Gardiner, KK, Kochar, A, Wilson, CL, George, SA, Zhang, M, Furyk, J, Thosar, D, Cheek, JA, Krieser, D, Rao, AS, Borland, ML, Cheng, N, Phillips, NT, Sinn, KK, Neutze, JM, and Dalziel, SR
- Abstract
AIM: The aetiology and clinical course of Bell's palsy may be different in paediatric and adult patients. There is no randomised placebo controlled trial (RCT) to show effectiveness of prednisolone for Bell's palsy in children. The aim of the study was to assess current practice in paediatric Bell's palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT). METHODS: A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell's palsy between 1 January, 2012 and 31 December, 2013 was performed. Potential participants were identified from ED information systems using Bell's palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management were entered into an online data base (REDCap). RESULTS: Three hundred and twenty-three presentations were included from 14 PREDICT sites. Mean age at presentation was 9.0 (SD 5.0) years with 184 (57.0%) females. Most (238, 73.7%) presented to ED within 72 h of symptoms, 168 (52.0%) had seen a doctor prior. In ED, 218 (67.5%) were treated with steroids. Prednisolone was usually prescribed for 9 days at around 1 mg/kg/day, with tapering in 35.7%. CONCLUSION: Treatment of Bell's palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the feasibility of an RCT of prednisolone for Bell's palsy in children.
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- 2017
24. Observational study of alternative therapies among paediatric emergency department patients
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Ding, J-L, Taylor, DM, Lee, M, Johnson, OG, Ashok, A, Griffiths, M, Simma, L, Craig, SS, Cheek, JA, Babl, FE, Ding, J-L, Taylor, DM, Lee, M, Johnson, OG, Ashok, A, Griffiths, M, Simma, L, Craig, SS, Cheek, JA, and Babl, FE
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OBJECTIVE: While complementary medicine use among ED paediatric patients is common, the use of alternative therapies (ATs; physical or spiritual therapies) is unknown. We aimed to determine the 12 month period prevalence and nature of AT use among paediatric patients and parent perceptions of AT use. METHODS: We undertook a cross-sectional survey of a convenience sample of parents of paediatric patients in three EDs in metropolitan Melbourne, Australia (January-June, 2015). Parents were invited to complete a validated, anonymous, self-administered questionnaire. The main outcomes were AT use by the patient and parent perceptions of ATs. RESULTS: A total of 806 parents were enrolled. In the previous 12 months, 393 (48.8%) patients had received at least one AT. There were no gender or ethnicity differences between AT users and non-users. AT use was more common among older patients (P < 0.05). Patients with chronic illness tended to use more ATs (P = 0.12). A total of 1091 courses of 43 different ATs had been provided. The most common were massage (16% of patients), chiropractic therapy (9.8%), relaxation (7.2%), meditation (6.2%) and aromatherapy (6.1%). ATs were generally used for musculoskeletal problems, health maintenance, stress and anxiety. Parents who arranged the ATs were significantly more likely to report that ATs are safe, prevent and treat illness, assist prescription medicines and offer a more holistic approach to healthcare (P < 0.001). CONCLUSION: AT use is common among paediatric ED patients. Parents who arrange AT have differing perceptions of AT usefulness and safety from those who do not.
