Michael Barrett

University College Dublin | UCD · Children's Health Ireland at Crumlin

Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evid...

Introduction The aim of this project is to determine the patterns, decision-making processes and parental preferences associated with unscheduled paediatric healthcare utilisation in Ireland. Unscheduled paediatric healthcare is outpatient care provided within primary care settings by general practitioners (GPs), emergency departments (EDs) located...

Background Hospital avoidance during the COVID-19 pandemic has been reported with a significant decrease in attendance at emergency departments among paediatric populations with potential increased morbidity and mortality outcomes. The present study sought to understand parents’ experiences of healthcare during the initial public health stages of t...

Objectives: This study aims to develop and internally validate a low-dimensional model to predict outcomes (admission or discharge) using commonly entered data up to the post-triage process to improve patient flow in the pediatric emergency department (ED). In hospital settings where electronic data are limited, a low-dimensional model with fewer...

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...

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...

Objective: The primary objective was to analyze the impact of the national cyberattack in May 2021 on patient flow and data quality in the Paediatric Emergency Department (ED), amid the SARS-CoV-2 (COVID-19) pandemic. Methods: A single site retrospective time series analysis was conducted of three 6-week periods: before, during, and after the cy...

Objectives LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, + indicating inclusivity to all identities) young people represent a vulnerable group, with higher rates of suicide and self-harm. LGBTQ+ young people may first present to the paediatric emergency department (PED). Sensitivity in clinical staff is therefore crucial to provid...

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...

Objective This study aimed to assess the competency of paediatric emergency department (PED) multidisciplinary staff in caring for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, + inclusive of all identities) adolescents. Design This was an observational study within which participants were required to complete the LGBT-Developmen...

The authors hypothesised that there was an increase in SPA radiological investigations during the first year of the Irish COVID pandemic. We aimed to establish the absolute numbers of radiological investigation of SPA in the region for the first year of the COVID pandemic and the preceding 4 years to determine if this was the case.

Background Paediatric stroke is a rare event, and timely intervention is required to minimise long-term disability, reduced quality of life and financial implications. Although reperfusion strategies such as thrombolysis and thrombectomy are now well established in the adult population, and paediatric consensus guidelines allow for reperfusion the...

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 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...

During the COVID-19 lockdown, social isolation from school closures and home visitation restrictions compounded known risk factors for child maltreatment. To determine the incidence and types of child protection concern (CPC) among inpatients during the COVID-19 lockdown compared to the matched timeframe in 2019. A retrospective chart review of CPC...

This collection contains both the dataset and accompanying readme file. The final nine variable de-identified dataset used in the paper ‘Development of a low-dimensional model to predict admissions from triage at a paediatric emergency department’ has been provided (outcome and eight predictors). Any research that makes use of this dataset must r...

Objectives: The advent of the COVID-19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED a...

Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 – February 2021) compared to the previous two years. ICD-10 classificati...

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...

Aims Our aim was to complete an audit loop and identify whether implementing a paediatric ECG checklist improved the documentation and therefore the quality of paediatric ECG interpretation. We designed a paediatric ECG and education proforma in a Paediatric Emergency Department and incorporated it into daily practice. Methods We audited the medica...

Background Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices. Objective To describe the outcomes for paediatric pain management of minor injuries pres...

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...

Most healthcare visits are related to pain and distress. The extensive short and long-term consequences of inadequately treated acute pain have led to universal acceptance that pain management should begin at the earliest opportunity

Objectives: During the last 3 decades newly formed pediatric emergency medicine (PEM) research networks have been publishing research. A desire of these networks is to produce and disseminate research to improve patient health and outcomes. The aims of the study were to quantitatively analyze and compare the literature by PEM research networks glo...

Objective To report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the Brit...

Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in fr...

Background Pain is very common in childhood emergency department (ED) attendances, but is under-recognised and undertreated. Sequential national paediatric analgesia audits demonstrate suboptimal outcomes in several domains. The Donabedian framework examines the structures, processes and outcomes to evaluate quality of care. To date there has been...

Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service. Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referr...

Aims To determine changes in mental health (MH) attendance at Emergency Departments (ED) by children aged five to 15 during the COVID-19 pandemic. Methods Analysis of MH presentations during the first year of the pandemic compared with prior year for three public paediatric EDs serving the greater Dublin area with a paediatric population of 430,000...

Universal health coverage (UHC) aims to improve child health. Ireland, the only country in the European Union without universal access to primary care, introduced general practitioner (GP) care at no charge for children aged under six in 2015. This paper aims to evaluate the impact of this policy on attendance at the emergency department (ED). A di...

Objective: During the last three decades newly formed pediatric emergency medicine (PEM) research networks have been publishing research. A desire of these networks is to produce and disseminate research to improve patient health and outcomes. To quantitatively analyze and compare the literature by PEM research networks globally through numeric and...

Introduction: Patients boarding in the Emergency Department can contribute to overcrowding, leading to longer waiting times and patients leaving without being seen or completing their treatment. The early identification of potential admissions could act as an additional decision support tool to alert clinicians that a patient needs to be reviewed f...

Objective To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland. Methods Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020–26 Mar...

Background The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisc...

Background The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices.AimsThe aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service.Methods We carried out a multisite retrospective longitudinal study of all pae...

Iron is essential for growth and haematopoiesis but iron overload can have detrimental effects. The aim of this study is to correlate iron indices at 1 month of age in very low birth weight infants undergoing intensive care prior to additional iron supplementation and correlate results with clinical measures and 2 year corrected neurodevelopmental...

