PIC Data Lab

History

Our group‘s research journey began with amplitude-integrated EEG (aEEG) in preterm infants, initially using mere visual assessment of the tracings. Since establishing the PIC Data Lab in 2020, our focus has shifted towards pediatric intensive care patients and the approach evolved using partially automated assessments. Today, we focus on fully automated analysis of aEEG and explore advanced quantitative EEG processing, including Fast Fourier Transformation, burst suppression ratio, asymmetry detection, and more.

Motivation

Preliminary evidence from small case series and adult intensive care suggests that certain quantitative EEG parameters may change before clinical neurological deterioration becomes apparent, potentially serving as early warning indicators. Additionally, our research is driven by the need for outcome prediction tools to inform clinical decision-making and provide accurate information for parent counseling.

Current Work

We are currently conducting comprehensive analyses of quantitative parameters from approximately 1,000 EEGs collected at our center. These recordings derive from diverse patient populations, including neurologically healthy children (awake and during sedation) and critically ill children. Examining these different cohorts will provide important insights into baseline changes induced by sedation and neurological/critical illness. Once established we plan to apply our technical expertise and content knowledge to expand these analyses to newborn and preterm infant populations with various neurological conditions.

Funding

• Stiftung Universitätsmedizin
• Medical Faculty of the University of Duisburg-Essen
• UMEA Clinican Scientist programme

Background

Traumatic Brain Injury (TBI) represents one of the major public health concerns in pediatric populations across the world. While moderate and severe TBI are luckily rare, this creates challenges in gathering large-scale data for research and evidence synthesis. At the same time, optimizing diagnostic and neuroprotective management during the acute phase is crucial in order to avoid secondary brain injury.

Routine healthcare data provides the opportunity to investigate moderate and severe TBI on a larger scale. The German hospital dataset offers nationwide comprehensive coverage of pediatric hospital discharges, creating an ideal platform for in-depth TBI research.

Methodological work

Because stratification or adjustment for injury severity is indispensable in trauma research, we have implemented two distinct methods to measure injury severity in pediatric trauma patients from routine health care data:

• An adapted mapping-based that allows to calculate the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) from the German modification of the International Classification of Diseases (ICD-10)
• An internal approach that calculates survival probability directly from cases within the database (survival risk ratios)

This foundational work provides the methodological basis for our current research using the German hospital dataset.

Current work

We are assessing various aspects of TBI in the German hospital dataset to answer – among others – these research questions:

• How do mortality and outcomes in children with severe traumatic brain injury differ depending on the timing of decompressive craniectomy?
• How does ICP monitoring in children with severe TBI affect mortality and outcomes?
• How do mortality and outcomes differ in children with serious TBI when treated in pediatric versus adult intensive care units?
• How did hospitalization numbers for mild versus moderate-severe TBI change during the pandemic-related reduction in TBI-related hospitalizations?

Because the reliability of routine healthcare data varies considerably depending on the context in which it was collected, we work on cross-verifying clinical data with routine healthcare data on both single and multicenter basis, e.g. For assessing organ dysfunction. Insights from these analyses will help to further develop approaches to reduce bias in research from routine healthcare datasets.

Funding

• Save-my-brain foundation

Background

Traumatic brain injury (TBI) is a major pediatric health concern worldwide, with about 92,000 hospital admissions annually in Germany. However, only 2.7% (ca. 2,500 per year) have confirmed intracranial injuries, and only 0.7% (ca. 600 per year) require neurosurgery. Germany’s hospitalization rate for pediatric TBI (687/100,000 child-years) strikingly exceeds those in other countries like, e.g., the UK (280/100,000) and the US (73/100,000).

This high rate likely stems from an interplay of lacking standardization of mild TBI (mTBI) care pathways, vague guideline recommendations regarding hospitalizations, and financial incentives to hospitalize children with mTBI for observation.

Consequently, children with mild TBI are often admitted despite lacking medical necessity. The median 2-day hospital stay exceeds the 6-12 hour window of risk during which complications typically manifest. In contrast to the German practice, international guidelines recommend no monitoring or only hourly monitoring in clinical settings for low-risk patients.

Trial

The SaVeBRAIN.Kids trial will test a novel care pathway in order to reduce unnecessary hospitalizations while maintaining safety. Key features of the novel care pathway include:

• Standardizing mTBI diagnosis and management
• Enabling short-term observation in the ED before admission or discharge
• Supporting home monitoring via a smartphone app

The study will be conducted in a multicenter cluster-randomized stepped-wedge trial with hospitalization rates and unplanned return visits as co-primary outcomes.  

Funding

• Innovationsfonds G-BA

Project Homepage

Coming soon

Background

Children treated in the Pediatric Intensive Care Unit (PICU) have a low mortality rate of approximately 1-3%, but face a relevant risk of long-term consequences, affecting around 50% of patients. The Post Intensive Care Syndrome in pediatrics (PICS-p), which encompasses physical, cognitive, psychological, and social impairments, is still frequently overlooked in Germany.

Currently, there are few structured follow-up care programs in Germany, despite international studies demonstrating the benefits of coordinated aftercare. The topic has gained increasing relevance through international research and feedback from affected families. A pilot phase for follow-up care was launched in at our children’s hospital in 2023 using an interdisciplinary approach that included various subspecialties.

Motivation

We are driven by the vision to:

• Improve long-term quality of life for PICU survivors
• Detect and treat long-term consequences timely
• Prevent chronification and reduce the burden on patients, their families, and siblings
• Learn from follow-up to implement improvements during the acute phase of illness

Aims

The EPPIC project aims to establish a structured interdisciplinary follow-up program and systematically identify PICS-p in routine care, providing support for affected children and their families. Transferable care models will be developed with the long-term goal to integrate such models into regular healthcare services and help shape national recommendations.

Current Work

We are working on establishing a multidisciplinary PICU follow-up outpatient program in Essen which is open for PICU survivors regardless of their primary hospital of care. To ensure the highest quality of care, we collaborate at national and international level to

• Develop information materials and care recommendations
• Integrate relevant disciplines such as child and adolescent psychiatry, psychology, neuropediatrics, physiotherapy, sports medicine, social work, and others
• Develop and test standardized follow-up protocols and validated screening instruments suitable for practical use in the German health care setting

We are proud co-founders and participants of the PIA Network!

Background

The Pediatric Intensive Care Unit Admissions (PIA) Network was established as a nationwide database in Germany to gather epidemiological, clinical, and outcome data on pediatric critical illness. Until the foundation of PIA in 2022, Germany had no recording system for pediatric intensive care admissions, hindering epidemiological and outcome assessments.

Aims

The PIA network intends to address these gaps by providing a framework for clinical and epidemiological research in pediatric intensive care. It collects data on diagnoses, treatment, clinical course, and short-term outcomes and aims to identify areas for improvement in care, enable disease surveillance, and one day serve as a tool for quality control.

Method

The PIA network builds upon the infrastructure of the German Pediatric Surveillance Unit ESPED for data collection. Anonymous data is entered into a central online database by local PIA investigators.

Data access

Data access is open to all participating PICUs of the PIA Network via proposals submitted to the steering committee.

Find out more

Homepage of the PIA Network (external link)