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- 2017
25. G298(P) Paediatric intentional head injuriesin the emergency department. A predict multicentre prospective cohort study
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Pfeiffer, H, primary, Borland, M, additional, Phillips, N, additional, Kochar, A, additional, Dalton, S, additional, Cheek, JA, additional, Gilhotra, Y, additional, Furyk, J, additional, Neutze, J, additional, Bressan, S, additional, Lyttle, MD, additional, Donath, S, additional, Molesworth, C, additional, Crowe, L, additional, Hearps, S, additional, Oakley, E, additional, Dalziel, SR, additional, and Babl, FE, additional
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- 2017
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26. G273 Accuracy of Physician Practice as Compared with Pecarn, Catch and Chalice Head Injury Clinical Decision Rules in Children. A Predict Prospective Cohort Study
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Lyttle, MD, primary, Borland, M, additional, Phillips, N, additional, Kochar, A, additional, Cheek, JA, additional, Gilhotra, Y, additional, Furyk, J, additional, Neutze, J, additional, Bressan, S, additional, Donath, S, additional, Molesworth, C, additional, Crowe, L, additional, Oakley, E, additional, Dalziel, SR, additional, and Babl, FE, additional
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- 2017
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27. G293(P) Defining mild traumatic brain injury: How classification differs across studies when applied to a large prospective data set. a predict prospective cohort study
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Crowe, L, primary, Lyttle, MD, additional, Hearps, S, additional, Anderson, V, additional, Borland, M, additional, Phillips, N, additional, Kochar, A, additional, Dalton, S, additional, Cheek, JA, additional, Gilhotra, Y, additional, Furyk, J, additional, Neutze, J, additional, Bressan, S, additional, Donath, S, additional, Molesworth, C, additional, Oakley, E, additional, Dalziel, SR, additional, and Babl, FE, additional
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- 2017
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28. G292(P) Diagnostic accuracy of the nexus II head injury clinical decision rule in children. A predict prospective cohort study
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Babl, FE, primary, Borland, M, additional, Phillips, N, additional, Kochar, A, additional, Dalton, S, additional, Cheek, JA, additional, Gilhotra, Y, additional, Furyk, J, additional, Neutze, J, additional, Bressan, S, additional, Donath, S, additional, Molesworth, C, additional, Crowe, L, additional, Hearps, S, additional, Arpone, M, additional, Oakley, E, additional, Dalziel, SR, additional, and Lyttle, MD, additional
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- 2017
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29. ANNUAL ACUTE HOSPITAL COST OF PAEDIATRIC HEAD INJURY IN AUSTRALIA – A PAEDIATRIC RESEARCH IN EMERGENCY DEPARTMENTS INTERNATIONAL COLLABORATIVE (PREDICT) STUDY
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Cheek, JA, primary, Lyttle, M, additional, Oakley, E, additional, Babl, F, additional, Borland, M, additional, Dalziel, K, additional, Kanal, GN, additional, Phillips, N, additional, Gilhotra, Y, additional, Kochar, A, additional, Dalton, S, additional, McCaskill, M, additional, Furyk, J, additional, Neutze, J, additional, and Dalziel, SR, additional
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- 2016
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30. Walk them or no leg to stand on! Diagnostic delay of neurologic conditions in young children
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Stock, A, Dunn, K, Cheek, JA, Stock, A, Dunn, K, and Cheek, JA
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Diagnosis of low incidence neurological conditions can be a challenge in paediatric emergency medicine. Neurological examination in young children can be very difficult, and medical staff may not previously have encountered conditions like acute demyelinating encephalomyelitis. We propose that the simple process of walking a child (provided they were previously ambulant) is the crucial step in the neurological examination. We present three cases to demonstrate this important part of the examination.
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- 2016
31. Lignocaine/phenylephrine nasal spray vs. placebo for the pain and distress of nasogastric tube insertion in children: a study protocol for a randomized controlled trial.
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Craig, SS, Seith, RW, Cheek, JA, West, A, Wilson, K, Egerton-Warburton, D, Craig, SS, Seith, RW, Cheek, JA, West, A, Wilson, K, and Egerton-Warburton, D
- Abstract
