Imperial College London

DrIanMaconochie

Faculty of MedicineDepartment of Infectious Disease

Professor of Practice (Paediatric Emergency Medicine)
 
 
 
//

Contact

 

+44 (0)20 3312 3729i.maconochie

 
 
//

Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

//

Summary

 

Publications

Publication Type
Year
to

303 results found

Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellat-Higgins T, Phillips C, Phillips T, Pockett RD, Russell IT, Strang J, Drummond Cet al., 2022, Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to emergency departments: three-arm pragmatic randomized trial (SIPS Junior high risk trial), ADDICTION, ISSN: 0965-2140

Journal article

Nijman RG, Honeyford K, Farrugia R, Rose K, Bognar Z, Buonsenso D, Da Dalt L, De T, Maconochie IK, Parri N, Roland D, Alfven T, Aupiais C, Barrett M, Basmaci R, Borensztajn D, Castanhinha S, Corrine V, Durnin S, Fitzpatrick P, Fodor L, Gomez B, Greber-Platzer S, Guedj R, Hartshorn S, Hey F, Jankauskaite L, Kohlfuerst D, Kolnik M, Lyttle MD, Mação P, Mascarenhas MI, Messahel S, Özkan EA, Pučuka Z, Reis S, Rybak A, Rinder MR, Teksam O, Turan C, Thors VS, Velasco R, Bressan S, Moll HA, Oostenbrink R, Titomanlio Let al., 2022, Patterns of presentations of children to emergency departments across Europe and the impact of the COVID-19 pandemic: retrospective observational multinational study

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>To investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Routine health data were extracted retrospectively from electronic patient records of children aged &lt;16 years, presenting to 38 emergency departments (ED) in 16 European countries for the period January 2018 – 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 (IRR) were used to compare age groups, diagnoses and outcomes.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>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 (incidence rate ratio (IRR) 2·62, 95% CI 2·19 to 3·13) and in children aged &gt;12 months (12-&lt;24 months IRR 0·89, 95% CI 0·86 to 0·92; 2-&lt;5years IRR 0·84, 95% CI 0·82 to 0·87; 5-&lt;12 years IRR 0·74, 95% CI 0·72 to 0·76; 12-&lt;16 years IRR 0·74, 95% CI 0·71 to 0·77; vs. age &lt;12 months as reference group). The impact on pediatric intensive care admissions (IRR 1·30, 95% CI 1·16 to 1·45) was not as great as the impact on general admissions. 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

Journal article

Stilwell PA, Fissler S, Burkitt S, Smith B, Stuttard G, Kenny S, Evans D, Maconochie Iet al., 2022, NHS 111 Clinical Assessment Services: paediatric consultations, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 107, ISSN: 0003-9888

Journal article

Zachariasse JM, Espina PR, Borensztajn DM, Nieboer D, Maconochie IK, Steyerberg EW, van der Lei J, Greber-Platzer S, Moll HAet al., 2022, Improving triage for children with comorbidity using the ED-PEWS: an observational study, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 107, Pages: 229-233, ISSN: 0003-9888

Journal article

Ong GY-K, Ang AJF, Chen ZJ, Chan YH, Tang PH, Fong ESS, Tan JY, Aurangzeb ASO, Pek JH, Maconochie I, Ng KC, Nadkarni Vet al., 2022, Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study, RESUSCITATION PLUS, Vol: 9, ISSN: 2666-5204

Journal article

Ropers F, Bossuyt P, Maconochie I, Smit FJ, Alves C, Greber-Platzer S, Moll HA, Zachariasse Jet al., 2022, Practice variation across five European paediatric emergency departments: a prospective observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055

Journal article

Stilwell PA, Stuttard G, Scott-Jupp R, Boyle A, Kenny S, Maconochie Iet al., 2022, Paediatric NHS 111 Clinical Assessment Services pilot: an observational study., Arch Dis Child, Vol: 107

OBJECTIVE: To determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service. DESIGN: Observational study. SETTING: Six NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians. PATIENTS: Under 16-year-olds prompting calls to NHS 111 over the study period. MAIN OUTCOME MEASURES: The disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians' and patient experience. RESULTS: 70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers' CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%). CONCLUSIONS: Introducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.

