Leading the way in paediatric emergency medicine research

Article from 2022/2023 Impact of Giving Annual Report

The RCH’s Emergency Department (ED) sees over 90,000 patients a year, with conditions ranging from broken bones and burns to heart failure and head wounds. As the largest paediatric Emergency Department in Australia, not only does it help sick and injured children, it’s also supporting world leading research.

Thanks to the generosity of the community, the RCH Foundation has helped harness this power by funding a dedicated Professor of Paediatric Emergency Medicine in the University of Melbourne’s Department of Paediatrics.

The aim? To improve the evidence base of acute and emergency care in children and young people.

Professor Franz Babl was appointed to the position in 2017. Based at the RCH, Franz’s role is to initiate and oversee acute care research, often in collaboration with other clinical and research teams onsite at the Melbourne Children’s Campus.

“For years, even decades, critical research issues in children and young people were put into the too hard basket. Because of this, there is much less evidence on the optimal management available in children and young people compared to many emergency conditions in adults.

“The white spots on the map are getting smaller but there are still many diseases and injuries children present with where we can do better. The focus of my research effort is to tackle some of these issues in the too hard basket,” said Franz.

Over the last five years, Franz’s role has helped position the Melbourne Children’s Campus as a leader in paediatric emergency medicine research.

The department has generated substantial new knowledge, contributing to more than 200 publications over the past five years. These include top tier journals such as New England Journal of Medicine, The Journal of the American Medical Association and The Lancet. Franz has also leveraged his position to obtain a further $35 million in project grant funding.

More than that, the role has led to substantial improvements in patient care at the RCH and beyond. In one example, Franz and his team looked at patients presenting to the ED with relatively mild head injuries.

“We see hundreds of children a month with head injuries. In children with more severe injuries, the decision to do a CT scan of the head is easy and we know in a few minutes if there is a bleed inside the head or not,” explained Franz.

“But what about the rare children who have a less severe head knock yet go on to have a bleed inside the head? We simply cannot do CT scans on all of these children with mild injuries because CT scans come with radiation exposure, which in turn can lead a to a small increase in the risk of cancer.

“So, we needed guidance for clinicians to indicate which combination of signs and symptoms in children with seemingly mild head injuries are at low risk and can forgo a CT scan, and which ones are at a higher risk where they need to be observed for a period of time or have a CT scan,” he added.

For this project, and for many others, Franz’s research team needed a very large cohort of patients – more than what presented to the RCH. Thankfully, the hospital is a founding member of a research network called PREDICT.

PREDICT, short for the Paediatric Research in Emergency Departments International Collaborative, is a network of all tertiary children’s hospital emergency departments and many of the emergency departments at the larger mixed emergency departments in Australia and New Zealand.

Through PREDICT, Franz and his team were able to look at 20,000 children across 10 hospitals and clarify what rules clinicians should use to optimise the use of observation and CT scans without missing any significant hidden injuries.
These findings have now been incorporated into national and regional head injury management guidelines and into acute and emergency care across the country.

For Franz, the key aspect of being Professor of Paediatric Emergency Medicine has been the positive impact he has had.

“This role has given me an amazing privilege to have a positive impact on the frontline care of many children across many hospitals, rather than looking after just one injured or sick child at a time.

“Probably just as important has been the opportunity of being involved in growing the next generation of clinicians and clinician researchers,” he said.