BACKGROUND: Patients and clinicians consistently rate insertion of a nasogastric tube (NGT) as one of the most painful and distressing emergency department procedures. Despite this, surveys of emergency clinicians suggest that provision of adequate procedural analgesia is often inconsistent and suboptimal. While many studies have demonstrated the effectiveness of various interventions to reduce pain and distress in adults, there have been few studies in the pediatric population. There are currently no studies comparing the effectiveness of a local anesthetic nasal spray for the prevention of the pain and distress associated with NGT insertion in children. This study aims to compare the analgesic efficacy of a proprietary preparation of lignocaine/phenylephrine nasal spray and placebo for this indication. METHODS/DESIGN: This is a prospective, randomized, controlled, double-blind superiority trial of 100 children aged 6 months to 5 years weighing at least 6 kg in whom a nasogastric tube is planned to be inserted. These children will be randomized to either intranasal lignocaine/phenylephrine or placebo. Pain severity is the primary outcome measure and will be measured utilizing the Face, Legs, Arms, Cry and Consolability (FLACC) pain severity rating scale. An independent staff member not involved in inserting the NGT and the child's parents or carer will also record pain and distress on a visual analog scale (VAS). FLACC scores and VAS scores will be presented as median and interquartile range (IQR). Non-normally distributed scores will be compared using a Wilcoxon rank-sum test. Categorical data will be analyzed using Fisher's exact test. Adverse events will be described as type and incidence. DISCUSSION: Previous studies on NGT insertion have not focused on the pediatric population. This study aims to establish the effectiveness of a simple intranasal spray of lignocaine/phenylephrine in children undergoing NGT insertion. A positive result of this study would provi
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- 2015
32. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): The Australasian Paediatric Head Injury Rules Study (APHIRST)
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Babl, FE, Lyttle, MD, Bressan, S, Borland, M, Phillips, N, Kochar, A, Dalziel, SR, Dalton, S, Cheek, JA, Furyk, Jeremy, Gilhotra, Y, Neutze, J, Ward, B, Donath, S, Jachno, K, Crowe, L, Williams, A, Oakley, E, Babl, FE, Lyttle, MD, Bressan, S, Borland, M, Phillips, N, Kochar, A, Dalziel, SR, Dalton, S, Cheek, JA, Furyk, Jeremy, Gilhotra, Y, Neutze, J, Ward, B, Donath, S, Jachno, K, Crowe, L, Williams, A, and Oakley, E
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- 2014
33. Evaluation of Blood Glucose in Neonates with a Reflectance Meter
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Shepard Fm, Cheek Ja, and Solowy Mk
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Blood Glucose ,Toluidines ,business.industry ,Infant, Newborn ,General Medicine ,Reflectivity ,Hypoglycemia ,Infant, Newborn, Diseases ,Photometry ,Glucose Oxidase ,Hematocrit ,Methods ,Humans ,Medicine ,Metre ,business ,Remote sensing - Published
- 1973
34. G273 Accuracy of Physician Practice as Compared with Pecarn, Catch and Chalice Head Injury Clinical Decision Rules in Children. A Predict Prospective Cohort Study
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Lyttle, MD, Borland, M, Phillips, N, Kochar, A, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Bressan, S, Donath, S, Molesworth, C, Crowe, L, Oakley, E, Dalziel, SR, and Babl, FE
- Abstract
AimsClinical decision rules (CDRs) can assist in determining the need for computed tomography (CT) in children with head injuries (HIs). We assessed the accuracy of 3 high quality CDRs (PECARN, CATCH and CHALICE) in a large prospective cohort of head injured children. However in addition to CDR accuracy, the baseline physician accuracy is one of a number of factors which are also important when determining whether a particular rule should be implemented. The objective of this study was to assess the diagnostic accuracy of physician practice in detecting clinically important traumatic brain injuries.MethodsProspective observational study of children<18 years with HIs of any severity at 10 mainly tertiary Australian/New Zealand centres. We extracted a cohort of children with mild HIs (GCS 13–15, presenting <24 hour) and assessed physician accuracy for the standardised outcome of clinically important traumatic brain injury (ciTBI); we compared this with the diagnostic accuracy of the PECARN, CATCH and CHALICE CDRs. Physician accuracy was calculated based on whether CT was obtained during the initial Emergency Department (ED) visit.ResultsOf 20 137 children, 18 913 had a mild HI as defined. Of these 1578 (8.3% = actual CT rate) received a CT scan during the ED visit; 160 (0.8%) had a ciTBI and 24 (0.1%) underwent neurosurgery. Physician practice accuracy for detecting ciTBI based on whether CT was performed had a sensitivity of 157/160 ((98.1% (94.6%–99.6%) and a specificity of 17,332/18,753 (92.4% (92.0%–92.8%)). Sensitivity of PECARN <2 years was 42/42 (100.0%, 91.6% to 100.0%), PECARN ≥2 years 117/118 (99.2%; 95.4% to 100.0%), CATCH (high/medium risk) 147/ 160 (91.9%; 86.5% to 95.6%) and CHALICE 148/160 (92.5%; 87.3% to 96.1%). Projected CT rates for PECARN ≤2/≥2 years were 8.0%/9.4% (high risk only) to 41.4%/48.5% (high and intermediate risk factors, considering the unlikely scenario that all patients in the intermediate risk group receive a CT scan), for CATCH 30.2% (medium and high risk) and for CHALICE 22.0%.ConclusionsPhysician accuracy was high. The implementation of PECARN, CATCH or CHALICE CDRs in this setting has the potential to increase the CT rate with limited potential to increase the accuracy of detecting ciTBI.