Journal article

Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang W-T, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh M-J, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim H-S, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang T-L, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM, Collaboratorset al., 2022, 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group., Circulation, Vol: 145, Pages: e645-e721

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Journal article

Maconochie I, Thompson N, 2022, Dispatcher-assisted CPR for cardiac arrest in children - Conventional versus compression-only CPR., Resuscitation, Vol: 172, Pages: 115-116

This study showed that conventional CPR outcomes in Cerebral Performance Category were better than those compression-onlybystander CPR that were achieved at 1 month post resuscitation. There was no difference in those with an initial shockable rhythm, requiring CPR for 20 minutes before hospital arrival, public defibrillation, advanced airway care or epinephrine administration. However, survival rates in paediatric CPR is low. Ways in which to improve the outcomes are suggested which included bystander CPR, teaching and training of dispatchers and additional technologies.

Journal article

Hagedoorn NN, Zachariasse JM, Borensztajn D, Adriaansens E, von Both U, Carrol ED, Eleftheriou I, Emonts M, van der Flier M, de Groot R, Herberg JA, Kohlmaier B, Lim E, Maconochie I, Martinón-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tsolia M, Zavadska D, Zenz W, Levin M, Vermont C, Moll HA, PERFORM consortiumet al., 2022, Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study, Archives of Disease in Childhood, Vol: 107, Pages: 116-122, ISSN: 0003-9888

OBJECTIVE: (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children. DESIGN/SETTING: Observational study in 11 European EDs (2017-2018). PATIENTS: Febrile children with measured blood pressure. MAIN OUTCOME MEASURES: Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs). RESULTS: Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8. CONCLUSIONS: High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.

Journal article

Tan CD, Hagedoorn NN, Dewez JE, Borensztajn DM, von Both U, Carrol ED, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie IK, Martinon-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Strle F, Tsolia M, Vermont CL, Yeung S, Zachariasse JM, Zenz W, Zavadska D, Moll HA, Consortium Pet al., 2022, Rapid Viral Testing and Antibiotic Prescription in Febrile Children With Respiratory Symptoms Visiting Emergency Departments in Europe, PEDIATRIC INFECTIOUS DISEASE JOURNAL, Vol: 41, Pages: 39-44, ISSN: 0891-3668

Journal article

Borensztajn D, Hagedoorn NN, Carrol E, von Both U, Dewez JE, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie I, Martinon Torres F, Nijman R, Pokorn M, Rivero-Calle I, Tsolia M, Vermont C, Zavadska D, Zenz W, Zachariasse J, Moll HAet al., 2022, Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study, BMJ OPEN, Vol: 12, ISSN: 2044-6055

Journal article

Nakubulwa MA, Greenfield G, Pizzo E, Magusin A, Maconochie I, Blair M, Bell D, Majeed A, Sathyamoorthy G, Woodcock Tet al., 2022, To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study., PLoS One, Vol: 17

National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics. Caller's action is 'compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30-59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls. Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service. This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote healthcare services go

Journal article

Rose K, Bressan S, Honeyford K, Bognar Z, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Roland D, Maconochie I, Moll HA, Titomanlio L, Nijman Ret al., 2021, Responses of Paediatric Emergency Departments to the first wave of the CoVID-19 pandemic in Europe: a cross sectional survey study, BMJ Paediatrics Open, Vol: 5, ISSN: 2399-9772

Objective: Understanding how paediatric emergency departments (PED) across Europe adapted their health care pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.Design: This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured 1) study site characteristics, 2) departmental changes, 3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January - May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared to peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres. Results:Overall 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18/28 (68%) short-stay units decreased; in contrast 2 units (7%) increased their capacity. In 12 (31%) PEDs they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs. There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.12).ConclusionOverall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.

Journal article

Mintegi S, Maconochie IK, Waisman Y, Titomanlio L, Benito J, Laribi S, Moll Het al., 2021, Pediatric Preparedness of European Emergency Departments A Multicenter International Survey, PEDIATRIC EMERGENCY CARE, Vol: 37, Pages: E1150-E1153, ISSN: 0749-5161

Journal article

Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang W-T, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh M-J, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim H-S, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang T-L, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM, COVID-19 Working Groupet al., 2021, 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group., Resuscitation, Vol: 169, Pages: 229-311

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Journal article

Jones MD, Clarke J, Feather C, Franklin BD, Sinha R, Maconochie I, Darzi A, Appelbaum Net al., 2021, Use of pediatric injectable medicines guidelines and associated medication administration errors: a human reliability analysis, Annals of Pharmacotherapy, Vol: 55, Pages: 1333-1340, ISSN: 1060-0280

Background:In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs).Objective:The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice (discrepancies) that contributed to large-magnitude and/or clinically significant MAEs.Methods:Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study.Results:In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs.Conclusion and Relevance:Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use.

