Browsing by Author "Farrugia, Ruth"

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    Presentations of children to emergency departments across Europe and the COVID-19 pandemic : A multinational observational study
    (2022-08) Nijman, Ruud G.; Honeyford, Kate; Farrugia, Ruth; Pučuka, Zanda; the REPEM network (Research in European Pediatric Emergency Medicine) as part of the EPISODES study group; Rīga Stradiņš University
    Background During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Methods and findings Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Conclusions Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell.
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    Research priorities for European paediatric emergency medicine
    (2019-09) Bressan, Silvia; Titomanlio, Luigi; Gomez, Borja; Mintegi, Santiago; Gervaix, Alain; Parri, Niccolo; Da Dalt, Liviana; Moll, Henriette A.; Waisman, Yehezkel; Maconochie, Ian K.; Oostenbrink, Rianne; Er, Anil; Anil, Murat; Bal, Alkan; Manzano, Sergio; Lacroix, Laurance; Galetto, Annick; Beattie, Tom; Bidlingmaier, Christoph; de Lucas, Nieves; Maranon, Rafael; Pucuka, Zanda; Loellgen, Ruth; Keitel, Kristina; Hoeffe, Julia; Geurts, Dorien; Dubos, Francois; Lyttle, Mark; Bognar, Zsolt; Simon, Gabor; Fodor, Laszlo; Romanengo, Marta; Gras-le-Guen, Christele; Greber-Platzer, Susanne; Cubells, Carles Luaces; Teksam, Ozlem; Turan, Caner; van de Voorde, Patrick; Basmaci, Romain; Frassanito, Antonella; Saz, Ulas; Irfanos, Ionannis; Sotoca, Jorge; Berant, Ron; Farrugia, Ruth; Velasco, Roberto; Nijman, Ruud; Macao, Patricia
    Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects. Design and Setting We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic. Results Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions 'fever', 'sepsis' and 'respiratory infections', and the processes/interventions 'biomarkers', 'risk stratification' and 'practice variation' as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research. Conclusions While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.