PIRN
Ongoing Projects
1
Care and outcomes of Canadian children hospitalized with periorbital and orbital cellulitis
Severe orbital infections, including periorbital and orbital cellulitis, are serious infections in children. There are several important unanswered research questions regarding how hospitalized children with these infections are managed, such as which antibiotics to use, and which children need a computed tomography (CT) scan. PIRN is conducting a retrospective study across 10 hospitals to determine how care for Canadian children can be improved.
2
Paediatric Hospital Care Priority Setting Study
PIRN, in collaboration with the James Lind Alliance (JLA), conducted a CIHR-funded Priority Setting Partnership (PSP) to identify the Top 10 research questions for Inpatient General Paediatrics in Canada from the perspective of patients, caregivers, and clinicians. These priorities will guide the future research agenda for hospitalized children in Canada, and include care of special inpatient populations (eg, children with medical complexity), shared decision-making, mental health supports, and supporting Indigenous families. Funding Source: CIHR Catalyst Grant in Patient Oriented Research
3
Renal ultrasound after first febrile urinary tract infection in hospitalized children: reducing overdiagnosis and cascade effects
Urinary tract infection (UTI) is one of the most common and costly reasons for childhood hospitalization. Based on low quality evidence, renal ultrasound is universally performed after the first febrile UTI in children at Canadian hospitals, which may result in overdiagnosis of ‘genitourinary abnormalities’ and lead to a cascade of unnecessary healthcare interventions. PIRN is conducting a national, prospective, pragmatic, observational study across 16 hospitals to determine the utility of universal screening renal ultrasound in hospitalized children after first febrile UTI. Funding Sources: Physicians’ Services Incorporated (PSI) Foundation and Canadian Institutes of Health Research (CIHR) Project Grant Program
4
Parenteral veRsus Enteral Fluids for infants hospitalizEd with bRonchiolitis: the PREFER shared decision making study
Bronchiolitis is one of the most common and costly reasons for hospitalization in children. For hospitalized children who are unsafe to feed orally, there is variation in use of intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids. While both are safe, little is known if parents are involved in shared decision making of selecting IV or NG fluids or informed of benefits and trade-offs is unknown. PIRN is conducting a national, prospective, pragmatic, observational study across 15 hospitals to generate knowledge on shared decision making with parents in choosing between IV and NG fluids and on the benefits and harms of these two treatment options for hospitalized children with bronchiolitis. Funding Source: CIHR Patient-Oriented Research: Early-Career Investigator Priority Announcement
5
A Data-driven Approach to Identify High Priority Research Topics for Pediatric Hospital Care
Despite extensive research on conditions managed in children’s hospitals and subspeciality units, conditions managed on general pediatric units are more prevalent. There are also important health inequalities in hospital use based on characteristics (e.g. socioeconomic status). PIRN was launched to address this gap and improve outcomes for hospitalized children. This population-based cross-sectional study of Canadian children and youth with hospital encounters will use health administrative data from the Canadian Institute for Health Information (CIHI) and Institut de la statistique du Québec (ISQ) to identify conditions that are the most costly, prevalent, and with the largest health inequalities as priorities for future research in hospital pediatrics.
6
Description of Canadian infants presenting with Brief Resolved Unexplained Events (BRUEs) and validation of a clinical prediction rule for risk stratification
Infants often experience Brief Resolved Unexplained Events (BRUEs) within the first year of life. These events are concerning for caregivers, can appear to be life-threatening and pose diagnostic and management challenges for healthcare providers as they attempt to identify events likely to recur, or those caused by a serious underlying illness. Although studies have been conducted to develop clinical practice guidelines and clinical prediction rules in the United States, no studies to date have assessed the BRUE population in Canada. PIRN will conduct a multi-site retrospective observational study of hospitalized children in Canada to identify variation in the clinical management of infants presenting with BRUEs, inform practitioners and improve outcomes. Funding Sources: American Academy of Pediatrics – Resident Research Grant Program; BC Children’s Hospital – BCCH Resident Research Funding; BC Children's Hospital Research Institute (E2i) – Seeds Grant (Early Investigator) and Canadian Pediatric Society (CPS) – Hospital Pediatrics Resident Grant
7
A planning grant to explore partnerships and opportunities for the participation of Indigenous children and families in the Pediatric Inpatient Research Network
Indigenous (First Nation, Métis, and Inuit) compared to non-Indigenous children are more likely to be hospitalized yet many knowledge gaps exist regarding their care and outcomes in the pediatric inpatient setting. With the development of PIRN, there is now an opportunity to advance the care and outcomes for children admitted to hospital. The current planning grant aims to develop infrastructure in PIRN to ensure meaningful, culturally-safe, partnership and participation of Indigenous children, families, and communities within this network. Funding Source: Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant
8
POPCORN (Pediatric Outcome Improvement through Coordination of Research Networks)
POPCORN unites pediatric health researchers from 16 research sites and existing national networks in pediatric research across Canada to enhance responsiveness to emerging COVID-19-related issues, including unintended consequences of preventive measures. The overall objective is to prepare Canadian child health researchers and their networks to respond rapidly and cohesively to current and future pandemic or public health issues of importance.
9
Understanding the use and outcomes of high flow nasal cannula among infants admitted to Canadian hospitals with bronchiolitis: a multi-centre, retrospective cohort study (CanFLO)
Bronchiolitis is the most common lower respiratory tract infection in children under two years of age. Despite its prevalence, there is significant variability in the management of bronchiolitis. Increasingly, respiratory support with high flow nasal cannula (HFNC)—higher flow rates of warm, humidified gas—has been used among patients with bronchiolitis. The potential to be used outside of the intensive care setting makes HFNC an attractive treatment option. PIRN is conducting a retrospective study across 10 hospitals to describe the clinical parameters guiding HFNC use and discontinuation. This study aims to understand the patient factors that are associated with HFNC treatment failure, allowing the identification of the patient population that is most likely to benefit from this treatment.
10
Low-value care, and variation in practice for children hospitalized with bronchiolitis – a multicentric prospective observational study (CARE-BEST)
Most healthcare costs associated with bronchiolitis are those related to hospitalization, and these costs have been increasing. Supportive care is recommended by national guidelines for the treatment of bronchiolitis, and many commonly used diagnostics and treatments in bronchiolitis are considered low-value. This mult-centre prospective observational cohort study of children hospitalized with bronchiolitis will develop effective interventions to reduce low-value care, and ensure the right resources go to the right patient at the right time.