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- 2017
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35. G298(P) Paediatric intentional head injuriesin the emergency department. A predict multicentre prospective cohort study
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Pfeiffer, H, Borland, M, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Bressan, S, Lyttle, MD, Donath, S, Molesworth, C, Crowe, L, Hearps, S, Oakley, E, Dalziel, SR, and Babl, FE
- Abstract
AimsWhile the majority of head injuries (HIs) in children are non-intentional, there is limited information on intentional HIs outside abusive head trauma. The objective of this study was to describe epidemiology, demographics and severity of intentional HIs in childhood in a multicentre study in Australia and New Zealand.MethodsPlanned secondary analysis of a prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and New Zealand between April 2011 and November 2014. Victorian state epidemiology codes (intent, activity, place, mechanism) were used to prospectively code the injuries. Clinical information including history of injury event and examination findings were collected and data were descriptively analysed.ResultsIntentional injuries were found in 372 of 20 137 (1.8%) head injured children. Injuries were caused by caregivers (103, 27.7%), by peers (97, 26.1%), by sibling (47, 12.6%), due to attack by stranger (35, 9.4%), by person with unknown relation to patient (21, 5.6%), intentional self-harm (7, 1.9%), legal intervention (1, 0.3%) or undetermined intent (61, 16.4%). 75.7% of victims of assault by caregiver were under 2 years old, whereas for other causes only 4.9% were under 2 years. Overall, 66.9% of victims were male. Rates for admission, CT scan and abnormal CT rates varied from 77.7%, 68.9% and 47.6% for assault by caregiver, 37.1%, 37.1% and 5.2% for attack by stranger, 23.7%, 18.6% and 5.2% for assault by peer and 8.5%, 2.1% and 2.1% for injuries caused by sibling respectively.ConclusionIntentional head injuries are infrequent in children. The most frequent cause is injury by caregiver or peer assault. HI due to assault by caregiver results in more abnormal findings on a CT scan than other mechanisms of intentional HI.
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- 2017
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36. G293(P) Defining mild traumatic brain injury: How classification differs across studies when applied to a large prospective data set. a predict prospective cohort study
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Crowe, L, Lyttle, MD, Hearps, S, Anderson, V, Borland, M, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Bressan, S, Donath, S, Molesworth, C, Oakley, E, Dalziel, SR, and Babl, FE
- Abstract
AimsMild traumatic brain injury (TBI) in children is a major public health issue, yet there is wide variation in the way ‘mild’ TBI is defined in the literature and in guidelines. To date no study has prospectively detailed the proportion of children presenting with mild TBI to Emergency Departments (EDs) according to these various definitions. The objective of this study was to apply published definitions of mild TBI to a large prospectively collected data set of childhood head injuries (HIs), and to determine the proportions of mild TBI when the various definitions are applied.MethodsProspective observational study of children with HIs of any severity presenting to 10 Australian/New Zealand centres. We applied 18 different definitions of mild TBI, identified through a systematic review of the literature, to children aged 3 to 16 years. We assessed the number and percentage of cases the definitions applied to when the specific inclusion and exclusion criteria were used.ResultsOf 20 137 children with HI of any severity, 11 907 were aged 3 to 16 years. Mean age was 8.2 years, 32% were female. 61.9% were fall related. Cranial CT rate was 12.7% and neurosurgery rate was 0.5%. Adjustments were made to some definitions to enable application to the data set: none in 7, minor in 9, substantial in 2. Percentages of the cohort covered by the definitions of ‘mild’ TBI ranged from 2.4% (284) to 98.7% (11,756) of the cohort. The median percentage of the cohort which was classed as ‘mild’ TBI using the 18 definitions investigated was 21.7% (2,589).ConclusionsWhen applying different definitions of mild TBI to a single data set including all severities, a wide range of cases are included depending on the definition used. Clinicians and researchers need to be aware of this important variability when attempting to apply the published literature to children presenting to EDs with TBI.
