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Emerging art of doing less
  1. Ruud Gerard Nijman1,2,
  2. Emily Cadman2,3,
  3. Ian Maconochie2
  1. 1Section of Paediatric Infectious Diseases, Imperial College London, London, UK
  2. 2Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
  3. 3Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Ruud Gerard Nijman, Section of Paediatric Infectious Diseases, Imperial College London, London SW7 2AZ, UK; r.nijman{at}

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The specialty of paediatric emergency medicine has firmly established itself in the UK training curriculum over the last decade, transforming the way we provide urgent and emergency care to children and young people. As for any aspiring specialty, defining and practising evidence-based medicine is a key component to validating its existence. Recently, a new wave of evidence is changing clinical practices in paediatric emergency medicine. Several key examples stand out, with some of the leading evidence coming from a successful collaborative research network: the Paediatric Emergency Research in the UK and Ireland network. As a result of this new evidence, a trend is emerging that strays from previous teachings and advocates for the art of doing less.

First, fewer procedures and treatments. The Forearm Fracture Recovery in Children Evaluation trial established that treating buckle fractures of the distal radius with a bandage was equivalent to treating with splint immobilisation.1 The Community-Acquired Pneumonia: A Randomised Controlled Trial showed that a shorter duration of antibiotics of 3 days was non-inferior to a longer course of antibiotics for the treatment of uncomplicated community-acquired pneumonia, following the belief that ‘shorter is better’ for most infections.2 Studies concluded that low-flow oxygen is equivalent to non-invasive high-flow oxygen support in children with moderate or severe bronchiolitis, challenging the role of non-invasive ventilatory support as a much fancied mainstay of treatment in childhood bronchiolitis.3 Updates in sepsis management are now advocating for restrictive fluid resuscitation especially in the absence of clinically evident shock.4

Second, …

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  • Contributors RGN wrote the first draft of the manuscript. All authors contributed to the conception, writing and careful revising of the manuscript.

  • Funding This study was funded by NIHR BRC Imperial College London.

  • Competing interests None declared.

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