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Letter
Pediatric Emergency Research in the UK and Ireland (PERUKI): developing a collaborative for multicentre research
  1. Mark D Lyttle1,2,
  2. Ronan O'Sullivan3,4,
  3. Stuart Hartshorn5,
  4. Catherine Bevan6,
  5. Francesca Cleugh7,
  6. Ian Maconochie8,
  7. on behalf of PERUKI
  1. 1Department of Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK
  2. 2University of the West of England, Bristol
  3. 3Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
  4. 4Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Dublin, Ireland
  5. 5Department of Paediatric Emergency Medicine, Birmingham Children's Hospital, Birmingham, UK
  6. 6Department of Paediatric Emergency Medicine, Royal Alexandra Children's Hospital, Brighton, UK
  7. 7Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
  8. 8Department of Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to Dr Mark D Lyttle, Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK; Mark.lyttle{at}uhbristol.nhs.uk

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Paediatric Emergency Medicine (PEM) has evolved significantly in the UK and Ireland. Recognition as a subspecialty by the Royal College of Paediatrics & Child Health (RCPCH) and the College of Emergency Medicine, and the existence of the Association of Pediatric Emergency Medicine (PEM), have resulted in structured training programmes and enhanced paediatric emergency care. However, the limited evidence base for a number of childhood conditions treated in Emergency Departments (EDs) leads to variability in practice.1 To further improve emergency care of children in our population, further evidence must be generated. This can only be achieved through cohesive multicentre PEM research.

With presentations encompassing the full spectrum of childhood illness and injury, EDs theoretically provide an ideal research environment, yet there are a number of perceived challenges. These are resource, clinical, attitudinal, or system based, and impact on development, delivery and translation of findings. They include:

  • Funding limitations;

  • Rarity of serious outcomes and adverse events;

  • Balancing service delivery targets against research delivery;

  • Quality of emergency episode data;

  • Difficulties tracking patients throughout the care episode;

  • Providing sufficiently informed consent;

  • Reluctance to approach families;

  • Limited formal junior researcher training;

  • Dominance of specialist centres, inhibiting generalisability of findings;

  • Delay in translation of findings to effect change.

National guidance on research involving children (including deferred consent) and investigation of human factors in the emergency setting have removed some barriers.2 ,3 Changes to national funding bodies and research infrastructure have also driven change. Coupled with the development of the Medicines for Children Research Network (MCRN, UK) and the National Children's Research Centre (Ireland) paediatric research has increased, with further rises a priority of the RCPCH.4

While multicentre research adds complexities including coordination and data sharing,5 this approach is necessary to produce generalisable results in realistic timeframes. Many existing challenges have been overcome by PEM research networks in other countries, including the Pediatric Emergency Medicine Collaborative Research Committee and the Pediatric Emergency Care Applied Research Network (PEMCRC and PECARN, US), Paediatric Emergency Research Canada (PERC), Paediatric Research in Emergency Departments International Collaborative (PREDICT, Australia/New Zealand) and Research in European Paediatric Emergency Medicine (REPEM), which have generated practice changing evidence for conditions including bronchiolitis, traumatic brain injury, meningitis, diabetic ketoacidosis, abdominal trauma, status epilepticus and febrile illness. Pediatric Emergency Research Networks (PERN) is an initiative which brings these networks together with the vision of answering globally relevant PEM research questions.6

Pediatric Emergency Research in the UK and Ireland (PERUKI) was formed in August 2012 as a collaborative clinical studies group to develop and deliver high quality PEM research for our population. It consists of 39 member sites from England, Ireland, Northern Ireland, Scotland and Wales (table 1), comprising 15 paediatric-specific and 24 mixed adult/paediatric EDs, with a total annual census of 1.1 million childhood ED encounters. PERUKI's guiding vision is to improve emergency care for children through rigorous multicentre research by:

  • Facilitating collaboration and coordinating research activities of participating institutions;

  • Developing a research agenda to produce high-quality studies in the short, medium and long term;

  • Creating an environment for communication between academics and clinicians with translation of findings;

  • Promoting sharing of expertise within the UK and Ireland, and the rest of the world;

  • Mentoring junior PEM researchers to create sustainability.

Table 1

Pediatric Emergency Research in the UK and Ireland (PERUKI) founding member sites

Individual membership is open to anyone with this vision including doctors, nurses and allied health professionals. Site membership is conditional on participation in PERUKI studies. A representative from each site sits on the Research Steering Committee, which contributes to studies to ensure they are realistic, deliverable, and likely to produce meaningful results. Proposals for potential PERUKI studies are presented at bi-annual meetings, and collaborations are formed to further develop and seek funding for adopted studies.

To develop a robust research agenda, PERUKI undertakes an annual research prioritisation exercise. Results are disseminated and shared with funding bodies in order to facilitate study development. Initial studies include determination of the epidemiology of PERUKI, analysis of prehospital triage tools for injured children and a programme of research into childhood asthma.

PERUKI's infrastructure functions synergistically with established research bodies to enhance the development and delivery of multicentre PEM research throughout the UK and Ireland and will enable involvement with international PEM research networks and engagement in global studies. To ensure sustainability, PERUKI provides a framework which individuals and sites can use to develop research capabilities. By taking a collaborative approach PERUKI will generate a body of high quality studies to answer key research questions—only in doing so can we continue to improve the emergency care of children in the UK and Ireland. Further information can be found at http://www.peruki.org or by request at perukimail@gmail.com.

Acknowledgments

We thank a number of individuals and organisations for their support in the development of PERUKI. In particular we thank Associate Professor Franz Babl (PREDICT), Professor Nathan Kuppermann (PECARN), Dr Santi Mintegi (REPEM), Professor Martin Osmond (PERC), Professor Tim Coats (NIHR Injuries & Emergencies Specialty Group), Dr Kevin Morris (Paediatric Intensive Care Society Study Group) and Dr Colin Powell (MCRN) for their invaluable advice and start-up support. We also acknowledge the financial support of the Association of Paediatric Emergency Medicine, which has provided funding for our initial infrastructure.

References

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Footnotes

  • Collaborators PERUKI site representatives: R Alcock, J Barling, J Bayreuther, C Bevan, C Blackburn, T Bolger, A Brown, D Burke, V Choudhery, J Criddle, F Davies, K Dickson-Jardine, C Dieppe, E Gilby, S Hartshorn, P Leonard, K Lenton, M Lyttle, I Maconochie, J Maney, O Marzouk, R McNamara, M Mitchelson, N Mullen, J Mulligan, R O'Sullivan, A Parikh, K Potier, C Powell, A Reuben, G Robinson, J Ross, A Rowland, J Smith, E Sutherland, J Thiagarajan, L Thomas, C Vorwerk, S Wong, P Younge.

  • Contributors MDL conceived and designed the article, drafted it and approved the final version. ROS, SH, CB, and FC appraised and assisted in drafting the article, and approved the final version. IKM assisted in the conception, drafting, appraisal and final approval of the article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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