History
Health outcomes for children visiting emergency departments may be limited by the availability of reliable data from randomized controlled trials (RCTs) and by the implementation of new knowledge by health care providers in the emergency department. My research program builds on the knowledge and experience gained from various projects, to include adaptive design and Bayesian analysis more formally into RCTs. The methods and approaches we are exploring so far align well with the concept of a platform trial, which focuses on the disease or condition rather than any particular therapy.
Our approach allows us to address the priorities identified by patients and families, potentially by simultaneously investigating multiple treatments and ensuring that all patients receive the best possible care regardless of where they seek care. While my background and expertise are grounded in pediatric emergency medicine (PEM), it is my hope that the methods we are developing will offer collaborative opportunities across many healthcare disciplines.
Our approach allows us to address the priorities identified by patients and families, potentially by simultaneously investigating multiple treatments and ensuring that all patients receive the best possible care regardless of where they seek care. While my background and expertise are grounded in pediatric emergency medicine (PEM), it is my hope that the methods we are developing will offer collaborative opportunities across many healthcare disciplines.
Active Projects
Translating Emergency Knowledge for Kids (TREKK)
Most acutely ill and injured children in Canada are managed within emergency departments that are not part of a children’s hospital. Difficulties in getting the right resources and training have been cited as barriers to providing the best possible care in these settings. This has resulted in variable levels of emergency care for children within Canada. TREKK launched in 2011 as a knowledge mobilization network through the Government of Canada's Networks of Centres of Excellence Knowledge Mobilization Initiative to address these critical knowledge gaps. TREKK is a not-for-profit network that aims to improve emergency care for children across Canada.
Network Director: Dr. Terry Klassen
For additional information visit: https://trekk.ca/
Funding:
2011-2015 Networks of Centres of Excellence
2016-2019 Networks of Centres of Excellence, Knowledge Mobilization Initiative
2020 - Children's Hospital Foundation of Manitoba
Network Director: Dr. Terry Klassen
For additional information visit: https://trekk.ca/
Funding:
2011-2015 Networks of Centres of Excellence
2016-2019 Networks of Centres of Excellence, Knowledge Mobilization Initiative
2020 - Children's Hospital Foundation of Manitoba
Innovative Pediatric Clinical Trials (iPCT)
The iPCT combines comparative effectiveness with implementation research and presents an integrated set of four innovative multi-centre clinical trials in pediatric emergency medicine, supported by core methodological expertise, data management, and network coordination. Our goal is to demonstrate that the proposed iPCT methods will allow the generation of evidence that will have an immediate impact on pediatric clinical decision-making.
Nominated Principal Investigator: Dr. Terry Klassen
Additional information is available here: Innovative Pediatric Clinical Trials (iPCT) Network
Funding:
2017-2020 Canadian Institutes of Health Research (CIHR)
- The No OUCH Trial will use a patient preference approach to randomization to evaluate the comparative effectiveness of ibuprofen alone, or in combination with acetaminophen or hydromorphone, in clinical pain relief for suspected fractures.
- The DOSE AGE Study is a pragmatic trial that will evaluate the safety and efficacy of multiple doses of ondansetron administered post-discharge to children with acute gastroenteritis.
- The KETODEX Study will determine if a combination of intranasal ketamine and intranasal dexmedetomidine (Ketodex) is just as effective as intravenous ketamine to sedate children undergoing realignment of a broken or dislocated bone.
- The BIPED Study builds on previous evidence and will definitively confirm whether combination therapy with epinephrine and dexamethasone is effective in treating bronchiolitis and reducing infant hospitalizations.
