Presentation delivered at William G. Barsan Emergency Medicine Research Forum, Ann Arbor, April 27, 2016

1. Pediatric Emergency Care Applied
Research Network (PECARN)
Conducting High Priority High Quality Research in Pediatric
Emergency Care
Alexander Rogers, MD

2. Disclosure
Support from the Great Lakes Emergency Medical Services for
Children Research Network (GLEMSCRN) on behalf of PECARN
PECARN is supported by the Health Resources and Services Administration (HRSA), Maternal and Child
Health Bureau (MCHB), and Emergency Medical Services for Children (EMSC) through the following grants:
DCC-University of Utah (U03MC00008), GLEMSCRN-Nationwide Children’s Hospital (U03-MC00003),
HOMERUN-Cincinnati Children’s Hospital Medical Center (U03-MC22684), PEMNEWS-Columbia University
Medical Center (U03-MC00007), PRIME-University of California at Davis Medical Center (U03-MC00001),
SW NODE-University of Arizona Health Sciences Center (U03MC28845), WBCARN-Children’s National
Medical Center (U03-MC00006), and CHaMP-Medical College of Wisconsin (H3MC26201). MCHB/HRSA
Contact: Elizabeth Edgerton, MD eedgerton@hrsa.gov

3. PECARN History
Funded in 2001 by
HRSA’s EMSC Program
First federally funded
pediatric emergency
care research network
Evidence based research
in emergency care for
kids
U of M’s Dr. Ron Maio
was a founding Nodal
Investigator

4. PECARN History
Funded in 2001 by
HRSA’s EMSC Program
First federally funded
pediatric emergency
care research network
Evidence based research
in emergency care for
kids
U of M’s Dr. Ron Maio
was a founding Nodal
Investigator

5. Why a Network
•Incidence of high impact pediatric emergencies relatively small
●
●
●
■ ●
●
●
●
●
● ●●
●
●
●
●
●
●
● = PRIME Node
● = GLEMSCRN Node
= PEM-NEWS Node
= WBCARN Node
●
●
■ = Data Coordinating Center
= HOMERUN Node●
= SW Node●
●
= CHaMP Node
●
●
●
●

6. Network Structure
PECARN
Steering Committee
Data
Coordinating
Center (DCC)
Pediatric Emergency
Medicine Northeast,
West and South
PEM-NEWS
Hospitals of the Midwest
Emergency Research
Node
HOMERUN
Great Lakes Emergency
Medical Services for
Children Research
Network
GLEMSCRN
Southwest Research
Node
SW-RNC
Washington, Boston,
Chicago Applied Research
Node
WBCARN
Pediatric Research in
Injuries and Medical
Emergencies
PRIME
PI: Peter Dayan
PI: Richard Ruddy
PI: Rachel Stanley
PI: Kurt Denninghoff
PI: James Chamberlain
PI: Nathan Kuppermann
PECARN Subcommittees
Protocol Review
and Development
Quality Assurance,
Safety and
Regulatory
Feasibility
and Budget
Grant
Writing and
Publication
HRSA/
MCHB/
EMSC
PI: J. Michael Dean
Charlotte, Houston and
Milwaukee Prehospital
EMS Research Node
Center
CHaMP
PI: E. Brooke Lerner

7. The PECARN Process
PECARN Research Concept and Protocol Development Process
If approved, protocol may be developed into grant application
Project concept initiated by
PECARN or Non- PECARN
Investigators or a
PECARN Working Group
Submit grant application for funding
Federal Project Officer
review
and approval of project
concept
Steering Committee final approval of grant application
(by electronic vote if necessary)
C oncept approval by Steering Committee(Mtg #1)
Subcommittees review preliminary protocol
Subcommittee Chairs send summary to investigator
within 2 weeks of meeting.
Protocol review/vote for approval by SC (Meeting #3)
Preliminary protocol developed and submitted to
Steering Committee
Investigator refines protocol incorporating
subcommittees’ recommendations.
Meet with
DCC
Consult
FAB
2 weeks prior to subsequent SC meeting:
I nvestigator submits revised protocol toSC

8. PECARN funding success - 80% grant funding rate

9. PECARN has researched these questions
•Do steroids work for children with bronchiolitis?
•When can you avoid CT scans for kids after head injury?
•When can you avoid CT scans after abdominal injuries?
•Can we use RNA technology to figure out whether infants with fever have
a bacterial or viral infection?
•What are the characteristics of c-spine injuries in children?
•What is the best treatment for children with status epilepticus?
•Can we effectively detect early alcohol use and alcohol problems in teens
presenting the ED? (ASSESS)

10. PECARN Publications

11. Current Research at U of M
• Established Status Epilepticus Treatment Trial (ESETT – with
NETT group)
• Probiotics for acute gastroenteritis
• Emergency Department screening tool for suicide risk in
teens (ED-STARS)
• RNA Biosignatures for the detection of bacterial disease in
febrile infants

12. A typical PEM case…
• A 25 day old infant comes into the ED with a fever of 101.5 and a non-
focal exam
• Parents terrified, ED is busy, hospital is full…
• What do we do?
• Catheterized UA/urine culture
• Bloodwork with IV placement
• Lumbar Puncture
• Admit for 48 hours of IV antibiotics awaiting culture results
• WE CAN’T TELL WHICH 5-10% OF INFANTS HAVE SERIOUS
BACERTIAL INFECTION (SBI) IN REAL TIME
• A Clinical Application of RNA Biosignatures for the Diagnosis of Febrile
infants (Mahajan, Ramilo and Kuppermann study PIs)

13. mRNA Biosignatures
Patient
Genotype
(DNA)
mRNA
Bacterium
ANALYSIS
Expression
Profile
Virus
mRNA

14. Biosignatures

15. Biosignatures
Current results are from about 250 samples – with another
2000 to be analyzed
• More robust signatures to differentiate viral, bacterial
or co-infections
• Narrow the confidence intervals around biosignatures
• Compare performance to current reference standard
• Define organism specific biosignatures

16. Next steps of Biosignatures
How stable are the RNA Biosignatures?
Does the biosignature remain stable over time?
Does the use of antibiotics alter the biosignature?
Does the use of antipyretics alter the biosignature?
More comprehensive pathogen identification
Biosignatures 2 currently in IRB review with
sequential samples and comprehensive viral testing to
further identify specific pathogens

17. Final Words
PECARN has a wide range of research, and has been a funded
network for 15 years
Goal is to improve evidenced-based care for children
>100 PECARN publications/presentations to date
Many study Principal Investigators from outside of PECARN –
We are always looking for new collaborators!!!
Go to www.PECARN.org for more information
Thank you to Dr. Prashant Mahajan and SJ Zuspan for slides

18. Questions?