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- 2017
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37. G292(P) Diagnostic accuracy of the nexus II head injury clinical decision rule in children. A predict prospective cohort study
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Babl, FE, Borland, M, Phillips, N, Kochar, A, Dalton, S, Cheek, JA, Gilhotra, Y, Furyk, J, Neutze, J, Bressan, S, Donath, S, Molesworth, C, Crowe, L, Hearps, S, Arpone, M, Oakley, E, Dalziel, SR, and Lyttle, MD
- Abstract
AimsClinical decision rules (CDRs) can be applied in Emergency Departments (EDs) to optimise the use of computed tomography (CT) in children with head trauma. The National Emergency X- Radiography Utilisation Study II (NEXUS II) CDR, as amended for children, has not been externally validated in a large paediatric cohort.The objective of this study was to conduct a multicentre external validation of the NEXUS II CDR in children.MethodsWe performed a prospective observational study of patients<18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs. In a planned secondary analysis we assessed the performance of the NEXUS II CDR for its diagnostic accuracy (with 95% confidence intervals (CI)) in predicting clinically important intracranial injury (ICI) as identified in CT scans performed in ED.ResultsOf 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had a clinically important ICI as defined by NEXUS II. 74 (19.6%) of these patients underwent neurosurgery. Sensitivity for clinically important ICI based on the NEXUS II CDR was 373/377 (98.9%; 97.3%–99.7%) and specificity 156/1585 (9.8%; 8.4%–11.4%). Positive and negative predictive values were respectively 373/ 1802 (20.7%; 18.8%–22.6%) and 156/160 (97.5%; 93.7%–99.3%). Of the 18 147 children who did not have a CT scan 49.5% had at least one NEXUS II risk criterion.ConclusionsNEXUS II had very high sensitivity when analysed with a focus on head injured patients who have had a CT performed, similar to the derivation study. With half of the unimaged patients positive for NEXUS II risk criteria the use of this CDR has the potential to increase the number of CTs.
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- 2017
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38. Pediatric sport and nonsport concussions presenting to emergency departments: injury circumstances, characteristics, and clinical management.
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Rausa VC, Borland ML, Kochar A, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Davis GA, Anderson V, Williams A, Dalziel SR, Hearps SJC, and Babl FE
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- Humans, Child, Male, Female, Adolescent, Child, Preschool, Prospective Studies, Glasgow Coma Scale, Brain Concussion epidemiology, Brain Concussion diagnosis, Brain Concussion therapy, Emergency Service, Hospital statistics & numerical data, Athletic Injuries epidemiology
- Abstract
Objective: The aim of this study was to compare injury circumstances, characteristics, and clinical management of emergency department (ED) presentations for sports-related concussion (SRC) and non-SRC., Methods: This multicenter prospective observational study identified patients 5-17 years old who presented to EDs within 24 hours of head injury, with one or more signs or symptoms of concussion. Participants had a Glasgow Coma Scale score of 13-15 and no abnormalities on CT (if performed). Data were stratified by age: young children (5-8 years), older children (9-12 years), and adolescents (13-17 years)., Results: Of 4709 patients meeting the concussion criteria, non-SRC accounted for 56.3% of overall concussions, including 80.9% of younger child, 51.1% of older child, and 37.0% of adolescent concussions. The most common mechanism of non-SRC was falls for all ages. The most common activity accounting for SRC was bike riding for younger children, and rugby for older children and adolescents. Concussions occurring in sports areas, home, and educational settings accounted for 26.2%, 21.8%, and 19.0% of overall concussions. Concussions occurring in a sports area increased with age, while occurrences in home and educational settings decreased with age. The presence of amnesia significantly differed for SRC and non-SRC for all age groups, while vomiting and disorientation differed for older children and adolescents. Adolescents with non-SRC were admitted to a ward and underwent CT at higher proportions than those with SRC., Conclusions: Non-SRC more commonly presented to EDs overall, with SRC more common with increasing age. These data provide important information to inform public health policies, guidelines, and prevention efforts.
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- 2024
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39. Facial Function in Bell Palsy in a Cohort of Children Randomized to Prednisolone or Placebo 12 Months After Diagnosis.
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Oakley E, Wilson CL, Hopper SM, Cheek JA, Hearps S, Mackay MT, Dalziel SR, and Lee KJ
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- Child, Humans, Prednisolone therapeutic use, Treatment Outcome, Parents, Bell Palsy diagnosis, Bell Palsy drug therapy, Facial Paralysis
- Abstract
Background: Information on the medium-term recovery of children with Bell palsy or acute idiopathic lower motor neuron facial paralysis is limited., Methods: We followed up children aged 6 months to <18 years with Bell palsy for 12 months after completion of a randomized trial on the use of prednisolone. We assessed facial function using the clinician-administered House-Brackmann scale and the modified parent-administered House-Brackmann scale., Results: One hundred eighty-seven children were randomized to prednisolone (n = 93) or placebo (n = 94). At six months, the proportion of patients who had recovered facial function based on the clinician-administered House-Brackmann scale was 98% (n = 78 of 80) in the prednisolone group and 93% (n = 76 of 82) in the placebo group. The proportion of patients who had recovered facial function based on the modified parent-administered House-Brackmann scale was 94% (n = 75 of 80) vs 89% (n = 72 of 81) at six months (OR 1.88; 95% CI 0.60, 5.86) and 96% (n = 75 of 78) vs 92% (n = 73 of 79) at 12 months (OR 3.12; 95% CI 0.61, 15.98)., Conclusions: Although the vast majority had complete recovery of facial function at six months, there were some children without full recovery of facial function at 12 months, regardless of prednisolone use., Competing Interests: Declaration of competing interest The authors report no relevant disclosures beyond the funding information listed., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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40. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial.
