PERC-led study recognized as one of Canada's top achievements in health research

You could call it paying it forward. A trip to the Emergency Department (ED) is every parent's worst nightmare. But what if the information documented as a result of your child's visit could help a child with similar symptoms a few provinces away?

Terry Klassen and his research team of leading pediatric emergency physicians at Pediatric Emergency Research of Canada (PERC) have done just that and the impact of their research is today recognized as one of the Top Canadian Achievements in Health Research in 2011. The award is bestowed jointly by the Canadian Institutes of Health Research (CIHR) and the Canadian Medical Association Journal (CMAJ).

Klassen, as Founding Director of PERC, generated important new knowledge that has substantially improved the outcomes of acutely ill or injured children seen in EDs in Canada and around the world. PERC has made key advances in three common childhood problems; croup, bronchiolitis, and mild head injuries. The most comprehensive achievement has had substantial influence on how croup is treated around the world.

Klassen is a Professor in the Department of Pediatrics and Child Health at the Faculty of Medicine and Director of Research for the Manitoba Institute of Child Health (MICH). The PERC team recognized with the award today include: David Johnson (University of Calgary), Martin Osmond (University of Ottawa), Amy Plint (University of Ottawa), and Lisa Hartling (University of Alberta).

"I congratulate Dr. Klassen and his colleagues across the country," said Dr. Digvir Jayas, Vice-President (Research and International) at the University of Manitoba. "This achievement is as a result of a national collaboration and putting evidence into practice for the benefit of all Canadians."

PERC recognized early on that many children with croup evaluated in general urban and rural EDs were not receiving optimal therapy. A series of randomized controlled trials found that the use of corticosteroids for children with mild, moderate, and severe croup was an effective use. Oral, intramuscular and inhaled doses have substantially cut the number of hospitalizations and return visits by half, resulting in reduced health care costs, parental stress and out-of-pocket expenses.

PERC has also been at the forefront of generating evidence for managing bronchiolitis. The group conducted the largest randomized controlled trial to date that involves infants with bronchiolitis. The study has shown that dexamethasone-a class of steroid drugs used to treat many inflammatory and autoimmune conditions-and epinephrine (commonly known as adrenaline) may interact in ways that enhance or magnify one or more effects when combined; resulting in a significant drop in hospital admission rates.

One of the challenging issues that spawned the national-wide research network, which formed in 1995, was the huge variation in the use of computed tomography (CT) for children visiting EDs with cases of mild head injury. The CIHR funded study, that enrolled more than 4,000 child patients, resulted in a practical clinical decision rule that assists physicians in determining if a child suffering mild head injury requires a CT scan. This rule is currently being tested in 5000 more children and if validated could result in a decrease in the number of young children facing unnecessary radiation exposure and potential long-term associated risks.