Pediatric Emergency Care Applied Research Network (PECARN) by Alexander Rogers

Pediatric Emergency Care Applied Research Network (PECARN)

Conducting High Priority High Quality Research in Pediatric Emergency Care

Alexander Rogers, MD

Disclosure

Support from the Great Lakes Emergency Medical Services for Children Research Network (GLEMSCRN) on behalf of PECARN

PECARN is supported by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), and Emergency Medical Services for Children (EMSC) through the following grants: DCC-University of Utah (U03MC00008), GLEMSCRN-Nationwide Children’s Hospital (U03-MC00003), HOMERUN-Cincinnati Children’s Hospital Medical Center (U03-MC22684), PEMNEWS-Columbia University Medical Center (U03-MC00007), PRIME-University of California at Davis Medical Center (U03-MC00001), SW NODE-University of Arizona Health Sciences Center (U03MC28845), WBCARN-Children’s National Medical Center (U03-MC00006), and CHaMP-Medical College of Wisconsin (H3MC26201). MCHB/HRSA

Contact: Elizabeth Edgerton, MD [email protected]

PECARN History

Funded in 2001 by HRSA’s EMSC Program First federally funded pediatric emergency care research network

Evidence based research in emergency care for kids

U of M’s Dr. Ron Maio was a founding Nodal Investigator

PECARN History

Funded in 2001 by HRSA’s EMSC Program First federally funded pediatric emergency care research network

Evidence based research in emergency care for kids

U of M’s Dr. Ron Maio was a founding Nodal Investigator

Why a Network

•Incidence of high impact pediatric emergencies relatively small

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● = PRIME Node● = GLEMSCRN Node

= PEM-NEWS Node= WBCARN Node

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■= Data Coordinating Center

= HOMERUN Node●

= SW Node●

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= CHaMP Node

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Network Structure

PECARNSteering Committee

Data Coordinating Center (DCC)

Pediatric Emergency Medicine Northeast,

West and South

PEM-NEWS

Hospitals of the Midwest Emergency Research

Node

HOMERUN

Great Lakes Emergency Medical Services for Children Research

Network

GLEMSCRN

Southwest Research Node

SW-RNC

Washington, Boston, Chicago Applied Research

Node

WBCARN

Pediatric Research in Injuries and Medical

Emergencies

PRIME

PI: Peter Dayan

PI: Richard Ruddy

PI: Rachel Stanley

PI: Kurt Denninghoff

PI: James Chamberlain

PI: Nathan Kuppermann

PECARN Subcommittees

Protocol Review and Development

Quality Assurance, Safety and Regulatory

Feasibility and Budget

Grant Writing and Publication

HRSA/MCHB/EMSC

PI: J. Michael Dean

Charlotte, Houston and Milwaukee Prehospital

EMS Research Node Center

CHaMPPI: E. Brooke Lerner

The PECARN Process

PECARN Research Concept and Protocol Development Process

If approved, protocol may be developed into grant application

Project concept initiated by PECARN or Non- PECARN

Investigators or a PECARN Working Group

Submit grant application for funding

Federal Project Officer

review and approval of project

concept

Steering Committee final approval of grant application (by electronic vote if necessary)

C oncept approval by Steering Committee (Mtg #1)

Subcommittees review preliminary protocol Subcommittee Chairs send summary to investigator

within 2 weeks of meeting.

Protocol review/vote for approval by SC (Meeting #3)

Preliminary protocol developed and submitted toSteering Committee

Investigator refines protocol incorporating subcommittees’ recommendations.

Meet with DCC Consult FAB

2 weeks prior to subsequent SC meeting: I nvestigator submits revised protocol to SC

PECARN funding success - 80% grant funding rate

PECARN has researched these questions

•Do steroids work for children with bronchiolitis?

•When can you avoid CT scans for kids after head injury?

•When can you avoid CT scans after abdominal injuries?

•Can we use RNA technology to figure out whether infants with fever have a bacterial or viral infection?

•What are the characteristics of c-spine injuries in children?

•What is the best treatment for children with status epilepticus?

•Can we effectively detect early alcohol use and alcohol problems in teens presenting the ED? (ASSESS)

PECARN Publications

Current Research at U of M

• Established Status Epilepticus Treatment Trial (ESETT – with NETT group)

• Probiotics for acute gastroenteritis

• Emergency Department screening tool for suicide risk in teens (ED-STARS)

• RNA Biosignatures for the detection of bacterial disease in febrile infants

A typical PEM case…

• A 25 day old infant comes into the ED with a fever of 101.5 and a non-focal exam

• Parents terrified, ED is busy, hospital is full…

• What do we do?• Catheterized UA/urine culture• Bloodwork with IV placement• Lumbar Puncture• Admit for 48 hours of IV antibiotics awaiting culture results

• WE CAN’T TELL WHICH 5-10% OF INFANTS HAVE SERIOUS BACERTIAL INFECTION (SBI) IN REAL TIME

• A Clinical Application of RNA Biosignatures for the Diagnosis of Febrile infants (Mahajan, Ramilo and Kuppermann study PIs)

mRNA Biosignatures

Patient Genotype(DNA)

mRNA

Bacterium

ANALYSIS

Expression Profile

Virus

mRNA

Biosignatures

Biosignatures

Current results are from about 250 samples – with another 2000 to be analyzed

• More robust signatures to differentiate viral, bacterial or co-infections

• Narrow the confidence intervals around biosignatures

• Compare performance to current reference standard

• Define organism specific biosignatures

Next steps of Biosignatures

How stable are the RNA Biosignatures?

Does the biosignature remain stable over time?

Does the use of antibiotics alter the biosignature?

Does the use of antipyretics alter the biosignature?

More comprehensive pathogen identification

Biosignatures 2 currently in IRB review with sequential samples and comprehensive viral testing to further identify specific pathogens

Final Words

PECARN has a wide range of research, and has been a funded network for 15 years

Goal is to improve evidenced-based care for children

>100 PECARN publications/presentations to date

Many study Principal Investigators from outside of PECARN – We are always looking for new collaborators!!!

Go to www.PECARN.org for more information

Thank you to Dr. Prashant Mahajan and SJ Zuspan for slides

Questions?