Clinton Administration Supports Research in Pediatric Emergency Medicine

Press Release Date: February 14, 1996

The Agency for Health Care Policy and Research, in collaboration with the Health Resources and Services Administration (HRSA), has announced four grant awards totaling $2.5 million for research leading to improvements in the provision of emergency medical services to children.

In announcing the awards, which were made in late fiscal year 1995, AHCPR Administrator Clifton R. Gaus said childhood injuries and illnesses constitute a major public health problem in the United States. "More than 20,000 children under 19 years of age die each year as a result of injury, and an additional 30,000 suffer permanent disability as a result of brain injury. Moreover, for each death of a child due to injury in the United States, as many as 42 children are hospitalized and 1,120 children visit emergency rooms," Dr. Gaus said.

According to Dr. Gaus there are important differences in the emergency care needs of children and adults. "In coping with pediatric emergencies, one size very definitely does not fit all," he said. "Differences in anatomy, physiology and psychology between children and adults mean there must be different and special equipment, different-sized instruments, different doses of different drugs, and different approaches to the psychological support and remedial care to be given to ill or injured children."

HRSA Administrator Ciro V. Sumaya, M.D., M.P.H.T.M., emphasized the need for more research in the area of pediatric emergency care. "Research topics in this field are outlined in a 1993 report by the Institute of Medicine (IOM) entitled Emergency Medical Services for Children. The IOM study, which was funded by HRSA's Maternal and Child Health Bureau, also describes the ongoing deficiencies in pediatric emergency care and recommends a variety of steps to correct the problems."

Following are descriptions of the newly funded research projects on emergency medical services (EMS) for children, with the names of grant recipients, principal investigators and amounts of the awards:

Harbour-UCLA Medical Center, Torrance, Calif., Marianne Gausche, M.D., principal investigator ($415,000): This two-year project will compare the use of two technologies, including endotracheal intubation (ETI) and bag-valve-mask (BVM) ventilation in providing emergency respiratory care to pediatric patients en route to the hospital. The most common cause of death in children is respiratory failure, and there is much controversy regarding the need for teaching thousands of paramedics the skills of ETI versus airway management with simple BVM ventilation. Preliminary data have indicated that BVM might be as effective as intubation in achieving survival of pediatric arrest victims.

University of Utah, Salt Lake City, Anthony J. Suruda, M.D., M.P.H., principal investigator ($612,000): This three-year project is a population-based epidemiologic study that will link data from existing sources—EMS data, aeromedical data, hospital inpatient and outpatient data, police crash data and poison control data—to determine the effect of EMS for children (EMSC) on patient outcomes. The epidemiology of pediatric emergencies and the cost of EMSC, including the cost and nature of EMSC aeromedical transport, will be described using the EMS system. Researchers will determine the effect of poison control center telephone consultation on subsequent EMSC and hospital care. The outcome of EMSC delivered by providers before and after EMSC training will be compared. Information from this study will be useful to public health officials and providers of emergency services for decisionmaking on preventive programs and for determining EMSC policies.

Arkansas Children's Hospital Research Institute, Little Rock, John M. Tilford, Ph.D., principal investigator ($747,000): This three-year project will investigate the relationship between cost containment efforts and the quality of care in pediatric intensive care units (PICUs). As managed care and cost-reducing measures alter the delivery of care in PICUs, knowledge of the relationship between resource utilization and patient outcomes will be important in assuring quality care for critically ill infants and children. Researchers will evaluate the usefulness of a severity of illness measurement system designed and validated specifically for prediction of PICU outcomes, and will determine the effect of patient characteristics such as insurance status and race on resource utilization.

Joseph Stokes Jr. Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pa., Flaura K. Winston, M.D., Ph.D., principal investigator ($749,000): Researchers will develop a biomechanical survey technique and "prediction score" for evaluating pedestrian and bicycling injuries. Pedestrian injuries are the leading cause of injury death in children from ages four to eight years. Biomechanical factors related to an injury (speed, energy delivered to the body, direction of impact, body rotation, etc.) are of key importance in determining the nature and severity of the injury. The score will be useful to pre-hospital care providers in determining appropriate mode of transport for the patient; to clinicians who must decide whether to perform emergency surgery for a suspected intra-abdominal bleed; to researchers evaluating the efficacy of new therapies; and to health economists evaluating the cost-effectiveness of care.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 ; or Salina Prasad, (301) 427-1864.