Nominated Principal Investigator: Dr. Terry Klassen
Additional information is available here: Innovative Pediatric Clinical Trials (iPCT) Network
Funding:
2017-2020 Canadian Institutes of Health Research (CIHR)
Pediatric Readiness Initiative for Emergency Departments
About a third of all general emergency department (ED) visits in Canada are from children. However, these children are vulnerable to receiving care based on adult’s methods of treatment each time they visit an ED, which puts their lives at risk. In Manitoba, there is only one children hospital that has ED that is designed to treat children with emergencies. Hence, we expect many more ED visits from children for years to come. Additionally, death in little children is about 2 to 4 times higher in the Indigenous and underserved population compared to other children. To reduce the risk of mismanagement of children in the EDs, We want to know the present state of EDs to care for injured and acutely ill children by looking into the 6 main sections of EDs:
Principal Investigators: Dr. Alex Aregbesola and Dr. Terry Klassen
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
2021 - Manitoba Medical Service Foundation
Publications:
Aregbesola A, Florescu O, Tam C, Coyle A, Knisley L, Hogue K, Beer D, Sawyer S, Klassen TP. Evaluation of baseline pediatric readiness of emergency departments in Manitoba, Canada. Int J Emerg Med. 2022 Oct 10;15(1):58. doi: 10.1186/s12245-022-00462-0. PMID: 36217121; PMCID: PMC9549829.
- Coordination of patient care,
- ED staffing and training,
- Quality improvement,
- Patient safety
- Policies and procedures
- Availability of pediatric equipment/supplies
Principal Investigators: Dr. Alex Aregbesola and Dr. Terry Klassen
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
2021 - Manitoba Medical Service Foundation
Publications:
Aregbesola A, Florescu O, Tam C, Coyle A, Knisley L, Hogue K, Beer D, Sawyer S, Klassen TP. Evaluation of baseline pediatric readiness of emergency departments in Manitoba, Canada. Int J Emerg Med. 2022 Oct 10;15(1):58. doi: 10.1186/s12245-022-00462-0. PMID: 36217121; PMCID: PMC9549829.
Readiness of Emergency Departments for Pediatric Patients: A systematic review
Principal Investigator: Dr. Alex Aregbesola
Pediatric Emergency Fellow: Dr. Jessica Harper
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
Pediatric Emergency Fellow: Dr. Jessica Harper
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
PEDIATRIC READINESS IN MANITOBA NURSING STATIONS
Principal Investigators: Dr. Alex Aregbesola and Dr. Terry Klassen
Pediatric Emergency Fellow: Dr. Kaitlin Hogue
Funding:
2019 - ongoing Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
Pediatric Emergency Fellow: Dr. Kaitlin Hogue
Funding:
2019 - ongoing Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
KNOWLEDGE TO ACTION IN PEDIATRIC EMERGENCY CARE DURING THE COVID-19 PANDEMIC
Information about COVID-19 in children changes fast as we learn more about the disease and its wider impact. This pandemic is affecting the lives of children who have COVID-19 and also in other ways. For example, the fear of getting COVID-19 may be affecting how families decide on where and when to seek health care. Children coming to the emergency
department during the COVID-19 pandemic have been sicker. Most children when they need emergency care in Canada first visit a general emergency department that is not part of a children’s hospital. It is important that healthcare providers in these emergency departments have the latest information on how best to care for children. Our research project will bring
world-leading child health researchers, parents, and emergency health care providers together to share the latest information on COVID-19 and how it is affecting children’s emergency care. We will use this information to create educational tools and resources so healthcare providers can quickly find and use the information they need when caring for children. Then we will test how useful these resources are for healthcare providers and if we need change them in any way. We will also parents and youth on what information is important for emergency healthcare providers to know. We will share these educational tools and resources will all emergency departments in Canada. We want to help emergency health care providers feel better prepared to give the best possible care to sick and injured children
Principal Investigators: Dr. Terry Klassen
Funding: Canadian Institutes of Health Research (CIHR)
University of Manitoba Article: UM researchers to develop COVID-19 resources related to kids coming to Emergency
department during the COVID-19 pandemic have been sicker. Most children when they need emergency care in Canada first visit a general emergency department that is not part of a children’s hospital. It is important that healthcare providers in these emergency departments have the latest information on how best to care for children. Our research project will bring
world-leading child health researchers, parents, and emergency health care providers together to share the latest information on COVID-19 and how it is affecting children’s emergency care. We will use this information to create educational tools and resources so healthcare providers can quickly find and use the information they need when caring for children. Then we will test how useful these resources are for healthcare providers and if we need change them in any way. We will also parents and youth on what information is important for emergency healthcare providers to know. We will share these educational tools and resources will all emergency departments in Canada. We want to help emergency health care providers feel better prepared to give the best possible care to sick and injured children
Principal Investigators: Dr. Terry Klassen
Funding: Canadian Institutes of Health Research (CIHR)
University of Manitoba Article: UM researchers to develop COVID-19 resources related to kids coming to Emergency
IMPROVING PATIENT CARE EXPERIENCE IN THE PEDIATRIC EMERGENCY DEPARTMENTS
The aim of the study is to assess the baseline patient experience in pediatric emergency care in Manitoba in order to identify existing gaps that affect the delivery of optimal care. We will also assess the improvement in patient care experience with the implementation of two or three of the gaps identified and prioritized by the Emergency Advisory Committee (EAC). We hypothesized that the care experience of patients in the Manitoba pediatric ED is average, and there are gaps in pediatric emergency care that can be improved through the assistance of the EAC.