Introduction Ischaemic stroke is an established complication of primary varicella infection. We discuss three cases of post-varicella ischaemic stroke. Case 1 A 4-year-old boy presented acutely with right-sided hemiparesis. Neuroimaging showed an area of ischaemia centred at the left putamen. Case 2 A 2-year-old boy presented with ataxia and left-s...

Background The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisc...

Emergency Medicine (EM), Anaesthetics and Intensive Care Medicine (ICM) doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. Methods A prospective online three-part longitudinal survey of frontline doctors across the UK and Irel...

Emergency Medicine (EM), Anaesthetics and Intensive Care Medicine (ICM) doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. Methods A prospective online three-part longitudinal survey of frontline doctors across the UK and Irel...

Introduction: Interprofessional (IP) education may improve collaboration and promote culture of learning among all members of the multidisciplinary team in the PED. An IP education programme aims to bring together professionals to learn with, from, and about one another to educate more effectively and efficiently in the delivery of safe, high-qual...

Microscopy of blood films for Plasmodium parasitemia is the mainstay of malaria diagnosis (1). There is a lack of consensus on the number of blood films required to safely rule out malaria in febrile paediatric patients (2). Currently, little is known about the utility of malaria rapid diagnostic tests (RDTs) in the pediatric emergency setting. Thi...

A decrease in attendance at emergency departments among paediatric populations has been reported during the Coronavirus Disease 2019 (COVID-19) pandemic. The present study sought to understand parents' hesitancy and concerns around accessing healthcare during the pandemic using a cross-sectional survey of parents of children under the age of 16 (N...

Anaphylaxis is a potentially life-threatening emergency. The standard audited was the institution’s anaphylaxis guideline: In patients presenting with anaphylaxis, are we compliant with considering “an adrenaline autoinjector (AAI)...if [they are] at risk of recurrence in the community”?

A retrospective observational study to identify patients who received ketamine in the Crumlin ED from 2012 to 2019 using the Misuse of Drugs Act records book

The aim of this audit is to assess the adherence to the CHI ED guidance with respect to indications for chest radiographs in bronchiolitis.

This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are...

Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evid...

Introduction The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the ps...

Introduction: Health systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion o...

Objective To establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales. Design, setting and patients Prospective unblinded study from April 2016 to February 2017 in a paediatric emergency department. Patients aged 1 month to 5 years, with vomiting and/or...

Aim To determine prevalence of head injury presenting to paediatric emergency departments (PEDs) and characterise by demographics, triage category, disposition neuroimaging or re-attendance. Methods Presentations in 2014 and 2015, with diagnoses of head injury, intracranial bleed, skull fracture including single or re-attendances within 28 days pos...

Background In Ireland, the paediatric emergency department (PED) is tasked with acute healthcare provision to children and adolescents under 16 years of age. The population > 15 years attending the PED remains undescribed.AimsThe objective of the study is to describe the presentations of patients > 15 years to the PED of a national tertiary academi...

The cover image is based on the Original Article Emergency intubation of children outside of the operating room by Elliot Long, Francis D Lockie, Michael Barrett et al., https://doi.org/10.1111/pan.13784.

Intubation of children outside of the operating room (OR) is performed infrequently, and is often associated with life‐threatening adverse events. This review aims to clarify the contributors to adverse events encountered during intubations outside of the OR, and provide preventative strategies. The primary contributors to adverse events during non...

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to...

Background: Pain from injuries is one of the commonest symptoms in children attending emergency departments (EDs), and this is often inadequately treated in both the pre-hospital and ED settings, in part due to challenges of continual assessment and availability of easily administered analgesic options. Pain practices are therefore a key research...

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to...

Background Throughout the developed world, the introduction of rotavirus vaccination has led to reductions in the incidence and severity of acute gastroenteritis (AGE) in young children and consequently to reductions in paediatric emergency department (PED) attendances with AGE. Rotavirus vaccination was added to the Irish National Immunisation Sch...

An 18 month old boy presented with right monoplegia and intermittent ataxia. This occurred five months post primary varicella infection. His CT brain revealed low dense lesion in the basal ganglia, a region associated with vasculopathy post varicella infection. The child showed motor recovery with physiotherapy, antiviral, steroid and aspirin. He d...

Paediatric arterial ischaemic stroke (AIS) is a potentially fatal condition with serious long term neurological sequelae. The rate of paediatric ischaemic stroke is 1.6 – 3.3 per 100,000 and 61% of these children are left with long term neurological difficulties. Thrombolysis guidelines for children were introduced in May 2017 by the Royal College...

Background Nasal foreign body(-ies) (FB) cause local irritation, inflammation, and mucosal erosion and carry a potential risk of aspiration. The aim is to describe the management of nasal FBs in our Emergency Department (ED). Method A retrospective study of 100 sequential suspected nasal FB presentations to a tertiary paediatric ED. Patient age, g...

Complex care in the arena of child health is a growing phenomenon. Although considerable research is taking place, there remains limited understanding and agreement on the concept of complex care needs (CCNs), with potential for ambiguity. We conducted a systematic concept analysis of the attributes, antecedents, and consequences of children's CCNs...

Aims To determine the burden and aetiology of traumatic brain injuries (TBIs) presenting to tertiary paediatric emergency departments (PEDs). To determine the number of TBIs that are symptomatic, requiring imaging, re-presenting and requiring admission. Methods Retrospective analysis of presentations of children 0–16 y to the 3 Paediatric Emergenc...