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1. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Author

Pereira, Matthew, Hardwick, Susie, Messahel, Shrouk, Noblet, Joanne, Lee, Elizabeth D, Greenwood-Bibby, Rachel, Buchanan, Mark, Lewis, Lucy, Hughes, Sharon, Hartshorn, Stuart, Rogers, Louise, Hopkins, Juliet, Lyttle, Mark D, Fernandez, Daphin, Potter, Sarah, Lavigne-Smith, Holly R, Moulsdale, Phoebe, Smith, Alice, Bingham, Tracey, Ross, James, Ramsey, Natasha, Hacking, Jo, Mullen, Niall, Corrigan, Paul P, Prudhoe, Sarah, Faza, Hani, Robinson, Gisela, Sunley, Rachel C, Smith, Coral J, Unsworth, Vanessa, Criddle, John, Laque, Martin, Sheedy, Alyce B, Anderson, Mark, Bell, Kathryn, Devine, Kirsty, Scott, Alex, Kumar, Ramesh, Armstrong, Sonia, Sutherland, Emer, Cantle, Fleur, Helyer, Sinead, Riozzi, Paul, Cotton, Hannah, Downes, Alice J, Mollard, Helen, Roland, Damian, Hay, Felix, Gough, Christopher, Finucane, Sonya, Bevan, Catherine, Ramsay, Rebecca, Walton, Emily, Maney, Julie-Ann, Dalzell, Elizabeth, Millar, Muriel, Howells, Rachel J, Appelboam, Andy, Mackle, Daisy, Small, Jennie, Neil, Ashleigh, Choudhery, Vince, MacLeod, Stewart, Browning, Jen, O'Neill, Thomas, Grahamslaw, Julia, Parikh, Ami, Skene, Imogen, Thomas, Rhys, Potier de la Morandiere, Katherine, Wilson, Jill L, Danziger, Donna, Burke, Derek, Ramlakhan, Shammi, Evans, Jayne, Morcombe, Julie, Gormley, Stuart, Barling, Jason M, Cathie, Katrina, Bayreuther, Jane, Ensom, Ruth, Iqbal, Yasser, Rounding, Sarah, Mulligan, Joanne, Bell, Claire, McLellan, Shona, Leighton, Shona, Sajjanhar, Tina, Nyirenda, Maggie, Crome, Laura, Williamson, Neil, Alcock, Anastasia, Edwards, Sara, Morgan, Jeff, Powell, Colin VE, Ramesh, Chaniyil A, Kamal-Uddin, Solomon, Linney, Mike, Vamvakiti, Katia, Floyd, Sharon, Hobden, Gill, Rainford, Naomi E A, Gamble, Carrol, Humphreys, Amy, Hickey, Helen, Woolfall, Kerry, Roper, Louise, Tate, Paul, Iyer, Anand, Evans, Vicki, and Appleton, Richard E

Published
2019
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2. Psychosocial Care for Injured Children: Worldwide Survey among Hospital Emergency Department Staff