Principal Investigators: Dr. Alex Aregbesola and Dr. Elisabete Doyle
Medical Student: Bhavan Dhaliwal and Evan Adam
Funding:
2022-2023 BSc Med, University of Manitoba
Principal Investigators: Dr. Alex Aregbesola and Dr. Elisabete Doyle
Medical Student: Bhavan Dhaliwal and Evan Adam
Funding:
2022-2023 BSc Med, University of Manitoba
Practice Variation in Urine Collection in Pre-toilet Trained Children with Urinary Tract Infection
The primary objective of the study is to determine the variation in practice among pediatric emergency physicians in Canadian Pediatric Emergency Departments in the diagnosis of UTI in pre-toilet trained children.
A survey will be sent to pediatric emergency departments across Canada to ascertain practice variation in urine collection for diagnosing UTIs. The study design will be a cross-sectional study dating from November 2019 to November 2020.
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Medical Student: Lucy Wilson
Funding:
2021 Med II, University of Manitoba
A survey will be sent to pediatric emergency departments across Canada to ascertain practice variation in urine collection for diagnosing UTIs. The study design will be a cross-sectional study dating from November 2019 to November 2020.
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Medical Student: Lucy Wilson
Funding:
2021 Med II, University of Manitoba
Improving the Care of Children with Somatic Symptom Disorder in Canadian Emergency Rooms
Background:
Some children visit emergency rooms with physical symptoms like pain or fatigue, but doctors can't find a medical cause through tests. This condition, called Somatic Symptom Disorder (SSD), might have psychological roots. Because it's hard to pinpoint, these kids often go through unnecessary tests, repeated emergency visits, and might even get wrongly diagnosed. This not only troubles the kids and their families but also burdens the health system, especially in children's emergency rooms.
What We're Doing:
We're setting out to understand and improve how SSD is handled in Canadian pediatric emergency rooms. Our main questions are:
We'll use a mix of methods, first figuring out how common SSD is and refining our detection tool. We'll then talk to healthcare providers about their struggles with SSD. Based on these insights, we'll test a new way to treat SSD in one hospital and later in several.
Why It Matters:
This is like untangling a really tricky knot. Kids with SSD need care that truly understands their condition. We're hoping to pave the way for better guidelines and practical tools for doctors. Our ultimate goal is to give these children the right care faster, easing the load on the health system and ensuring all Canadian kids get fair and equal treatment.
In a Nutshell:
SSD is a puzzle in Canadian children's emergency rooms. We aim to solve it by learning more about it, designing better treatment methods, and sharing our discoveries. Our findings could lead to quicker, better care for these kids, helping them, their families, and the entire health system.
Some children visit emergency rooms with physical symptoms like pain or fatigue, but doctors can't find a medical cause through tests. This condition, called Somatic Symptom Disorder (SSD), might have psychological roots. Because it's hard to pinpoint, these kids often go through unnecessary tests, repeated emergency visits, and might even get wrongly diagnosed. This not only troubles the kids and their families but also burdens the health system, especially in children's emergency rooms.