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, and Dalziel SR
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- Humans, Prednisolone therapeutic use, Clinical Trials, Phase III as Topic, Randomized Controlled Trials as Topic, Infant, Child, Preschool, Child, Adolescent, Bell Palsy complications, Bell Palsy drug therapy, Bell Palsy epidemiology, Facial Paralysis drug therapy, Pain drug therapy, Pain epidemiology, Pain etiology
- Abstract
Objective: To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis., Methods: This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups., Results: Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain)., Conclusions: Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease., Trial Registration Number: ACTRN12615000563561., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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41. Paediatric diabetes-related presentations to emergency departments in Victoria, Australia from 2008 to 2018.
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Kao KT, Lei S, Cheek JA, White M, and Hiscock H
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- Male, Female, Adolescent, Humans, Child, Aged, Victoria epidemiology, Retrospective Studies, Hospitalization, Emergency Service, Hospital, Diabetic Ketoacidosis epidemiology, Diabetic Ketoacidosis etiology, Diabetic Ketoacidosis therapy, Diabetes Mellitus epidemiology
- Abstract
Objectives: Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018., Methods: Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. 'Non-preventable' presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence., Results: Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001)., Conclusions: Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth., (© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)
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- 2024
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42. Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized Controlled Trial.
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Xiong X, Huang L, Herd DW, Borland ML, Davidson A, Hearps S, Mackay MT, Lee KJ, Dalziel SR, Dalziel K, Cheek JA, and Babl FE
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- Child, Humans, Cost-Benefit Analysis, Drug Therapy, Combination, Australia, Prednisolone therapeutic use, Bell Palsy diagnosis
- Abstract
Background and Objectives: Bell palsy is the third most frequent diagnosis in children with sudden-onset neurologic dysfunction. The cost-effectiveness of treating Bell palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell palsy in children compared with placebo., Methods: This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (Bell Palsy in Children [BellPIC]) conducted from 2015 to 2020. The time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician-diagnosed Bell palsy and who completed the trial were included (N = 180). Interventions were oral prednisolone or taste-matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a health care sector perspective and included Bell palsy-related medication cost, doctor visits, and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analysis by age 12 to <18 years vs <12 years was conducted., Results: The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% CI -A$47 to A$179). QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95% CI -0.01 to 0.03). The incremental cost to achieve 1 additional recovery was estimated to be A$1,577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6,625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%). Subgroup analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to <18 years (probability is 98%) and much less so for those <12 years (probability is 51%)., Discussion: This provides new evidence to stakeholders and policymakers when considering whether to make prednisolone available in treating Bell palsy in children aged 12 to <18 years., Trial Registration Information: Australian New Zealand Clinical Trials Registry ACTRN12615000563561., (© 2023 American Academy of Neurology.)
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- 2023
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43. Incidence of traumatic brain injuries in head-injured children with seizures.
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Borland ML, Dalziel SR, Phillips N, Dalton S, Lyttle MD, Bressan S, Oakley E, Kochar A, Furyk J, Cheek JA, Neutze J, Eapen N, Hearps SJ, Rausa VC, and Babl FE
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- Child, Humans, Child, Preschool, Incidence, Seizures epidemiology, Seizures etiology, Prospective Studies, Risk Factors, Emergency Service, Hospital, Glasgow Coma Scale, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic epidemiology
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Objective: Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature., Methods: Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores., Results: Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR -16.1 [95% CI -20.4 to -11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6-7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1-15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8-12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8-12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8-4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4-3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13., Conclusions: PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival., (© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)
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- 2023
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44. Sports-related traumatic brain injuries and acute care costs in children.
