Protocol for a Group-Sequential Two-Stratum Multicenter Open-Label Randomized Clinical Trial of Respiratory Support in Infants With Acute Bronchiolitis: Breathing Assistance in Children With Bronchiolitis (BACHb).

Objectives: The Breathing Assistance in Children with bronchiolitis (BACHb) trial aims to evaluate the clinical and cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with humidified standard oxygen (HSO) in infants with moderate bronchiolitis, and HFNC with continuous positive airway pressure (CPAP) in severe bronchiolitis.

Design: Pragmatic, group-sequential, two-stratum, multicenter, open-label randomized clinical trial.

Setting: Fifty hospitals across England, Scotland, and Wales.

An update on paediatric traumatic brain injury in the emergency department: a narrative review.

Traumatic brain injury (TBI) affects an estimated 330,000 to 500,000 children annually in England and Wales and represents a significant burden on healthcare systems. Presentations range from mild to severe, and each case presents unique challenges to the Emergency Department (ED) clinicians. Most paediatric TBIs are mild, and several validated clinical decision rules (CDRs) such as PECARN help guide CT use.

Bivalent prefusion F vaccination in pregnancy and respiratory syncytial virus hospitalisation in infants in the UK: results of a multicentre, test-negative, case-control study.

Background: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in infants younger than 6 months globally. A maternal bivalent RSV prefusion F (RSVpreF) vaccine was introduced to the UK in late summer in 2024 (August 12 in Scotland and September 1 in England), with all pregnant women at 28 weeks or more of gestation eligible for vaccination. We aimed to understand RSVpreF vaccine effectiveness in a real-world setting.

The protocol for a multicentre prospective randomized noninferiority trial of surgical reduction versus non-surgical casting for displaced distal radius fractures in children : Children's Radius Acute Fracture Fixation Trial (CRAFFT) protocol.

Aims: The remarkable capacity for distal radius fractures in children to remodel raises questions about the necessity and extent of the intervention required to achieve anatomical alignment. The British Society of Children's Orthopaedic Surgery prioritized this uncertainty as one of their most important research questions. This is the protocol for a randomized, controlled, multicentre, prospective, noninferiority trial of non-surgical casting versus surgical reduction for severely displaced fractures of the distal radius in children: the Children's Radius Acute Fracture Fixation Trial.

Magnet ingestion in children in the United Kingdom: a national prospective observational surveillance study.

Objective: Magnet ingestion in children and young people (CYP) is associated with significant harm. We aimed to describe the incidence, circumstances and outcomes of magnet ingestion in CYP in the United Kingdom (UK).

Design: Prospective multicentre observational surveillance study.

Predictors of persisting symptoms after concussion in children following a traumatic brain injury: a longitudinal retrospective cohort study.

Objectives: To identify predictors of persisting symptoms after concussion (PSaC) in children, following any medically attended traumatic brain injury (TBI).

Design: Retrospective cohort study.

Setting: Linked primary and secondary care data from UK Clinical Practice Research Datalink and Hospital Episode Statistics.

Analysis of the asthma scores recommended in guidelines for children presenting to the emergency department: a Pediatric Emergency Research Networks study.

Rationale: While there are numerous published paediatric asthma scores, it is unknown how commonly scores are recommended in asthma guidelines across different geographical regions globally, and what their validation status is.

Objectives: (1) To describe which clinical guidelines recommend asthma scores across different geographical regions. (2) To describe the initial and subsequent validation of the commonly recommended asthma scores.

Disposable female urinal bottle (the UniWee) improves patient experience for immobile women with lower limb fractures.

Background: Female patients with lower limb fractures experience pain and loss of dignity when manoeuvered onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Staff at Great Western Hospital Emergency Department modify disposable male urinal bottles to accommodate the female perineum without need to reposition the patient.

Evidence of Poor Utility of Current Sepsis Screening Tools in an At-risk Population of Children With Community-Acquired Pneumonia.