What We're Doing:
We're setting out to understand and improve how SSD is handled in Canadian pediatric emergency rooms. Our main questions are:
- How common is SSD in children's emergency rooms in Canada, and can we trust the tool we use to identify it?
- What problems do doctors face when figuring out and treating SSD, and can we design a better care plan?
- How well does our new approach (based on our findings in question 1) work in a small test, and then in a bigger trial across multiple hospitals?
- How can we share our findings so that doctors, patients, and families benefit, and how can we partner with TREKK to put our findings into practice?
We'll use a mix of methods, first figuring out how common SSD is and refining our detection tool. We'll then talk to healthcare providers about their struggles with SSD. Based on these insights, we'll test a new way to treat SSD in one hospital and later in several.
Why It Matters:
This is like untangling a really tricky knot. Kids with SSD need care that truly understands their condition. We're hoping to pave the way for better guidelines and practical tools for doctors. Our ultimate goal is to give these children the right care faster, easing the load on the health system and ensuring all Canadian kids get fair and equal treatment.
In a Nutshell:
SSD is a puzzle in Canadian children's emergency rooms. We aim to solve it by learning more about it, designing better treatment methods, and sharing our discoveries. Our findings could lead to quicker, better care for these kids, helping them, their families, and the entire health system.
Using a single dose of dexamethasone at 0.6mg versus 0.15 mg/kg of body weight for the treatment of croup: a multicenter chart review
USING A SINGLE DOSE OF DEXAMETHASONE AT 0.6MG VERSUS 0.15 MG/KG OF BODY WEIGHT FOR THE TREATMENT OF CROUP: A MULTICENTER CHART REVIEW
The primary objective is to examine the current practice regarding the doses of dexamethasone to treat croup and the associated adverse events.
Principal Investigator: Dr. Alex Aregbesola
Co-Investigator: Dr. Terry Klassen
Funding: Children's Hospital Research Institute of Manitoba
The primary objective is to examine the current practice regarding the doses of dexamethasone to treat croup and the associated adverse events.
Principal Investigator: Dr. Alex Aregbesola
Co-Investigator: Dr. Terry Klassen
Funding: Children's Hospital Research Institute of Manitoba
Using a single dose of dexamethasone at 0.6mg/kg of body weight versus 0.15 mg/kg of body weight for the treatment of croup: an internal vanguard randomized controlled non-inferiority trial
USING A SINGLE DOSE OF DEXAMETHASONE AT 0.6MG/KG OF BODY WEIGHT VERSUS 0.15 MG/KG OF BODY WEIGHT FOR THE TREATMENT OF CROUP: AN INTERNAL VANGUARD RANDOMIZED CONTROLLED NON-INFERIORITY TRIAL
The primary objective is to determine a feasible sample size estimation and the noninferiority margin for the definitive RCT.
Principal Investigator: Dr. Alex Aregbesola
Co-Investigator: Dr. Terry Klassen
Funding: Children's Hospital Research Institute of Manitoba
The primary objective is to determine a feasible sample size estimation and the noninferiority margin for the definitive RCT.
Principal Investigator: Dr. Alex Aregbesola
Co-Investigator: Dr. Terry Klassen
Funding: Children's Hospital Research Institute of Manitoba
Completed Projects
P-VALUE AND BAYESIAN ANALYSIS IN RANDOMIZED CONTROLLED TRIALS IN CHILD HEALTH RESEARCH PUBLISHED OVER TEN YEARS (2007-2017)
There is an unresolved debate about the reliability of the interpretation of P value. Some investigators have suggested that an alternative Bayesian method is preferred in conducting health research. As randomized-controlled trials (RCTs) are important in generating research evidence, we decided to investigate the extent, if any, the inferential statistical framework in published RCTs in child health research have changed over 10 years. We aim to examine the change in P value and Bayesian analysis in RCTs in child health research papers published from 2007 to 2017.
This review will present the difference in the proportion of trials that reported on P value and Bayesian analysis between 2007 and 2017 to assess the 10-year change. The implications for future clinical research will be discussed and this research work will be published in a peer-reviewed journal. This review has the potential to help inform the need for a change in the methodological approach from the null hypothesis significance test to Bayesian methods.
