EQuIS Research



EQuIS Partnered Projects



A Collaborative Multicenter open-label, non-inferiority, randomized controlled trial comparing appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children (APPY Trial)



Project Lead: Dr. Mary Brindle




Researcher Profile

Acute appendicitis is the most common surgical emergency in children. The lifetime risk of developing appendicitis is 7-8%, with a peak incidence in the teenage years. The associated financial burden of treating appendicitis is huge. For over 100 years, surgical removal of the appendix has been deemed necessary to effectively treat acute appendicitis. Appendectomy remains the cornerstone of treatment for acute appendicitis. However, in recent years this surgical dogma has been challenged and there is growing literature to suggest that antibiotics without surgery may be an effective treatment for acute appendicitis in adults and more recently in children. This non-operative management of acute appendicitis remains controversial and unproven due to the lack of well-designed large prospective randomized controlled trials.

The existing literature relating to the efficacy of non-operative treatment of acute appendicitis is predominantly from adult patients. In children, the literature is limited. While antibiotic therapy appears successful in the majority of children with acute uncomplicated appendicitis, no large randomized study has yet been performed.

Research Objective: This randomized controlled trial will compare appendectomy with non-operative treatment in children with acute appendicitis. The principal research question is: Can children with acute uncomplicated (non-perforated) appendicitis be treated without appendectomy?


Trial Page
APPY Video

Pain management and opioid use in pediatric orthopedic surgery



Project Lead: Dr. Elaine Joughin




Researcher Profile

Orthopedic procedures are associated with the highest incidence of significant postoperative pain after hospital discharge. Post-operative pain in children is increasingly managed at home with the increase in day surgery procedures and shortened hospital stays. One study investigating pain management after treatment of fractures reported that a significant proportion of children received inadequate analgesia at home. Unrelieved postoperative pain causes unnecessary post-operative morbidity and unanticipated hospital readmissions. In the long term, this can result in increased sensitivity to pain later in life and other serious physiologic and immunologic effects.

This study consists of a prospective audit of patients 3 months to 17 years undergoing orthopedic surgery at the Alberta Children's Hospital. Patients and families are contacted via telephone and email survey during the first 48 hours after discharge to evaluate post-operative pain, medications administered, and subjective evaluation of discharge teaching.


Preliminary results: Codeine prescription on discharge may not be necessary in some operative procedures, especially after upper limb surgery. Fewer opioid prescriptions after surgery will decrease morbidity due to side effects and decrease the opioid availability for abuse in the community.





A pilot study evaluating pain outcomes of ketorolac administration in children undergoing circumcision



Project Lead: Dr. Bryce Weber




Researcher Profile

Despite current analgesia standards, pediatric surgical patients are often at risk of being undertreated for postoperative pain when the regional anesthesia resolves. Pain is by far the most common complaint of parents after circumcision and a common reason for parents to avoid pursuing circumcision for their child. Ketorolac is an effective nonsteroidal anti-inflammatory drug (NSAID) that is able to provide an analgesic effect through inhibition of COX-1 and COX-2 within the body. Compared to opioid use for analgesia, ketorolac offers equivalent levels of pain relief with a decreased incidence of postoperative nausea and vomiting. A single dose of systemic ketorolac has been demonstrated to be an effective adjunct in multimodal analgesia regimens in order to reduce post-operative pain. Therefore, pre-operative ketorolac may be an effective analgesic to be used in pediatric circumcision surgery.

While circumcision remains the most common surgical procedure performed on children, there have been no studies evaluating the perioperative use of ketorolac in this procedure. It is important to determine the effectiveness of ketorolac for this indication as the control of post-operative pain is essential in order to decrease patient morbidity, and improve patient and parent satisfaction.

Research Objective: The primary objective of this study is to evaluate whether a single systemic perioperative dose of ketorolac leads to increased analgesia duration for children undergoing circumcision surgery. Secondary objectives are to compare the total postoperative analgesic consumption, incidence of bleeding, and other associated complications in the post-operative period between groups.


Trial Page

Adolescent Trauma in Calgary Zone: To Peds or Not to Peds?



Project Lead: Dr. Natalie Yanchar




Researcher Profile

Management of major injury in the adolescent population is often perceived as a conundrum. On the one hand, they have the physical size and physiology of young adults. Indeed, even the mechanisms of trauma may be considered more along adult lines, especially the most common mechanism of motor vehicle crashes, where they can be positioned as either a passenger or a driver. On the other hand, they have the mental thinking and psyche closer to that of a teenager. As such, adolescents sustaining major injury are often managed in adult-based trauma centers where the presence of expertise linked to experience based on larger case numbers is felt to confer better outcomes, especially with regards to resuscitation and interventional management.

Contrary to this is evidence suggesting better outcomes when injured children are managed in pediatric centers related to lesser risk of surgical intervention in the case of solid organ injuries, more judicious use of computed tomography to limit exposure to ionizing radiation, lower threshold for neurosurgical intervention in the case of traumatic brain injury, stronger family and patient-centered care reflecting cognizance of risk for development of post-traumatic stress disorders and commitment to ongoing follow-up, especially relating to psychoeducational needs of the adolescent.

Many recent studies have investigated variations in outcomes for adolescents treated at pediatric versus adult centers. However, these outcomes generally focus on mortality, which, being a relatively uncommon outcome, may not be the best one to use.

Research Question: What, if any, are the differences in outcomes between adolescents sustaining an intraabdominal injury, TBI or femur fracture at a pediatric versus an adult trauma center?


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