What are some examples of research questions suitable for pediatric residents to investigate?

Research Questions Suitable for Pediatric Residency

Pediatric residents should focus on research questions that address quality improvement, clinical outcomes, and practical gaps in evidence-based care, particularly in areas where current practice varies widely or where existing guidelines identify knowledge deficits. 1

High-Yield Clinical Quality Improvement Questions

Respiratory Conditions

• What is the optimal timing and content of discharge education to reduce 30-day readmissions for bronchiolitis? 2, 3 This addresses a critical gap since lower respiratory infections are among the most common reasons for pediatric hospitalization and have high readmission rates, with 5.5% of LRI hospitalizations followed by readmission. 2

• Does implementation of evidence-based bronchiolitis care pathways reduce chest radiograph utilization below the achievable benchmark of 32.4%? 4 This is particularly suitable for residents because it involves measurable quality indicators with established benchmarks across 42 children's hospitals. 4

• What factors predict which children with asthma will require readmission within the first 15 days post-discharge versus days 16-30? 3 This question is clinically relevant since more than 50% of readmissions after acute conditions occur within 15 days, and asthma has a 30-day readmission rate requiring targeted intervention strategies. 3

Asthma Education and Outcomes

• Does nurse-delivered asthma education in the emergency department reduce subsequent ED visits compared to usual care? 5, 6 While education reduces ED visits (RR 0.73,95% CI 0.65 to 0.81) and hospital admissions (RR 0.79,95% CI 0.69 to 0.92), the optimal type, duration, and intensity remain unclear. 5

• What is the minimal important difference for pediatric asthma quality of life questionnaires when used as primary endpoints? 7, 1 This addresses a fundamental research gap identified by the American Thoracic Society for proper power calculations in clinical trials. 1

Diagnostic and Treatment Optimization Questions

Infectious Disease

• Can clinical prediction rules distinguish viral from bacterial pneumonia in hospitalized children to reduce antibiotic overuse? 1 The lack of simple, noninvasive diagnostic tests results in inappropriate antibiotic use and rising antimicrobial resistance. 1

• What is the optimal duration of antibiotic therapy for community-acquired pneumonia in children without complications? 4 This builds on the finding that initial narrow-spectrum antibiotic use has an achievable benchmark of 60.7%, suggesting room for standardization. 4

Chronic Disease Management

• Does aggressive asthma treatment in children with sickle cell disease reduce readmission rates? 1, 3 This is particularly relevant since sickle cell anemia has the highest 30-day readmission rate at 19.1%, and 82% of readmissions are for the same or closely related conditions. 3, 1

• What adherence strategies improve compliance with prescribed therapies in children with chronic respiratory conditions? 1 This addresses the psychology of adherence, which remains poorly understood despite being critical to outcomes. 1

Health Services and Quality of Life Research

Readmission Prevention

• Do post-discharge phone calls within 48 hours reduce readmissions for children with chronic conditions compared to acute conditions? 3 This question leverages the finding that readmissions after chronic conditions occur more uniformly throughout 30 days, while acute conditions cluster early. 3

• What is the relationship between number of comorbidities and readmission timing (days 1-7 vs 8-15 vs 16-30)? 3 Higher comorbidity numbers are associated with increased readmission risk across all time periods, but the specific thresholds and interventions remain undefined. 3

Quality of Life Assessment

• Does routine use of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) in clinic visits lead to better asthma control outcomes? 7 While the PAQLQ is validated for ages 6-18 years, whether formal HRQOL tools in routine clinical care improve outcomes remains unknown. 7

• What is the correlation between parent-reported and child-reported quality of life measures in children aged 6-12 years with chronic respiratory conditions? 7 This addresses the critical issue that children's responses change when assisted by parents, yet children under 12 may have difficulty completing questionnaires independently. 7

Methodological Considerations for Residents

Study Design Strengths

• Residents should prioritize questions that can be answered with retrospective chart reviews or quality improvement projects rather than requiring prospective randomized trials, as these are more feasible within residency time constraints. 4

• Questions using administrative databases (like Pediatric Health Information System) allow multi-center comparisons and establish benchmarks, making them particularly suitable for resident research. 4

• Focus on outcomes that matter to patients and families—mortality, morbidity, quality of life, and healthcare utilization—rather than surrogate endpoints. 8

Common Pitfalls to Avoid

• Avoid questions requiring long-term follow-up beyond residency duration (>3 years). 1
• Ensure the question addresses a population actually seen in your training setting—don't study rare conditions unless at a specialized center. 8
• Recognize that single-center studies have limitations for chronic lung disease questions and other complex conditions requiring larger sample sizes. 1
• Don't rely solely on paper diaries in pediatric studies, as they are subject to poor adherence and data fabrication; electronic monitoring should be prioritized when measuring adherence or symptoms. 1

Practical Research Questions for Specific Settings

For residents in general pediatrics:

• What percentage of children hospitalized for pneumonia receive complete blood count testing, and does this correlate with length of stay? 4 The achievable benchmark is 28.8%, providing a clear quality improvement target. 4

For residents interested in emergency medicine:

• What proportion of children with asthma receive ipratropium bromide for >2 days, and what factors predict extended use? 4 The achievable benchmark is 0%, suggesting this represents overuse. 4

For residents in continuity clinic:

• Does implementation of trauma-informed care screening at well-child visits identify more children needing mental health referral? 7 This addresses the growing recognition that adverse childhood experiences affect health outcomes. 7