Damian Timothy Roland

University of Leicester | LE · Department of Health Sciences

Background Children and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub...

Objectives Paediatric trauma elbow radiographs are difficult to interpret and there is a potential for harm if misdiagnosed. The primary goal of this study was to assess the ability of healthcare professionals internationally to interpret paediatric trauma elbow radiographs from the radiograph alone by formulating the correct diagnosis. Methods Th...

Objectives The objective of this study was to evaluate the characteristics of children presenting with new onset diabetes and diabetic ketoacidosis (DKA) in the first COVID pandemic year, compared to pre-pandemic evidence and identify the factors associated with DKA at diagnosis. Design Retrospective medical record review. Setting Forty-nine pedi...

Objectives CYP presenting with MH crises are frequently admitted to general acute paediatric wards as a place of safety, despite centres not always having MH resources or training.¹ The management of CYP MH problems is a primary challenge for acute paediatric services,² further exacerbated by the rise in MH problems amongst CYP during the COVID-19...

Objectives Children and Young People (CYP) with mental health crises frequently require admission to acute general inpatient wards. Although there are concerns these admissions have increased, particularly during the COVID-19 pandemic, a detailed description of these patterns is lacking.1–3 The aim of this study is to describe the changing burden o...

Background Emergency department (ED) crowding causes increased mortality. Professionals working in crowded departments feel unable to provide high-quality care and are predisposed to burnout. Awareness of the impact on patients, however, is limited to metrics and surveys rather than understanding perspectives. This project investigated patients’ ex...

Introduction In pre-hospital settings, identifying a deteriorating child can be challenging, especially considering that the proportion of paediatric patients with acute illnesses is lower compared with adults. This challenge is exacerbated in pre-hospital settings, where information might be scarce. Physiological alterations indicating changes in...

Objectives To identify and present the available evidence regarding workforce well-being in the emergency department. Design Scoping review. Setting The emergency department (ED). Data sources CINAHL, MEDLINE, APA PsycINFO and Web of Science were searched with no publication time parameters. The reference lists of articles selected for full-text...

Background Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence....

Aims The aim of this trial was to assess the cost-effectiveness of a soft bandage and immediate discharge, compared with rigid immobilization, in children aged four to 15 years with a torus fracture of the distal radius. Methods A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective, as well...

This survey study assesses the ability of health care professionals to discern whether abstracts were written by investigators or by an artificial intelligence (AI) chatbot.

Objective Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing. Design Two-phase study between June 2020 and Se...

We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons. This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in I...

Objective To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis. Design PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five...

Rationale There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines. Objectives To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographi...

Introduction Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the...

Introduction Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the...

Electronic patient records (EPRs) produce a wealth of data but contain significant missing information. Understanding and handling this missing data is an important part of clinical data analysis and if left unaddressed could result in bias in analysis and distortion in critical conclusions. Missing data may be linked to health care professional pr...

Background Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). Objective To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. Methods MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey lit...

Background Interventions introduced to reduce the spread of SARS-CoV-2 led to a widespread reduction in childhood infections. However, from spring 2021 onwards the United Kingdom and Ireland experienced an unusual out-of-season epidemic of respiratory disease. Methods We conducted a prospective observational study (BronchStart), enrolling children...

Objective To identify the outcomes considered important, and factors influencing the patient experience, for parents and caregivers of children presenting to hospital with a severe acute exacerbation of asthma. This work contributes to the outcome-identification process in developing a core outcome set (COS) for future clinical trials in children w...

Objective: To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health reasons, particularly in MH crisis. Design: PubMed, Embase, PsychINFO, Web of Science and Google Scholar were searched. We addressed five search questions to inform: trends and/or the...

BACKGROUND Acute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first line therapy consists of high dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first line therapy is problematic: use of intravenous agents is inconsistent and side effects are frequent. Hig...

Background Acute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first-line therapy consists of high-dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first-line therapy is problematic: the use of intravenous agents is inconsistent, and side effects are frequent...

Link to abstract: https://erj.ersjournals.com/content/62/suppl_67/PA2099

Introduction Febrile infants 90 days and younger are at risk of invasive bacterial infections (bacteraemia and meningitis) and urinary tract infections. Together this is previously termed serious bacterial infection with an incidence of approximately 10–20%. The National Institute for Health and Care Excellence guidance advocates a cautious approac...

Objectives To observe variation in imaging requests after publication of the Royal College of Radiologists UK Paediatric Trauma Protocols in 2014, recommending limited use of thoracic computed tomography (CT) to appropriately clinically risk stratified children. Method A retrospective observational study using data from the Trauma Audit & Research...

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The...

The paper investigates participation and engagement during an online medical education conference by examining delegate interactions in the parallel chat function of the video platform. Although much is known about the experiential nature of online conferencing, we know far less about what actually happens in the live unfolding chat itself. We coll...

