Damian Timothy Roland

University of Leicester | LE · Department of Health Sciences

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...

Background Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and e...

Background During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues....

Objective To report the diagnostic test accuracy of dipstick urinalysis for the detection of urinary tract infections (UTIs) in febrile infants aged 90 days or less attending the emergency department (ED). Design Retrospective cohort study. Patients Febrile infants aged 90 days or less attending between 31 August 2018 and 1 September 2019. Main...

Aims Paediatric emergency departments (PED) around the world have reported a large decrease in the utilisation of emergency care services amongst children during the COVID-19 pandemic. This phenomenon has been observed during previous epidemics but the extent, trends or causes are not clear.The aim of the study was To assess the impact of epidemics...

Aims Point-of-care testing (POCT) is diagnostic testing performed at or near to the site of the patient. It has the potential to provide rapid and accurate results that can help deliver optimal patient care in emergency and acute care settings, help prevent and resolve department crowding and protracted discharge times, in addition to enhanced pati...

Aims There is an urgent need to address racism in medicine. Medical images are a crucial resource but there is a lack of diversity in skin tone representation of images and a specific paucity of data on how this impacts on health care professionals and patient outcomes. The aim of this study was to assess the diagnostic knowledge of healthcare prof...

Aims Respiratory syncytial virus (RSV) causes annual winter epidemics that usually peak in December in the UK and Ireland. Infants are disproportionately affected, with infection leading to lower respiratory tract disease, most commonly bronchiolitis, that often result in emergency department visits and hospitalisations. Non-pharmaceutical interven...

Aims To report the technological barriers (access to devices, and connectivity) with video consultations in paediatrics reported in the medical literature. Methods A systematic review was undertaken with searches of PudMed, Embase, and CINAHL databases in the areas of Paediatric Asthma, Diabetes, Epilepsy, and Nephrology. Included studies’ data we...

Aims Paediatric emergency departments saw an unusual increased incidence and severity of disease presentation in children with new onset diabetes in the early phase of the COVID-19 pandemic. The DIMPLES study(Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) aimed to characterise t...

Aims Adolescent trauma patients transition through services and dependent on age, may be managed in either paediatric, adult or mixed trauma departments. Clinicians are posed with a dilemma whether to follow adult or paediatric trauma guidelines. There is currently little in the way of published studies which compare adolescent (10-24) trauma patte...

What you need to know • Aggressively treating or investigating all patients with early undifferentiated illness is poor medical practice and can be harmful • Time is an important diagnostic tool but creates a period of uncertainty and risk for patients with serious underlying conditions • Safety-netting can help mitigate this risk, and the traffic...

Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper...

Background: The most common fractures in children are torus (buckle) fractures of the wrist. Controversy exists over treatment, which ranges from splint immobilisation and discharge to cast immobilisation, follow-up, and repeat imaging. This study compared pain and function in affected children offered a soft bandage and immediate discharge with t...

Rhinoviruses have persisted throughout the COVID‐19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such as masking and other forms social distancing, especially during the national lockdown periods. Rh...

Background Torus (buckle) fractures of the wrist are the most common fractures in children involving the distal radius and/or ulna. It is unclear if children require rigid immobilisation and follow-up or would recover equally as well by being discharged without any immobilisation or a bandage. Given the large number of these injuries, identifying t...

Study objective Approximately 250,000 children undergo pediatric procedural sedation (PPS) in UK & Irish emergency departments (ED) annually. PPS practice in our setting has not been described as fully as in other high income countries. We aimed to evaluate PPS in UK and Irish EDs. Methods Online survey distributed through Pediatric Emergency Rese...

Major incidents are rare but require a large amount of preparation, co-ordination and communication across different emergency services and specialities. This ensures that casualties are efficiently managed within the constraints of limited clinical resources. This article aims to provide a brief understanding of what constitutes as a major inciden...

Background and importance: Body temperature is considered an independent determinant of respiratory rate and heart rate; however, there is limited scientific evidence regarding the association. This study aimed to assess the association between temperature, and heart rate and respiratory rate in children. Objective: The objective of this study w...

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four...

Background We hypothesised that the clinical characteristics of hospitalised children and young people (CYP) with SARS-CoV-2 in the UK second wave (W2) would differ from the first wave (W1) due to the alpha variant (B.1.1.7), school reopening and relaxation of shielding. Methods Prospective multicentre observational cohort study of patients <19 ye...

Background To investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe. Methods Routine health data were extracted retrospectively from electronic patient records of children aged <16 years, presenting to 38 emergency departments (ED) in 16 European countries for the...

Background Due to limited evidence to guide management of periorbital cellulitis (POC), we surveyed current practice and assessed quality and consistency of local clinical practice guidelines (CPGs) to highlight future research priorities. Methods A web-based survey was sent to a designated emergency physician (who clinically assesses children) at...

BronchStart is a prospective cohort study of infants with clinical bronchiolitis attending Emergency Departments in the United Kingdom and Ireland. We found the 2021 summer lower respiratory tract infection peak, although temporally disrupted and with an attenuated disease burden, predominantly affected younger age groups as in previous years.

Aims/Objectives/Background There is a specific need to refresh knowledge of and update Major Incident Protocols (MIP) but a department may have less than one Major Incident (MI) every 5 years.As part of our department’s COVID-19 pandemic response, a ‘silent movie’ of PPE donning-and-doffing techniques was played on large screens in the background d...

Aims/Objectives/Background Approximately 250,000 children undergo paediatric procedural sedation (PPS) in UK and Irish emergency departments (ED) annually. In comparison to other countries, PPS practice in our setting has not been described. We therefore aimed to evaluate PPS practice in UK and Irish EDs. Methods/Design Online survey distributed t...

Background Medical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care. Aims To investigate diversity in training resources used by users of an International onli...

Aims/Objectives/Background We aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed). Methods/Design Data were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results...

Objective: The aim of this study was to evaluate the ability of the Irish Paediatric Early Warning Score (PEWS), the Paediatric Observation Priority Score (POPS), and the Irish Children's Triage System (ICTS) to predict patient disposition pathways in an emergency department (ED) setting. Methods: Data were prospectively collected on patients ag...

Brief resolved unexplained events (BRUE) are concerning episodes of short duration (typically < 1 min) characterized by a change in breathing, consciousness, muscle tone (hyper- or hypotonia), and/or skin color (cyanosis or pallor). The episodes occur in a normal-appearing infant in the first year of life, self-resolve, and have no readily identifi...

Paediatric emergency department (PED) attendances reduced worldwide during the COVID-19 pandemic (2020) but anecdotally babies under 30 days (BUD) appeared less affected. We collated monthly PED attendances (16 years and under) across four hospitals (three district general hospitals and a tertiary specialist PED) in England, UK from January 2017 to...

Background : Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding cap...

Aim: To develop a model for a paediatric sepsis registry for use in emergency care settings. A regional study, in the UK, was undertaken to identify the most basic registry components which are desirable and feasible using the concept of a minimum viable product. Methods: Two-round survey of clinicians using a modified Delphi methodology in conjunc...

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 conducte...

Abstract Background Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. Methods An evidence-based, the...

The BronchStart study is a prospective multi-centre cohort study. Paediatric emergency departments (PED) within PERUKI (Paediatric Emergency Research in the UK and Ireland) submit data on all children under 2 years of age who visit a PED with symptoms of an acute lower respiratory tract infection (diagnosed as bronchiolitis, lower respiratory tract...