Research capacity and limitations in Canadian paediatric emergency departments: An observational study on biomarker discovery

Background: Paediatric research is essential to acquire effective diagnoses and treatment for children, but it has historically been under-prioritized. The PRIMED study aimed to characterize the bio-profiles of children with appendicitis and investigate their use as a clinical prediction tool. We evaluated the clinical research capacity of several Canadian paediatric emergency departments (EDs) and described both the challenges experienced in the implementation of the PRIMED study and the strategies which were used to improve local research capacity. Methods: Eleven paediatric EDs across Canada provided basic demographic and administrative data along with laboratory- and human-resource availability during the PRIMED study enrollment. Data were summarized using descriptive statistics. Results: Fewer than half of the study sites (5/11, 45%) had access to a laboratory that would process research samples 24 hours per day. Four study sites (36%) only enrolled patients during business hours (8:00-17:00). There was no nighttime coverage for patient enrollment and sample collection. Only three study sites (27%) had enrollment hours that captured over 75% of the potential study participants. Over half of the study sites (6/11, 55%) developed novel processes to enable study success, for example, creating graduate student on-call schedules and hiring bioscience-trained site coordinators to process samples. Interpretation: Despite site-specific efforts to overcome resource barriers, the gap in clinical research capacity at academic paediatric EDs remains a significant concern. University research institutes and paediatric hospitals should invest in infrastructure and human resources to increase after-hours research capacity to optimize child health and wellness outcomes.