Journal article

Koldeweij C, Clarke J, Rodriguez Gonzalvez C, Nijman J, Sinha R, Maconochie I, Appelbaum Net al., 2021, Mind the gap: Mapping Variation between National and Local Clinical Practice Guidelines for Acute Paediatric Asthma from the United Kingdom and the Netherlands

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged

Journal article

Borenzstajn D, Hagedoorn N, Carrol ED, von Both U, Dewez JE, Emonts M, Van Der Flier M, de Groot R, Herberg J, Kohlmaier B, Lim E, Maconochie IK, Martinon-Torres F, Nieboer D, Nijman R, Oostenbrink R, Pokorn M, Rivero Calle I, Strle F, Tsolia M, Vermont CL, Yeung S, Zavadska D, Zenz W, Levin M, Moll HAet al., 2021, A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children, The Lancet Regional Health - Europe, Vol: 8, ISSN: 2666-7762

BackgroundProlonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow.MethodsThe MOFICHE study prospectively collected data on febrile children (0–18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculating the area under the receiver operating curve (AUC).FindingsOf 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84).The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likelihood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predictive value 0..95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90- 0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use.InterpretationPatient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow.FundingEuropean Union, NIHR, NHS.

Journal article

Thomas B, Goodacre S, Lee E, Sutton L, Bursnall M, Loban A, Waterhouse S, Simmonds R, Biggs K, Marincowitz C, Schutter J, Connelly S, Sheldon E, Hall J, Young E, Bentley A, Challen K, Fitzsimmons C, Harris T, Lecky F, Lee A, Maconochie I, Walter Det al., 2021, Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study, EMERGENCY MEDICINE JOURNAL, Vol: 38, Pages: 587-+, ISSN: 1472-0205

Journal article

Nijman R, Oostenbrink R, Moll HA, Casals-Pascual C, von Both U, Cunnington A, De T, Eleftheriou I, Emonts M, Fink C, Van Der Flier M, de Groot R, Kaforou M, Kohlmaier B, Kuijpers TW, Lim E, Maconochie I, Paulus S, Martinon-Torres F, Pokorn M, Romaine S, Rivero Calle I, Schlapbach L, Smit FJ, Tsolia M, Usuf E, Wright V, Yeung S, Zavadska D, Zenz W, Levin M, Herberg J, Carrol EDet al., 2021, A novel framework for phenotyping children with suspected or confirmed infection for future biomarker studies, Frontiers in Pediatrics, Vol: 9, Pages: 1-18, ISSN: 2296-2360

Background: The limited diagnostic accuracy of biomarkers in children at risk of a serious bacterial infection (SBI) might be due to the imperfect reference standard of SBI. We aimed to evaluate the diagnostic performance of a new classification algorithm for biomarker discovery in children at risk of SBI.Methods: We used data from five previously published, prospective observational biomarker discovery studies, which included patients aged 0– <16 years: the Alder Hey emergency department (n = 1,120), Alder Hey pediatric intensive care unit (n = 355), Erasmus emergency department (n = 1,993), Maasstad emergency department (n = 714) and St. Mary's hospital (n = 200) cohorts. Biomarkers including procalcitonin (PCT) (4 cohorts), neutrophil gelatinase-associated lipocalin-2 (NGAL) (3 cohorts) and resistin (2 cohorts) were compared for their ability to classify patients according to current standards (dichotomous classification of SBI vs. non-SBI), vs. a proposed PERFORM classification algorithm that assign patients to one of eleven categories. These categories were based on clinical phenotype, test outcomes and C-reactive protein level and accounted for the uncertainty of final diagnosis in many febrile children. The success of the biomarkers was measured by the Area under the receiver operating Curves (AUCs) when they were used individually or in combination.Results: Using the new PERFORM classification system, patients with clinically confident bacterial diagnosis (“definite bacterial” category) had significantly higher levels of PCT, NGAL and resistin compared with those with a clinically confident viral diagnosis (“definite viral” category). Patients with diagnostic uncertainty had biomarker concentrations that varied across the spectrum. AUCs were higher for classification of “definite bacterial” vs. “definite viral” following the PERFORM algorithm than using the “SBI” vs. “non-SBI” c