Objectives: Bronchiolitis remains a major cause of morbidity and mortality in children under 24 months. During the first year of the pandemic, non-pharmacological interventions resulted in a significant reduction of bronchiolitis cases. Early in 2021, a rebound of bronchiolitis was reported with a description of out-of-season outbreaks. In this stu...

Objectives The number of children attending the emergency department in England has been increasing over the last decade, contributing to longer waiting times and increasing pressures on staff. Being able to predict emergency department attendance and admissions could improve patient flow. Existing literature suggests that linear models perform equ...

Objectives Supraventricular tachycardia (SVT) is the most common tachyarrhythmia in childhood and presents in a variety of fashions from cardiorespiratory collapse to mild discomfort. It is relatively uncommon as a presenting complaint and even less common is iatragenic arrhytmia precipitated by a drug given within a medical setting. This study is...

Importance: Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists. Objective: To characterize the prevalence...

Objectives To describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection. Design Retrospective medical record review. Setting Forty nine paediatric ED...

Objectives: The aim is to compare adolescent (10-24.99 years) trauma patterns and interventions to adult (≥25) and paediatric cases (<10) and to identify any transition points. Design and setting: Data were collected from the Trauma and Audit Research Network (TARN) over a 10-year period. We conducted a retrospective cross-sectional analysis. P...

Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge...

The article discusses the debate around school closures as a non-pharmaceutical intervention during the COVID-19 pandemic. While schools were closed in many countries in the early stages of the pandemic, the reopening process was more variable. The article highlights extreme variability in the duration of school closures between January 2020 and De...

Background Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs. Methods We developed a web-based survey...

Background Acute exacerbations of asthma are common in children, however, treatment decisions for severe exacerbations are challenging due to a lack of robust evidence. In order to create more robust research, a core set of outcome measures needs to be developed. In developing these outcomes, it is important to understand the views of clinicians wh...

Background Interventions introduced in 2020 to reduce the spread of SARS-CoV-2 led to a widespread reduction in childhood infections, including respiratory syncytial virus (RSV), in the subsequent year. However, from the spring of 2021 onwards the United Kingdom and Ireland began to experience an unusual out of season epidemic of childhood respirat...

Aim: High heart and respiratory rates are key indicators in many published guidelines to identify and treat serious bacterial infection and sepsis in children, but the credibility of evidence underpinning what is considered abnormal is questionable. This study established the distribution of heart and respiratory rates of children using a large da...

Objectives Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to MH crisis, and there have been longstanding concerns about the quali...

Objectives Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. A recent systematic review of interventions to avoid inpatient admissions for CYP presenting in MH crisis¹ showed that evidence is poor and limited. Meaning that CYP are likely to con...

Objectives We aimed to evaluate the international variation in the use of evidence-based management (EBM) in bronchiolitis. We hypothesised that management consistent with full-EBM practices is associated with the research network of care, adjusted for patient-level characteristics. Secondary objectives were to determine the association between ful...

Aims, Objectives and Background Acute wheeze is one of the commonest reasons for childhood Emergency Department (ED) attendances. Ongoing recovery following discharge should be supported with robust safety-netting advice including advice for ongoing bronchodilator use. Evidence for recovery bronchodilator dosing is lacking, likely leading to variat...

The impacts of the lack of skin tone diversity in medical education images on healthcare professionals (HCPs) and patients are not well studied. The aim of this study was to assess the diagnostic knowledge of HCPs and correlate this with confidence and training resources used. An online multiple choice quiz was developed. The participants’ demograp...

Background Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define opt...

Background Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and...

Background Ileocolic intussusception requires timely reduction to prevent complications. Reduction can be distressing. Sedation is uncommon due to controversial beliefs surrounding an increased risk of perforation. Analgesia and sedation practices for children undergoing reduction of intussusception remain largely unknown. Objectives To characteri...

The practical dissemination of new knowledge is not given adequate attention despite large investment in undertaking high-quality research and the desire for evidence-based practice. It is important that those involved in knowledge translation and continuing medical education understand the fundamental principles of effective presentations, whether...

Objective To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. Setting Systematic review. Design Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care...

This is the 4th biennial report from the Trauma Audit and Research Network’s TARNlet paediatric trauma group and covers a time in which there were very unusual impacts on children’s lives due to the Covid19 pandemic. This report contains data from the whole of the 2-year period from January 2019 to December 2020 - the specific effects of ‘lockdown’...

Aim: Sepsis is an acute illness associated with significant morbidity and mortality. Early detection and time sensitive management of sepsis has been shown to improve outcomes. We report the results of a scoping review to explore methods evaluated for identification of sepsis in children presenting to emergency departments. Methods: A systematic...