Background: Children (6-24 kg) with lower respiratory tract infections were prospectively recruited in emergency departments to high or low doses of oral amoxicillin. We identified children who met the criteria for medium and high risks of sepsis, as per the UK's National Institute for Health and Care Excellence (NICE). Of those able to be discharged with oral antibiotics; 54% (318/591) had high-risk sepsis criteria.

The Landscape of Pediatric Procedural Sedation in the United Kingdom and Irish Emergency Departments; an International Survey Study.

Approximately 250 000 children undergo pediatric procedural sedation (PPS) in Emergency Departments (ED) in the United Kingdom and Ireland annually. PPS practice in our setting has not been described as fully as other high-income countries. We aimed to evaluate PPS in EDs in the United Kingdom and Ireland.

Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study.

Introduction: Children with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED, and to establish whether a clinical decision tool designed to support them would be beneficial.

Performance of clinical decision aids (CDA) for the care of young febrile infants: a multicentre prospective cohort study conducted in the UK and Ireland.

Background: Between 1% and 4% of febrile infants, aged from birth to 90 days of age, presenting to hospital will be diagnosed with an invasive bacterial infection (IBI). Traditional teaching has advocated a treat all approach but more recently a number of clinical decision aids (CDA) have been developed to classify febrile infants into lower and higher risk cohorts, with lower risk infants suitable for management without immediate parenteral antibiotics and lumbar puncture. The aim of this study was to apply these CDA to a UK and Irish cohort.

Update to: Study Pre-protocol for "BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study".

Background: In 2021 we launched the BronchStart study, which collected information on 17,899 presentations in children with serious respiratory tract infections following the release of lockdown restrictions. Our study informed the Joint Committee on Vaccination and Immunisation's decision to recommend the introduction maternal respiratory syncytial virus (RSV) vaccination, which was introduced in the United Kingdom in August/September 2024.

Study Question: We modified our original protocol to conduct a United Kingdom-wide assessment of maternal vaccination against RSV.

Cost-effectiveness analysis of soft bandage and immediate discharge versus rigid immobilization in children with distal radius torus fractures.

Aims: The aim of this trial was to assess the cost-effectiveness of a soft bandage and immediate discharge, compared with rigid immobilization, in children aged four to 15 years with a torus fracture of the distal radius.

Methods: A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective, as well as a broader societal point of view. Health resources and quality of life (the youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)) data were collected, as part of the Forearm Recovery in Children Evaluation (FORCE) multicentre randomized controlled trial over a six-week period, using trial case report forms and patient-completed questionnaires.

Seizure control via pH manipulation: a phase II double-blind randomised controlled trial of inhaled carbogen as adjunctive treatment of paediatric convulsive status epilepticus (Carbogen for Status Epilepticus in Children Trial (CRESCENT)).

Background: Paediatric convulsive status epilepticus is the most common neurological emergency presenting to emergency departments. Risks of resultant neurological morbidity and mortality increase with seizure duration. If the seizure fails to stop within defined time-windows, standard care follows an algorithm of stepwise escalation to more intensive treatments, ultimately resorting to induction of general anaesthesia and ventilation.

Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review.

Objectives: The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents.

Methods: Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care.

Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland.

Objective: Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.

Design: Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.

Which elements of hospital-based clinical decision support tools for the assessment and management of children with head injury can be adapted for use by paramedics in prehospital care? A systematic mapping review and narrative synthesis.

Objective: Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care.

Analysis of guideline recommendations for treatment of asthma exacerbations in children: a Pediatric Emergency Research Networks (PERN) study.

Rationale: There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines.

Objectives: To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions.

Infections diagnosed in children and young people screened for malaria in UK emergency departments: a retrospective multi-centre study.

Background: Data on imported infections in children and young people (CYP) are sparse.

Aims: To describe imported infections in CYP arriving from malaria-endemic areas and presenting to UK emergency departments (ED) who were screened for malaria.

Methods: This is a retrospective, multi-centre, observational study nested in a diagnostic accuracy study for malaria rapid diagnostic tests.

Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study.

The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs.