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Emergency Care for Children: Growing Pains
ducted little research in the prehospital environment. The one exception is a current study on cervical spine injury, addressing the immobilization practices of prehospital providers. The study involves focus groups of prehospital providers to evaluate their opinions on immobilization practices and their willingness to participate in research evaluating those practices retrospectively. PECARN recently established an out-of-hospital working group to develop EMS research ideas. However, research in prehospital pediatric emergency care has lagged far behind that in ED-based pediatric emergency care, both within PECARN and in other research efforts.
Data indicate that the volume of research in pediatric emergency care has grown considerably. Spandorfer and colleagues (2003) reviewed abstracts on pediatric emergency medicine research submitted to national scientific meetings of the American Psychological Association (APA), American College of Emergency Physicians (ACEP), American Academy of Pediatrics (AAP), and Society for Academic Emergency Medicine (SAEM) and found that there had been a substantial increase in such research between 1987 and 1999. There had also been an increase in the number of population-based and multicenter clinical trials in the field. Additionally, the number of trials that were randomized and blinded had grown over time, although they still represented just 7 percent of pediatric emergency care studies published during the period. The design of studies had varied little between 1987 and 1999; there had been no increase in the proportion of studies that were prospective or used an analytic design (Spandorfer et al., 2003). However, the use of more sophisticated statistics had become more prevalent over time. Between 1993 and 2002, five journals published slightly more than half of the published articles related to pediatric emergency care: PediatricEmergency Care, Pediatrics, Annals of Emergency Medicine, Pediatric Clinics of North America, and Archives of Pediatrics and Adolescent Medicine (Gough et al., 2004).
CONTINUED NEED FOR RESEARCH
Although the amount of research conducted in pediatric emergency care has increased considerably over the past 25 years, significant information gaps remains. Indeed, the gaps that exist today include many of the broad, systems-level questions identified as research priorities in the 1993 IOM report on emergency care for children. Additionally, many new, unanswered questions have emerged in the last 10 years as our understanding of the determinants of quality care delivery has improved. This section reviews progress made toward addressing the information gaps that existed in 1993 and identifies some other areas in which research could contribute to improved care. Finally, it presents the rationale for devoting resources to addressing the information gaps that persist today.