Thomas Waterfield, Mark D Lyttle, Michael Shields, Derek Fairley, Damian Roland, James McKenna, Kerry Woolfall. ADC, 2019

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The Petechiae in Children (PiC) study assesses the utility of presenting features and rapid diagnostic tests in the diagnosis of serious bacterial infection in feverish children with non-blanching rashes. An embedded qualitative study explored parents’ and clinicians’ views on the acceptability of the PiC study, including the use of research without prior consent (RWPC) in studies of diagnostic test accuracy.

Simone L, Lyttle MD, Roland D, Stephens D, Schuh S. EMJ, 2019

A PERC and PERUKI study

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Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a full sepsis workup with lumbar puncture, despite lack of evidence for this practice and lack of clinical practice guidelines for this population. The primary objective of this survey study, delivered in collaboration between PERC (Canada) and PERUKI, was to investigate practice variation in investigation of febrile infants aged ≤30 days with bronchiolitis. It demonstrated wide variability in reported practice, with significant variation found for factors including network, <10 years in ED practice, and comfort level with diagnosing bronchiolitis in newborns. An unexpected but striking finding was the difference in risk tolerance between networks, which is likely to be a contributing factor in any practice variation. This study opens the door to further global research on risk tolerance in PEM, and to further work to establish best practice guidelines for this specific cohort of children. Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a full sepsis workup with lumbar puncture, despite lack of evidence for this practice and lack of clinical practice guidelines for this population. The primary objective of this survey study, delivered in collaboration between PERC (Canada) and PERUKI, was to investigate practice variation in investigation of febrile infants aged ≤30 days with bronchiolitis. It demonstrated wide variability in reported practice, with significant variation found for factors including network, <10 years in ED practice, and comfort level with diagnosing bronchiolitis in newborns. An unexpected but striking finding was the difference in risk tolerance between networks, which is likely to be a contributing factor in any practice variation. This study opens the door to further global research on risk tolerance in PEM, and to further work to establish best practice guidelines for this specific cohort of children.

The use of mobile devices and medical applications by health care professionals in emergency departments is currently poorly described.  Established and existing technologies potentially allow greater interaction than ever before, with consequent impact on patient care. National policy recommendations are more rapid integration of daily practice into digital platforms, but the current enablers and obstacles have not previously been explored. The study team, led by Haiko Jahn, therefore surveyed current provision and use of mobile device technology and medical apps in paediatric emergency care across PERUKI from a departmental and individual clinician perspective. This research is currently undergoing analysis. This research provides an overview of current practice, and will inform future areas of research mapping the digitalisation of emergency care. 

Peri-orbital cellulitis, a bacterial infection of tissues anterior to the orbital septum, may lead to sight- (orbital cellulitis) and life-threatening (intracranial infection) consequences if inadequately treated. However there is little evidence on indications for treatment, and the mode of delivery and duration of that treatment. This study therefore aims to evaluate variation in practice across the PERUKI network, specifically in relation to investigation and treatment choices.  The study is led by Meriel Tolhurst-Cleaver, with components including a survey of practice, and review of existing institution clinical practice guidelines. The study is now in write up, with results due later in 2019.