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Emergency Care for Children: Growing Pains
deliver that care, and to understand the costs and benefits of the [emergency care system] now in place and toward which the nation should move” (IOM, 1993, p.16). The report contained a research agenda and called for the development of a uniform dataset that would be used by states to collect, analyze, and report data to EMS; include all elements of a national uniform dataset; describe the nature of EMS provided to children; and link data generated by separate components of EMS (IOM, 1993).
After the report’s release, the EMS-C program established the National EMS Data Analysis Resource Center (NEDARC) to help grantees and state EMS offices develop capabilities to collect, analyze, and utilize EMS and other data to improve the delivery of emergency and trauma care. Specifically, NEDARC staff provide research design consultation, information on data collection (e.g., which elements to collect, hardware/software issues, confidentiality issues), information on statistics, general analysis of data, and probabilistic linkage (MCHB, 2004a).
Also in the 1990s, the first infrastructure for multicenter pediatric emergency care research was established when the American Academy of Pediatrics’ Section on Emergency Medicine created the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC). The infrastructure of PEM CRC is privately funded and has served as the platform for many research projects, the majority of which have been clinical (PECARN, 2003; AAP, 2005). At least seven studies supported by the collaborative were published between 1994 and 2004 (AAP, 2005).
Perhaps the most significant development in pediatric emergency care research occurred when the EMS-C program created the Pediatric Emergency Care Applied Research Network (PECARN)—a collaborative research group consisting of hospital emergency departments (EDs) organized into nodes, with central coordination from a steering committee (PECARN, 2003, 2005). PECARN is focused on the conduct of multicenter, randomized trials and observational studies on a variety of pediatric emergency care issues. There are four Regional Node Centers, each of which coordinates five or six Hospital Emergency Department Affiliates. The strength of PECARN lies in the annual number of patient encounters it covers—900,000 ill and injured children (PECARN, 2006). Additionally, the research involves senior-level pediatric emergency medicine researchers and clinicians with expertise in epidemiology, statistics, and health services research. While PECARN is still young, it appears to hold significant promise for advancing research in pediatric emergency care. A research agenda specific to multi-institutional studies is being developed by the PECARN steering committee and will be available in late 2006 (Personal communication, D. Kavanaugh, May 10, 2006).
An important shortcoming of PECARN, however, is that it has con-