Journal article

Nijman R, Borensztajn D, Zachariasse J, Hajema C, Freitas P, Greber-Platzer S, Smit F, Alves C, van der Lei J, Steyerberg E, Maconochie I, Moll Het al., 2021, A clinical prediction model to identify children at risk for revisits with serious illness to the emergency department: a prospective multicentre observational study, PLoS One, Vol: 16, Pages: 1-19, ISSN: 1932-6203

BackgroundTo develop a clinical prediction model to identify children at risk for revisits with serious illness to the emergency department.Methods and findingsA secondary analysis of a prospective multicentre observational study in five European EDs (the TRIAGE study), including consecutive children aged <16 years who were discharged following their initial ED visit (‘index’ visit), in 2012–2015. Standardised data on patient characteristics, Manchester Triage System urgency classification, vital signs, clinical interventions and procedures were collected. The outcome measure was serious illness defined as hospital admission or PICU admission or death in ED after an unplanned revisit within 7 days of the index visit. Prediction models were developed using multivariable logistic regression using characteristics of the index visit to predict the likelihood of a revisit with a serious illness. The clinical model included day and time of presentation, season, age, gender, presenting problem, triage urgency, and vital signs. An extended model added laboratory investigations, imaging, and intravenous medications. Cross validation between the five sites was performed, and discrimination and calibration were assessed using random effects models. A digital calculator was constructed for clinical implementation. 7,891 children out of 98,561 children had a revisit to the ED (8.0%), of whom 1,026 children (1.0%) returned to the ED with a serious illness. Rates of revisits with serious illness varied between the hospitals (range 0.7–2.2%). The clinical model had a summary Area under the operating curve (AUC) of 0.70 (95% CI 0.65–0.74) and summary calibration slope of 0.83 (95% CI 0.67–0.99). 4,433 children (5%) had a risk of > = 3%, which was useful for ruling in a revisit with serious illness, with positive likelihood ratio 4.41 (95% CI 3.87–5.01) and specificity 0.96 (95% CI 0.95–0.96). 37,546 (39%) had a risk <0.5%, whi

Journal article

Deluca P, Coulton S, Alam MF, Boniface S, Cohen D, Donoghue K, Gilvarry E, Kaner E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett RD, Russell I, Strang J, Drummond Cet al., 2021, Brief interventions to prevent excessive alcohol use in adolescents at low-risk presenting to Emergency Departments: Three-arm, randomised trial of effectiveness and cost-effectiveness, INTERNATIONAL JOURNAL OF DRUG POLICY, Vol: 93, ISSN: 0955-3959

Journal article

Hagedoorn N, Borensztajn D, Nijman R, Nieboer D, Herberg J, Balode A, von Both U, Carroll E, Eleftheriou I, Emonts M, Van Der Flier M, de Groot R, Kohlmaier B, Lim E, Maconochie I, Martinon-Torres F, Pokorn M, Strle F, Tsolia M, Zavadska D, Zenz W, Levin M, Vermont C, Moll Het al., 2021, Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE a prospective observational study, Archives of Disease in Childhood, Vol: 106, Pages: 641-647, ISSN: 0003-9888

Objectives To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers.Design Prospective observational study.Setting 12 emergency departments (EDs) in 8 European countries.Patients Febrile children aged 0–18 years.Main outcome measures IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs).Results Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%–2.0% performed poorly (ranges: sensitivity 0.59–0.93, negative LR 0.14–0.57, specificity 0.52–0.88, positive LR 1.9–4.8) and comprised 9784 patients (60%).Conclusions The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions.

Journal article

Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie Iet al., 2021, Paediatric Life Support European Resuscitation Council Guidelines 2021, NOTFALL & RETTUNGSMEDIZIN, Vol: 24, Pages: 650-719, ISSN: 1434-6222

Journal article

Perkins GD, Gräsner JT, Semeraro F, Olasveengen T, Soar J, Lott C, Van de Voorde P, Madar J, Zideman D, Mentzelopoulos S, Bossaert L, Greif R, Monsieurs K, Svavarsdóttir H, Nolan JP, Akin S, Andres J, Baubin M, Behringer W, Boccuzzi A, Böttiger B, Burkart R, Carli P, Cassan P, Christophides T, Cimpoesu D, Clarens C, Delchef J, De Roovere A, Dirks B, Eldin G, Khalifa G, Friberg H, Goemans E, Gradisek P, Hassager C, Heltne JK, Hendrickx D, Hunyadi Anticevic S, Koppl J, Kreimeier U, Kuzovlev A, Maas M, Maconochie I, Attard Montalto S, Mpotos N, Tageldin Mustafa M, Nikolaou N, Pitches K, Raffay V, Renier W, Ristagno G, Safri S, Sanchez Santos L, Schilder S, Truhlar A, Trummer G, Vaahersalo J, Van Grootven H, Wyllie Jet al., 2021, Executive summary: European Resuscitation Council Guidelines 2021, Notfall und Rettungsmedizin, Vol: 24, Pages: 274-345, ISSN: 1434-6222

Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.

