Associate Professor of Pediatrics, University of Colorado School of Medicine
Section of Emergency Medicine, Children’s Hospital Colorado
Dr. Scott’s goal is to become an independent health services researcher focused on improving the quality of care for pediatric emergency conditions, particularly sepsis, through the synthesis of scientific evidence, creation of learning health systems, and pragmatic trials to test implementation of evidence-based practice in emergency settings. As an early investigator, her studies addressed an area with little data and increasing medical and public health interest – the early, undifferentiated phase of sepsis in children. She created an institutional clinical sepsis program at Children’s Hospital Colorado, and participates in national sepsis and resuscitation guideline and quality improvement committees. Her research focus is to build on these clinical quality improvement experiences, to conduct research that improves the quality and safety of emergency care of time-sensitive conditions in children.
1. Why is your area of science important?
Sepsis is a leading cause of death of children, much of it potentially preventable with timely diagnosis and first-hours resuscitation. Spurred by high-profile pediatric deaths from sepsis, multiple states have passed legislation requiring hospitals to have pediatric sepsis protocols, yet evidence to inform the content of such protocols is lacking. I am particularly interested in the question of sepsis diagnosis – how can we find sepsis sooner, and more accurately, delivering resource-intensive resuscitation to the sepsis patients whose lives require it, without over treating the millions of children who present for emergency care with self-limited febrile illnesses every year? What diagnostic tools will be most effective in the emergency care setting, and do they look different in a pediatric emergency department vs a general emergency department vs an urgent care center?
2. What are the major take home messages your current research provides?
There are two major take home messages in my current research:
1) There is a critical window of time in which the diagnosis of sepsis is uncertain to a bedside clinician, before progression to fulminant organ failure and shock. Providing treatment during that time could improve outcomes. We have described that there are far more patients with an uncertain diagnosis than prior research had identified. Treating all of these patients as if they had sepsis would have direct negative consequences to those patients and the healthcare system (and not treating them could be deadly!), so finding ways to make a clear diagnosis earlier is important.
2) There is more information available in the Electronic Health Record than clinicians are using to make diagnoses. Applying prediction modeling techniques to the data that already exists in the EHR can improve on the bedside judgment of clinicians to improve the accuracy of early diagnosis of sepsis – and ultimately, we hope, outcomes.
3. What are your goals or areas for future research?
Tertiary children’s hospitals, like Children’s Hospital Colorado, have been focused on improving pediatric sepsis care for the last 10 years and have made enormous strides. However, most children in the US do not first present for emergency care to a pediatric emergency department. Sepsis care cannot wait for a patient to be transferred – the right care must be provided immediately where the child first arrives. My goal is to develop diagnostic tools that can be used throughout the emergency care continuum, and in the future to use implementation and dissemination science to evaluate their effectiveness outside of tertiary pediatric hospitals.
4. What is important in your Health Services Research training?
Learning the tools of pragmatic trials is important in my training. Sepsis as a disease process and Emergency Medicine as a field are extremely time-sensitive, and treatment proceeds on a clinically-presumed diagnosis. Thus, explanatory trials are not always a good fit for this setting, both in terms of trial enrollment and eventual clinical application of results. One goal of my career development award is to acquire the skills to design and execute a rigorous pragmatic trial. Additionally, the statistical and informatics expertise within ACCORDS have been invaluable in my training and research.
5. What advice do you have for researchers who want to work in this area? / What is the most important advice you have received from your mentors?
Persist! Especially as someone in non-organ-system based research, it was hard to figure out which funding agency would be interested in my research questions. Non-molecular sepsis research and pediatric emergency medicine didn’t seem to neatly map to a specific agency’s portfolio, and I had unsuccessful grant submissions to one agency before switching agencies and getting funded. My research mentors continued to support me and encouraged me to try again, and I’m so glad they did!