Author

Osmond, Martin, Plint, Amy, Freedman, Stephen, Johnson, David, Murray, Diana, Williamson-Urquhart, Sarah, Curran, Janet, Dixon, Andrew, Meckler, Garth, Bialy, Liza, Doan, Quynh, Stang, Antonia, Mater, Ahmed, Beer, Darcy, Joubert, Gary, Crocco, Anthony, Davis, Adrienne, Moore, Andrea, Alqurashi, Waleed, Dubrovsky, Sasha, Trottier, Evelyne, Blanchet, Mathieu, Hurley, Katrina, Porter, Robert, Auerbach, Marc, Chang, Todd, Cruz, Andrea, Macias, Charles G., Florin, Todd A., Kharbanda, Anupam B., Mahajan, Prashant, Mistry, Rakesh, Schnadower, David, Stanley, Rachel, Nigrovic, Lise, Michelson, Kenneth, Zorc, Joe, Lyttle, Mark, Maconochie, Ian, Hartshorn, Stuart, Foster, Steven, Bevan, Cath, O'Sullivan, Ronan, Mitchelson, Mark, Maney, Julie-Ann, Potter, Sarah, Younge, Paul, Powell, Colin V.E., Robinson, Gisela, Blackburn, Carol, Bolger, Turlough, McNamara, Roisin, Leonard, Paul, Reuben, Adam, Choudhery, Vince, Mulligan, Joanne, Alcock, Roger, Davies, Ffion, Mehta, Bimal, Parikh, Ami, Ross, James, Criddle, John, Sutherland, Emer, Sajjanhar, Tina, Wong, Shye, Thiagarajan, Jai, Rowland, Andrew, Potier, Katherine, Dieppe, Clare, Thomas, Lucy, Smith, Jason, Vorwerk, Chris, Lenton, Kate, Burke, Derek, Barling, Jason, Mullen, Niall, Dickson-Jardine, Kirsty, Mintegui Raso, Santiago, Gómez, Borja, Da Dalt, Liviana, Gervaix, Alain, Moll, Henriette, Waisman, Yehezkel, Parri, Niccolò, Titomanlio, Luigi, Benito, Javier, Yilmaz, Hayri Levent, Teksam, Ozlem, Srivastava, Geetanjali, Bognar, Zsolt, Moldovan, Diana, Luaces-Cubells, Carles, Qureshi, Nadeem, Cheron, Gerard, Kreier, Felix, Velasco, Roberto, Leroy, Sandrine, Simon, Gabor, Van de Voorde, Patrick, Mintegi, Santiago, Ruddy, Richard, Dayan, Peter, Hickey, Robert, Kuppermann, Nathan, Chamberlain, James, Dean, J. Michael, Lerner, E. Brooke, Rogers, Alexander, Cohen, Daniel, Babcock, Lynn, Brousseau, David, Kwok, Maria, Macias, Charles, Bajaj, Lalit, Chun, Thomas, Bennett, Jonathan, Tzimenatos, Leah, Nelson, Douglas, Brown, Kathy, Powell, Elizabeth, Cheng, Nicholas, Zhang, Michael, Craig, Simon, Babl, Franz E., Dalziel, Stuart, Sinn, Kam, McCaskill, Mary, George, Shane, Jocelyn Neutze, Phillips, Natalie, Borland, Meredith, Barrow, Lisa, Rao, Arjun, Furyk, Jeremy, Kochar, Amit, Chamberlain, Jim, Kharbanda, Anupam, Babl, Franz, Alisic, Eva, Hoysted, Claire, Kassam-Adams, Nancy, Landolt, Markus A., Curtis, Sarah, and Lyttle, Mark D.

Published
2016
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5. Point-of-care testing in paediatric settings in the UK and Ireland: A cross-sectional study

Author

Pandey, Meenu, Lyttle, Mark D., Cathie, Katrina, Munro, Alasdair, Waterfield, Thomas, Roland, Damian, Boyle, Adrian, Heinz, Peter, Messahel, Shrouk, Hawcutt, Dan, Ponmani, Caroline, Bird, Chris, Jyothish, Deepthi, Williams, Catherine, O’Sullivan, Ronan, Jones, Elizabeth, Lyttle, Mark, Sargant, Nwanneka, Ross, James, Barrett, Michael, Harty, Sinead, Bolger, Turlough, Coghlan, David, Fitzpatrick, Patrick, Hensey, Conor, Hussan, Tim, Charlick, Kate, Verling, William, Christian, Peter, Clark, Matthew, Shah, Bhavni, Criddle, John, Cheung, Ronny, Alcock, Roger, Aldridge, Patrick, Peek, Russell, Anderson, Mark, Herrieven, Elizabeth, Jerman, Katherine, Murad, Arshid, Brown, Charlotte, Marshall, Andy, Cantle, Fleur, Wilson, Gavin, Downes, Alice, Bandi, Srini, Da-Costa, Adebayo, Barry, Ray, De Vere, Natasha, Dieppe, Clare, Evans, Jane, Hann, Gayle, Tipper, Clare, Bassay, Bengisu, Dalton, Dermot, Fraser, Lauren, Gough, Chris, Gardner, Sharryn, Tighe, Mark, Ranasinghe, Darren, Birch, Simon, Hall, Sharon, Patton, Gareth, Turner, Steve, Walton, Emily, Maney, Julie Ann, Bourke, Tom, Thakker, Manish, Robinson, Gisela, Starkey, Lizzie, Appelboam, Andrew, Wong, Shye Wei, Foster, Steven, Pollock, Louisa, Browning, Jen, Potier, Katherine, Challen, Kirsty, Gilby, Elizabeth, Kehler, Lisa, Gray, Sebastian, Ramlakhan, Shammi, Mullen, Niall, Bayreuther, Jane, Jarman, Heather, Thompson, Neil, Parikh, Ami, Paul, Siba, Trippick, Sarah, Sutcliffe, Alastair, Mulligan, Joanne, Keers, Sophie, Morgan, Jeff, Jacobs, Michelle, Linney, Mike, Wilson, Sarah, Jamall, Erum, and On behalf of GAPRUKI, PERUKI