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Publication:
Aregbesola A, Gates A, Coyle A, Sim S, Vandermeer B, Skakum M, Contopoulos-Ioannidis D, Heath A, Hartling L, Klassen TP. P value and Bayesian analysis in randomized-controlled trials in child health research published over 10 years, 2007 to 2017: a methodological review protocol. Syst Rev. 2021 Mar 10;10(1):71.
This review will present the difference in the proportion of trials that reported on P value and Bayesian analysis between 2007 and 2017 to assess the 10-year change. The implications for future clinical research will be discussed and this research work will be published in a peer-reviewed journal. This review has the potential to help inform the need for a change in the methodological approach from the null hypothesis significance test to Bayesian methods.
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Publication:
Aregbesola A, Gates A, Coyle A, Sim S, Vandermeer B, Skakum M, Contopoulos-Ioannidis D, Heath A, Hartling L, Klassen TP. P value and Bayesian analysis in randomized-controlled trials in child health research published over 10 years, 2007 to 2017: a methodological review protocol. Syst Rev. 2021 Mar 10;10(1):71.
PEDIATRIC READINESS IN THE CHILDREN'S HOSPITAL, HSC, WINNIPEG
As an add on to the Pediatric Readiness Initiative, it is evident that the peculiarity of Manitoba’s population and geography would to some extent influence pediatric emergency needs and the readiness required. The Manitoba research checklist, which is an adaption of the survey of the NPRP in the United States and the Provincial Council for Maternal and Child Health (PCMCH), Ontario, Canada, is being used to assess pediatric readiness of all EDs within our province. This sub-study would apply the same checklist to the only pediatric specialized ED in Manitoba, located within the Health Science Centre (HSC) in Winnipeg to provide a reference for all EDs in Manitoba.
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Pediatric Emergency Fellow: Dr. Oana Florescu
Medical Student: Mirna Ragheb
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Pediatric Emergency Fellow: Dr. Oana Florescu
Medical Student: Mirna Ragheb
Funding:
2019 - Children's Hospital Research Institute of Manitoba (CHRIM) - In kind support
GLUCOCORTICOIDS FOR CROUP IN CHILDREN: UPDATED REVIEW
Principal Investigator: Dr. Alex Aregbesola and Dr. Terry Klassen
Publication: Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2023 Jan 10;1(1):CD001955. doi: 10.1002/14651858.CD001955.pub5. PMID: 36626194; PMCID: PMC9831289.
Publication: Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2023 Jan 10;1(1):CD001955. doi: 10.1002/14651858.CD001955.pub5. PMID: 36626194; PMCID: PMC9831289.
CLUSTER RANDOMIZED CONTROLLED TRIALS IN CHILD HEALTH FROM 2007 AND 2017: CHARACTERIZATION AND ASSESSMENT OF METHODOLOGICAL RIGOUR
Principal Investigator: Dr. Terry Klassen
Summer Student: Megan Pinette
Funding:
2021 Children's Hospital Research Institute of Manitoba, Summer Student Award
Summer Student: Megan Pinette
Funding:
2021 Children's Hospital Research Institute of Manitoba, Summer Student Award
USEFULNESS OF CHILD HEALTH RANDOMIZED-CONTROLLED TRIALS RESEARCH
There is an unresolved debate about the reliability of the interpretation of P-value. Some suggest that a Bayesian method is preferred in conducting health research. We are investigating the extent the inferential statistical framework in published RCTs in child health research have changed over 10 years. We are examining the change in P-value and Bayesian analysis in RCTs in child health research papers published from 2007 to 2017.
Principal Investigators: Dr. Alex Aregbesola and Dr. Terry Klassen
Medical Student: Bart Kaminski
Funding: 2021-2022 BSc Med, University of Manitoba
Abstract presented at PAS 2023, Washington DC
Principal Investigators: Dr. Alex Aregbesola and Dr. Terry Klassen
Medical Student: Bart Kaminski
Funding: 2021-2022 BSc Med, University of Manitoba
Abstract presented at PAS 2023, Washington DC