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Singh S, Hoch JS, Hearps S, Dalziel K, Cheek JA, Holmes J, Anderson V, Kuppermann N, and Babl FE
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- Male, Animals, Horses, Female, Prospective Studies, Emergency Service, Hospital, Australia epidemiology, Athletic Injuries epidemiology, Brain Injuries, Traumatic epidemiology, Brain Injuries, Traumatic therapy
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Objective: To estimate traumatic brain injuries (TBIs) and acute care costs due to sports activities., Methods: A planned secondary analysis of 7799 children from 5 years old to <18 years old with head injuries enrolled in a prospective multicentre study between 2011 and 2014. Sports-related TBIs were identified by the epidemiology codes for activity, place and injury mechanism. The sports cohort was stratified into two age groups (younger: 5-11 and older: 12-17 years). Acute care costs from the publicly funded Australian health system perspective are presented in 2018 pound sterling (£)., Results: There were 2903 children (37%) with sports-related TBIs. Mean age was 12.0 years (95% CI 11.9 to 12.1 years); 78% were male. Bicycle riding was associated with the most TBIs (14%), with mean per-patient costs of £802 (95% CI £644 to £960) and 17% of acute costs. The highest acute costs (21%) were from motorcycle-related TBIs (3.8% of injuries), with mean per-patient costs of £3795 (95% CI £1850 to £5739). For younger boys and girls, bicycle riding was associated with the highest TBIs and total costs; however, the mean per-patient costs were highest for motorcycle and horse riding, respectively. For older boys, rugby was associated with the most TBIs. However, motorcycle riding had the highest total and mean per-patient acute costs. For older girls, horse riding was associated with the most TBIs and highest total acute costs, and motorcycle riding was associated with the highest mean per-patient costs., Conclusion: Injury prevention strategies should focus on age-related and sex-related sports activities to reduce the burden of TBIs in children., Trial Registration Number: ACTRN12614000463673., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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45. Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Zhang M, Velusamy K, Sullivan F, Oakley E, Davidson A, Hopper SM, Cheek JA, Berkowitz RG, Hearps S, Wilson CL, Williams A, Elborough H, Legge D, Mackay MT, Lee KJ, and Dalziel SR
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- Child, Humans, Australia, Glucocorticoids therapeutic use, Double-Blind Method, Treatment Outcome, Prednisolone therapeutic use, Bell Palsy drug therapy
- Abstract
Background and Objectives: Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month., Methods: We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group)., Results: Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes., Discussion: In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery., Trial Registration Information: Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true., Classification of Evidence: This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone., (© 2022 American Academy of Neurology.)
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- 2022
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46. Cost-effectiveness of patient observation on cranial CT use with minor head trauma.
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Singh S, Hearps S, Nishijima DK, Cheek JA, Borland M, Dalziel S, Holmes J, Kuppermann N, Babl FE, and Hoch JS
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- Australia, Child, Cost-Benefit Analysis, Glasgow Coma Scale, Humans, Prospective Studies, Tomography, X-Ray Computed, Craniocerebral Trauma diagnostic imaging, Emergency Service, Hospital
- Abstract
Objective: To evaluate the cost-effectiveness of planned observation on cranial CT use in children with minor head trauma., Design: Planned secondary analysis of a multicentre prospective observation study., Setting: Australia and New Zealand., Patients: An analytic cohort of 18 471 children aged <18 years with Glasgow Coma Scale scores 14-15 presenting <24 hours after blunt head trauma stratified by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories., Intervention: A plan for observation and immediate CT scan were documented after the initial assessment. The planned observation group included those with planned observation and no immediate plan for CT., Main Outcome Measures: Taking an Australian public-funded healthcare perspective, we estimated the cost-effectiveness of planned observation on the adjusted mean costs per child and CT use reduction by net benefit regression analysis using ordinary least squares with robust SEs and bootstrapping. All costs presented in 2018 euros., Results: Planned observation in 4945 (27%) children was cost-saving of €85 (95% CI -120 to -51) with 10.4% lower CT use (95% CI 9.6 to 11.2). This strategy was cost-saving for the PECARN high-risk (-€757 (95% CI -961 to -554)) and intermediate-risk (-€52 (95% CI -99 to -4.3)) categories, with 43% (95% CI 39 to 47) and 11% (95% CI 9.6 to 12.4) lower CT use, respectively. The very low-risk category incurred more cost of €86 (95% CI 67 to 104) with planned observation and 0.05% lower CT use (95% CI -0.61 to 0.71)., Conclusion: Planned ED observation in selected children with minor head trauma is cost-effective for reducing CT use for the PECARN intermediate-risk and high-risk categories., Trial Registration Number: ACTRN12614000463673., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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47. Paediatric traumatic brain injury severity and acute care costs.
