Since helping to found the Pediatric Emergency Care Applied Research Network, Nathan Kuppermann has led or helped to lead collaborative, practice-changing studies around key challenges in the pediatric ED. Some highlights:
Traumatic brain injury
Kuppermann was principal investigator and first author of a 2009 Lancet study that derived and validated prediction rules for clinically important TBIs in a large, diverse population with minor head trauma. The large sample – more than 42,000 enrolled infants and children – allowed for derivation and validation of separate rules for patients younger and older than 2 years. UC Davis ED colleague Dr. James Holmes was a close collaborator.
In a pre-PECARN NEJM study of 400 patients in 2001, Glaser, Kuppermann and colleagues showed it was unlikely that treatment with fluids – a controversial practice – was contributing to further brain injury. They bookended that research last year with a more robust PECARN study published in NEJM in 2018, which found that fluid infusion during treatment does not cause brain injury in children with DKA.
Kuppermann was senior investigator on a 2007 NEJM study of 600 children that found use of steroid medication to treat bronchiolitis does not prevent hospitalization or improve respiratory symptoms. The findings from 21 PECARN hospitals resolved controversy from prior research, and were expected to help guide treatment for the most common cause of infant hospitalization.
In a 2016 JAMA study, PECARN researchers established a proof of principle for a high-throughput RNA analysis that can enable clinicians to distinguish bacterial infections from other causes of fever in infants up to two months old. The study could someday help ER doctors avoid invasive exams and unnecessary treatment for many of the more than 500,000 febrile infants who arrive at hospitals each year. Kuppermann was a principal investigator, along with Prashant Mahajan of the University of Michigan and The Ohio State University’s Octavio Ramilo.
A JAMA Pediatrics study this year led by Kuppermann also derived and validated a new ED protocol that can determine which young infants with fevers are at low risk of significant bacterial infections. The research, which involved nearly 2,000 patients at 26 hospitals, has important implications for identifying the need for spinal taps or other invasive care.
TXA for trauma
Kuppermann, co-principal investigator Daniel Nishijima and colleagues are evaluating feasibility of a confirmatory, multicenter clinical trial around tranexamic acid (TXA) in children with severe trauma and hemorrhagic injuries. The antifibrinolytic drug improves adult survival, but hasn’t been clinically trialed in severely injured children.