PERUKI research studies opening soon
Near fatal asthma (NFA) is the most severe form of survivable asthma attack. Our aim is to describe the frequency, risks factors, clinical care and future asthma risk of children and young people (aged 5-15 years) experiencing a Delphi defined near fatal asthma attack. We will explore both commonly identified clinical factors, but also for the first time describe in detail the variance in medical management (acute and intensive care) that could lead to future clinical trials and guideline development to standardise care. The study will also describe, through data-linkage, socio-demographic factors associated with NFA, to include pollution, pollen, weather, viral prevalence that could lead to better care for higher risk patients. This is an observational surveillance study using British Paediatric Surveillance Unit methodology (https://www.rcpch.ac.uk/work-we-do/bpsu/near-fatal-asthma). The study is funded by the Chief Scientist Office, Scotland. For more information contact loth.bpsunfa@nhslothian.scot.nhs.uk.
PTTSS - Parents of child who come into the emergency department with acute injuries have a significant role in their child’s emotional post-trauma recovery. Research has suggested that there are several domains of parenting associated with children’s post-traumatic stress symptoms. These domains include overprotection, avoidance of trauma discussion and cognitive/behavioural coping strategies. This Economic and Social Research Council-funded PhD is aiming to develop and pilot an intervention for parents of children who have visited the emergency department for acute injures (e.g., motor vehicle accidents, burns, etc.). This intervention will be a psychoeducational resource to inform families about normal vs. persistent/problematic child psychological responses to trauma, and how they can support their child’s psychological post-trauma recovery. The current study is aiming to hold one-to-one interviews or focus groups with emergency department clinicians and practitioners to understand their views on implementing this intervention into emergency departments. The main aim of this study is to explore clinicians’ views on potential barriers/facilitators to successfully implementing the intervention, and any factors to consider within intervention development.
Cefalexin for UTIs – Right treatment Length in Young children (the CURLY trial)
Cefalexin is the NICE-recommended first-line oral antibiotic for children and young people with a febrile UTI, but there is limited evidence for its optimal duration. This is highlighted as a research priority in national guidelines, and is of particular importance given the high incidence of the condition and the increasing emergence of multidrug-resistant organisms.
CURLY is an NIHR HTA-funded RCT which will evaluate the efficacy, safety, and effect on bacterial resistance of five cefalexin treatment durations (3, 5, 6, 8 or 10 days) in children with febrile UTIs. The primary objective of CURLY is to determine the optimal cefalexin duration (the shortest effective treatment duration) for the treatment of febrile UTIs in children, determined using both clinical and microbiological cure. The trial will also assess the impact of cefalexin treatment duration on UTI recurrence, antibiotic-associated adverse events, adherence, antimicrobial resistance, quality of life, and cost-effectiveness.
Approximately 8 PERUKI sites will be required to recruit a total of 705 patients over a 16 month period. Sites will be contacted for expressions of interest in winter 2022, for recruitment to commence in May 2023.
PICBone – Imaging in Paediatric Osteomyelitis - Osteomyelitis and septic arthritis are bacterial bone and joint infections (BJI) and, in children, these are typically introduced through haematogenous spread. Early differentiation of BJI from less urgent conditions mimicking the symptoms is critical to prevent irreversible joint damage, bone destruction and sepsis.
Clinical presentation is variable and often non-specific and there is wide practice variation in first-line investigations, which may include blood markers of infection and inflammation and plain radiography. After initial work-up, diagnosis is often uncertain and advanced imaging may be considered. Ultrasound is more accessible but the overall diagnostic value is unknown. MRI has high diagnostic value in adult BJI, but often requires anaesthesia in children.
PICBone is an NIHR HTA-funded study which aims to understand how helpful ultrasound and MRI scans are in diagnosing BJI in children, and to create a pathway that ED clinicians can use to more successfully diagnose BJI. It will comprise two components:
Retrospective study - To start December 2022 (for 15 months)
Data collection for 6000 cases of potential BJI (e.g. presenting complaint = atraumatic limp, fever and joint swelling, etc.)
Prospective study - To start March 2023 (for 12 months)
Data collection for 1500 cases of potential BJI for external validation of the model’s predictive performance.
Consent will be obtained from families for a 3-month follow-up call.
If you are interested in participating, and haven’t already completed the PERUKI online survey for expression of interest, please email picbone@ndorms.ox.ac.uk
Supracondylar fracture management across the UK & Ireland, where’s the equipoise? -
Supracondylar fractures are a common childhood injury which are typically graded using the Gartland classification system (type 1-3). Variable research has occurred into the optimal management of these injuries with limited low-quality evidence for Gartland type 1 fractures. Our PERUKI wide site level survey (x1 survey per site), using images of various supracondylar fractures, aims to capture the current practice of Emergency and Orthopaedic departments across the UK and Ireland. Variation is well known to occur in healthcare and the results will help inform where or if equipoise exists across PERUKI to support future study proposals. For further details contact patrickjaldridge@hotmail.com.
Empirical oral AntibioticS for possible UTI in well appearing Young febrile infants (EASY).
A multi-centre randomised, non-inferiority trial comparing parenteral antibiotics with oral antibiotics for the management of suspected urinary tract infections in well appearing young febrile infants.
Objectives
1. To determine if the clinical effectiveness of oral antibiotics pending urine culture results is non-inferior to parenteral antibiotics pending urine culture results in terms of requirement for additional parenteral antibiotics, treatment failure and a range of secondary outcomes.
2. To evaluate the impact of oral antibiotics on healthcare resource use, costs and selected outcomes via a cost-consequence analysis.
Intervention:
Oral antibiotics (the choice of oral antibiotic prescribed is at the discretion of the clinical team and should reflect antibiotic availability and locally agreed prescribing protocol) .
Comparator:
Parenteral antibiotics (the choice of parenteral antibiotic prescribed is at the discretion of the clinical team and should reflect antibiotic availability and locally agreed prescribing protocols).
Primary Outcome
Additional parenteral antibiotics within seven days of randomisation.
Countries of Recruitment
England, Northern Ireland, Scotland, Wales
Target Sample Size
584
Study Duration
42 months
Funding
NIHR
EOI available at: https://redcap.link/EASYSTUDY