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Singh S, Babl FE, Huang L, Hearps S, Cheek JA, Hoch JS, Anderson V, and Dalziel K
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- Child, Costs and Cost Analysis, Critical Care, Emergency Service, Hospital, Humans, Brain Injuries, Traumatic diagnosis, Brain Injuries, Traumatic therapy
- Abstract
Competing Interests: Competing interests: None declared.
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- 2022
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48. Trends of paediatric head injury and acute care costs in Australia.
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Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, and Cheek JA
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- Adolescent, Australia epidemiology, Child, Child, Preschool, Costs and Cost Analysis, Emergency Service, Hospital, Health Care Costs, Hospitalization, Humans, Prospective Studies, Retrospective Studies, Craniocerebral Trauma epidemiology
- Abstract
Aim: Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs., Methods: Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend., Results: The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs., Conclusion: PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)
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- 2022
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49. Pediatric Abdominal Pain in Children Presenting to the Emergency Department.
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Lee WH, O'Brien S, Skarin D, Cheek JA, Deitch J, Nataraja R, Craig S, and Borland ML
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- Adolescent, Australia, Child, Emergency Service, Hospital, Humans, Pilot Projects, Prospective Studies, Abdominal Pain epidemiology, Abdominal Pain etiology, Appendicitis complications, Appendicitis diagnosis, Appendicitis epidemiology
- Abstract
Background: Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED)., Objectives: The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED., Methods: A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site. The primary outcome was to describe the prevalence of CSAP and appendicitis. Age, sex, length of stay, surgery or interventional procedure, investigations, and analgesia use were recorded., Results: There were 555 presentations with abdominal pain during the study period with a median age of 9 years (interquartile range, 6-12 years). Eighty-two patients (14.8%; 95% confidence interval, 11.8-17.7) had CSAP, of which 41 (7.4%, 5.2-9.6) had appendicitis. Three hundred forty-eight (62.7%, 58.7-66.7) were discharged directly from ED, and 207 (37.3%, 33.2-41.3) were admitted. Two hundred fifty-five (45.9%, 41.8-50.1) had pathology tests, and 173 (31.2%, 27.3-35.1) had imaging tests in ED. Of those contacted for telephone follow-up, 100 (50.5%, 43.5-57.5) of 198 reported ongoing pain after discharge, and 13.1% (8.4-17.8) had missed over a week of school due to abdominal pain., Conclusions: The prevalence of CSAP and appendicitis in our study was 14.8% (11.8-17.7) and 7.4% (5.2-9.6), respectively. Fewer than half of patients received blood tests, and a third received imaging during their ED attendance. The presentation of abdominal pain conveys a significant health burden on families with time off school and ongoing symptoms of pain., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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50. PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study.
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Bressan S, Eapen N, Phillips N, Gilhotra Y, Kochar A, Dalton S, Cheek JA, Furyk J, Neutze J, Williams A, Hearps S, Donath S, Oakley E, Singh S, Dalziel SR, Borland ML, and Babl FE
- Subjects
- Adolescent, Algorithms, Child, Cohort Studies, Decision Support Techniques, Emergency Service, Hospital, Humans, Infant, Prospective Studies, Risk Assessment, Tomography, X-Ray Computed, Craniocerebral Trauma epidemiology, Emergency Medical Services
- Abstract
Background: The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors., Methods: This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables., Results: Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%-11.6%), 0.2% (95% CI = 0.0%-0.6%), and 0.0% (95% CI = 0.0%-0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%-7.2%), 0.7% (95% CI = 0.5%-1.0%), and 0.0% (95% CI = 0.0%-0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was "signs of palpable skull fracture" for younger children (11.4%, 95% CI = 5.3%-20.5%) and "signs of basilar skull fracture" in children ≥2 years (11.1%, 95% CI = 3.7%-24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%-80.6%) followed by the combination of "severe mechanism of injury" and "severe headache" (7.7%, 95% CI = 0.2%-36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis., Conclusions: The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predictors will help further refine clinical judgment and decision making on neuroimaging., (© 2021 Society for Academic Emergency Medicine.)
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- 2021
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