Field:

  • Emergency medicine
  • Paediatrics
  • Trauma and critical care

Location: Centre for Children's Health Research

Type of student: Volunteer/extra-curricular

Type of work: Chart review

Asthma is a common reason for Australian children to attend an emergency department. Most children are managed with inhaled bronchodilators (such as salbutamol) and oral steroids. A small number of these children are very unwell, and require assistance with their breathing, or intravenous medication (magnesium, aminophylline, or salbutamol).

Currently, there is minimal information to guide clinicians on which treatment to choose. A 2008 survey of Australian and New Zealand paediatric emergency doctors found significant variation in practice patterns in the treatment of critical asthma in children. 45% reported using aminophylline, 55% magnesium, and 87% salbutamol.

Unfortunately, none of these medications are “perfect” – they all have side-effects, including tremor, vomiting, abnormal heart rhythms and low blood pressure, and we do not know which one is more effective.

The Paediatric Research in Emergency Departments International Collaborative (PREDICT) network was established in 2004 and includes research institutions, healthcare providers, and researchers involved in paediatric emergency care across Australia and New Zealand. Currently, the network comprises hospitals from Victoria, New South Wales, Queensland, ACT, Western Australia, South Australia and New Zealand.

We are planning to undertake multi-centre research into severe acute asthma in children, with the eventual aim to determine which intravenous therapy is best through an NHMRC-funded multi-centre randomised trial.

Before doing the trial it is essential to establish baseline information regarding the burden and severity of severe paediatric asthma across Australia and New Zealand, and to determine which outcomes are most appropriate to measure.

When comparing treatments, it is important to determine whether or not they can reduce the risk of severe complications, or whether they make a difference in important treatment outcomes. Most children – even those with severe asthma – do well. Severe complications, such as the need for intubation (a breathing tube), or intensive care admission are rare.

This project will allow us to:
- Determine current management practices for children with severe acute asthma and/or wheeze across Australia and New Zealand.
- Determine the incidence of (and complications relating to) severe acute asthma requiring IV bronchodilator therapy or ventilator support across Australia and New Zealand.
- Determine where differences in therapy exist between states / regions across Australia and New Zealand given our previous research.
Once complete, this project will provide important data regarding the burden of disease, current asthma treatments, and outcomes which are important to patients. This data will directly inform the design of our randomized trial of intravenous bronchodilator therapy in acute severe paediatric asthma.

The Paediatric Emergency Research Unit (PERU) are seeking medical student/s to assist with the conduction of medical record audit and database entry. Full training and support will be provided. This is a fantastic opportunity to work on an international project and will provide students with research skills which are easily transferrable for future research.

Prerequisite skills: Nil, full training will be provided

Time frame: November 2017- June 2018

Websitehttp://www.predict.org.au/projects/asthma-retrospective/

Supervisor

Dr Natalie Phillips

Medical Lead Paediatric Emergency Research Unit (PERU)
Lady Cilento Children's Hospital