Journal article

Perkins GD, Gräsner JT, Semeraro F, Olasveengen T, Soar J, Lott C, Van de Voorde P, Madar J, Zideman D, Mentzelopoulos S, Bossaert L, Greif R, Monsieurs K, Svavarsdóttir H, Nolan JP, Ainsworth S, Deakin CD, Lippert F, Sandroni C, Akin S, Delchef J, Lockey AS, Sari F, Alfonzo A, Dirks B, Scapigliati A, Andres J, Djakow J, Lulic I, Schilder S, Attard Montalto S, Djarv T, Maas M, Schlieber J, Barelli A, Druwe P, Maconochie I, Schnaubelt S, Baubin M, Eldin G, Behringer W, Ersdal H, Martinez-Mejias A, Shammet S, Bein B, Friberg H, Masterson S, Singletary EM, Biarent D, Genbrugge C, Skåre C, Bingham R, Georgiou M, Meyran D, Skrifvars MB, Blom M, Goemans E, Monsieurs KG, Smyth M, Boccuzzi A, González-Salvado V, Morley C, Soar J, Borra V, Gradisek P, Moulaert VRM, Gräsner JT, Mpotos N, Szczapa T, Böttiger BW, Greif R, Nikolaou N, Taccone F, Breckwoldt J, Handley AJ, Nolan JP, Tageldin Mustafa M, Brissaud O, Hassager C, Te Pas A, Burkart R, Haywood K, Oliver E, Thies KC, Cariou A, Heltne JK, Paal P, Tjelmeland IBM, Carli P, Hendrickx D, Pellis T, Trevisanuto D, Carmona Fet al., 2021, Corrigendum to “European Resuscitation Council Guidelines 2021: Executive summary” [Resuscitation (2021) 1–60] (Resuscitation (2021) 161 (1–60), (S0300957221000551), (10.1016/j.resuscitation.2021.02.003)), Resuscitation, Vol: 163, Pages: 97-98, ISSN: 0300-9572

The authors regret that the list of the ERC 2021 Guidelines Collaborators which were included in Appendix A was incomplete. The complete list of collaborators is provided below: [Table presented] The authors would like to apologise for any inconvenience caused.

Journal article

Li E, Dewez JE, Luu Q, Emonts M, Maconochie I, Nijman R, Yeung Set al., 2021, Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study design Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.Setting Two university teaching hospitals in London and Newcastle.Participants 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).Results There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.Conclusion In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinici

Journal article

Honeyford K, Coughlan C, Nijman R, Expert P, Burcea G, Maconochie I, Kinderlerer A, Cooke G, Costelloe Cet al., 2021, Changes in emergency department activity and the first COVID-19 lockdown; a cross sectional study, Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health, Vol: 22, Pages: 603-607, ISSN: 1936-900X

BackgroundEmergency Department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses; one likely to be affected by lockdown measures (gastroenteritis) and one likely to be unaffected (appendicitis). MethodsRetrospective cross-sectional study conducted across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival and discharge location were compared. We used SNOMED codes to define attendances for gastroenteritis and appendicitis. ResultsED attendances fell from 1129 per day before lockdown to 584 in-lockdown; 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0% and the proportion admitted to intensive care increased four-fold. Attendances for gastroenteritis fell from 511 to 103; 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41; 28.5% of pre-lockdown rates.ConclusionED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, though the fall in appendicitis-related attendances suggests that behavioural factors are also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the COVID-19 pandemic.

Journal article

Borensztajn D, Zachariasse JM, Greber-Platzer S, Alves CF, Freitas P, Smit FJ, van der Lei J, Steyerberg EW, Maconochie I, Moll HAet al., 2021, Shortness of breath in children at the emergency department: Variability in management in Europe, PLOS ONE, Vol: 16, ISSN: 1932-6203

Journal article

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

Request URL: http://wlsprd.imperial.ac.uk:80/respub/WEB-INF/jsp/search-html.jsp Request URI: /respub/WEB-INF/jsp/search-html.jsp Query String: respub-action=search.html&id=00306323&limit=30&person=true