Subjects
Emergency Medicine
Abstract

Background: Point-of-care testing (POCT) is diagnostic testing performed at or near to the site of the patient. Understanding the current capacity, and scope, of POCT in this setting is essential in order to respond to new research evidence which may lead to wide implementation. Methods: A cross-sectional online survey study of POCT use was conducted between 6th January and 2nd February 2020 on behalf of two United Kingdom (UK) and Ireland-based paediatric research networks (Paediatric Emergency Research UK and Ireland, and General and Adolescent Paediatric Research UK and Ireland). Results: In total 91/109 (83.5%) sites responded, with some respondents providing details for multiple units on their site based on network membership (139 units in total). The most commonly performed POCT were blood sugar (137/139; 98.6%), urinalysis (134/139; 96.4%) and blood gas analysis (132/139; 95%). The use of POCT for Influenza/Respiratory Syncytial Virus (RSV) (45/139; 32.4%, 41/139; 29.5%), C-Reactive Protein (CRP) (13/139; 9.4%), Procalcitonin (PCT) (2/139; 1.4%) and Group A Streptococcus (5/139; 3.6%) and was relatively low. Obstacles to the introduction of new POCT included resources and infrastructure to support test performance and quality assurance. Conclusion: This survey demonstrates significant consensus in POCT practice in the UK and Ireland but highlights specific inequity in newer biomarkers, some which do not have support from national guidance. A clear strategy to overcome the key obstacles of funding, evidence base, and standardising variation will be essential if there is a drive toward increasing implementation of POCT.

Published
2022

8. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Author

Lyttle, Mark D., Rainford, Naomi E.A., Gamble, Carrol, Messahel, Shrouk, Humphreys, Amy, Hickey, Helen, Woolfall, Kerry, Roper, Louise, Noblet, Joanne, Lee, Elizabeth D., Potter, Sarah, Tate, Paul, Iyer, Anand, Evans, Vicki, Appleton, Richard E., Pereira, Matthew, Hardwick, Susie, Greenwood-Bibby, Rachel, Buchanan, Mark, Lewis, Lucy, Hughes, Sharon, Hartshorn, Stuart, Rogers, Louise, Hopkins, Juliet, Fernandez, Daphin, Lavigne-Smith, Holly R., Moulsdale, Phoebe, Smith, Alice, Bingham, Tracey, Ross, James, Ramsey, Natasha, Hacking, Jo, Mullen, Niall, Corrigan, Paul P., Prudhoe, Sarah, Faza, Hani, Robinson, Gisela, Sunley, Rachel C., Smith, Coral J., Unsworth, Vanessa, Criddle, John, Laque, Martin, Sheedy, Alyce B., Anderson, Mark, Bell, Kathryn, Devine, Kirsty, Scott, Alex, Kumar, Ramesh, Armstrong, Sonia, Sutherland, Emer, Cantle, Fleur, Helyer, Sinead, Riozzi, Paul, Cotton, Hannah, Downes, Alice J., Mollard, Helen, Roland, Damian, Hay, Felix, Gough, Christopher, Finucane, Sonya, Bevan, Catherine, Ramsay, Rebecca, Walton, Emily, Maney, Julie Ann, Dalzell, Elizabeth, Millar, Muriel, Howells, Rachel J., Appelboam, Andy, Mackle, Daisy, Small, Jennie, Neil, Ashleigh, Choudhery, Vince, MacLeod, Stewart, Browning, Jen, O'Neill, Thomas, Grahamslaw, Julia, Parikh, Ami, Skene, Imogen, Thomas, Rhys, Potier de la Morandiere, Katherine, Wilson, Jill L., Danziger, Donna, Burke, Derek, Ramlakhan, Shammi, Evans, Jayne, Morcombe, Julie, Gormley, Stuart, Barling, Jason M., Cathie, Katrina, Bayreuther, Jane, Ensom, Ruth, Iqbal, Yasser, Rounding, Sarah, Mulligan, Joanne, Bell, Claire, McLellan, Shona, Leighton, Shona, Sajjanhar, Tina, Nyirenda, Maggie, and Crome, Laura

