Break-out Sessions

The acute care of children in emergency departments has been evolving rapidly over the last 25 years with clinical expertise, training and a growing evidence base as to how to optimally manage these children. Research networks have created new knowledge to guide evidence-based practice in acute respiratory illness, injury and gastroenteritis. However, the care of these children often occurs in an emergency department that is not part of a children’s hospital and hence may not have the same level of access to this new evidence. To address this gap of knowledge translation, Translating Emergency Knowledge for Kids (TREKK) was funded by the Networks of Centers of Excellence program in Canada.

Recognising and responding to child maltreatment is an area where paediatricians work hand in hand with statutory child protection and judicial services.  Expert paediatric opinion is often pivotal to decisions about children’s safety and there is growing emphasis on a rigorous evidence base for signs of abuse. However, robust evidence for the core business of child protection services, placement of children in out-of-home care, remains elusive. This lack of evidence contrasts with the growing numbers of children being placed out of home at an earlier age. I will present findings of a systematic review of out of home care and discuss approaches to randomisation and trial design in the context of judicial decisions about children.

I have worked as a faculty member both in India and McMaster University, Canada. I compare my experiences with implementing Evidence-based Practice In Neonatology (EPIN) in the developing and developed world. EBM is all about the “care of individual patients”. In India, high workloads preclude thinking about EPIN at the level of the individual patient. There is lack of internet access at the bedside and ward; and making a trip to the office or home is impractical. Lack of local data on baselines risks, pre-test probabilities, and lack of well conducted studies in developing countries often precludes meaningful calculation of NNT’s and post-test probabilities. In private hospitals, lack of medical insurance and loss of wages results in a demand for unrealistic and quick-fix clinical improvements, even if they are by non-evidence-based remedies. In McMaster, there was widespread awareness about EBM, but tendencies to relegate EPIN to a theoretical exercise limited to journal clubs and not used as a practical tool at the bedside. There was an unwillingness to use data generated elsewhere to the extent that it hampered introduction of effective treatment options. As in India, there was a reluctance to make estimates about baseline risks or pre-test probabilities in individual patients. In both setups, physicians preferred published evidence-based guidelines and protocols.