Subjects
Centre for Health and Clinical Research, levetiracetam, phenytoin, convulsive status epilepticus, epilepsy, paediatric
Abstract

Background Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management of paediatric convulsive status epilepticus.Methods This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time from randomisation to cessation of convulsive status epilepticus, analysed in the modified intention-to-treat population (excluding those who did not require second-line treatment after randomisation and those who did not provide consent). This trial is registered with ISRCTN, number ISRCTN22567894.Findings Between July 17, 2015, and April 7, 2018, 1432 patients were assessed for eligibility. After exclusion of ineligible patients, 404 patients were randomly assigned. After exclusion of those who did not require second-line treatment and those who did not consent, 286 randomised participants were treated and had available data: 152 allocated to levetiracetam, and 134 to phenytoin. Convulsive status epilepticus was terminated in 106 (70%) children in the levetiracetam group and in 86 (64%) in the phenytoin group. Median time from randomisation to cessation of convulsive status epilepticus was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (24 to not assessable) in the phenytoin group (hazard ratio 1·20, 95% CI 0·91–1·60; p=0·20). One participant who received levetiracetam followed by phenytoin died as a result of catastrophic cerebral oedema unrelated to either treatment. One participant who received phenytoin had serious adverse reactions related to study treatment (hypotension considered to be immediately life-threatening [a serious adverse reaction] and increased focal seizures and decreased consciousness considered to be medically significant [a suspected unexpected serious adverse reaction]). Interpretation Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus.

Published
2019

9. Setting up a youth violence prevention project in a London hospital emergency department.

Author

Ilan-Clarke, Yael, Bunn, Amanda, DeMarco, Jeffrey, Bifulco, Antonia, Criddle, John, and Holdsworth, Gillian

Subjects
VIOLENCE prevention, HUMAN services programs, ATTITUDE (Psychology), CHI-squared test, STATISTICAL correlation, FOCUS groups, HOSPITALS, HOSPITAL emergency services, INFORMATION storage & retrieval systems, MEDICAL databases, INTERVIEWING, RESEARCH methodology, MEDICAL personnel, MEDICAL records, HEALTH outcome assessment, QUESTIONNAIRES, RESEARCH funding, RISK assessment, WORLD Wide Web, PILOT projects, SOCIOECONOMIC factors, DATA analysis software, DESCRIPTIVE statistics, ADOLESCENCE
Abstract

Purpose -- Youth violence victimisation impacts on health,mental health and future risk trajectories. A London hospital emergency department (ED) outreach youth service provides a unique intervention opportunity to support adolescents involved in violence. The purpose of this paper is to describe the set-up of the service. Design/methodology/approach -- Young people (YP) targeted were aged 12-18, from two London boroughs and attended ED with injuries from a violent incident. They were referred to Oasis youth workers for a mentoring/youth work intervention. Lifestyle and symptom scales were used to assess risk profile. Hospital staff questionnaires determined service awareness in the first six months, and interviews/focus group identified potential barriers to service uptake. Findings -- By 12 months, the service was operating smoothly. Of the first 505 YP attending ED, a third were referred, a third ineligible and a third non-contactable/refused. Detailed analysis of the first 30 attending found most were male (87 per cent), equal White or Black ethnicity (40 per cent) with 20 per cent "Other" ethnicities, with only a third living with both biological parents. This was similar to the full population attending. Nearly half (49 per cent) had been assaulted, 30 per cent had injuries self-generated through poor anger management, the remainder injured in fighting. Over half (57 per cent) had disorder, mostly behavioural, correlated with lifestyle risk scores. Barriers to service use/implementation included YP mistrust and fear of reprisals, problems with service visibility in the busy hospital environment and ineffective staff communication with YP, all countered during the running of the service. Gauging outcome at follow-up is the second evaluation stage. Originality/value -- The youth violence project is an important initiative for intervention in youth violence. [ABSTRACT FROM AUTHOR]

Published
2013
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