The Pediatric Emergency Care Applied Research Network A History of Multicenter Collaboration in the United States Leah Tzimenatos, MD,* Emily Kim, MPH,* and Nathan Kuppermann, MD, MPH*† Abstract: In this article, we review the history and progress of a large multicenter research network pertaining to emergency medical services for children. We describe the history, organization, infrastructure, and re- search agenda of the Pediatric Emergency Care Applied Research Net- work and highlight some of the important accomplishments since its inception. We also describe the network’s strategy to grow its research portfolio, train new investigators, and study how to translate new evi- dence into practice. This strategy ensures not only the sustainability of the network in the future but the growth of research in emergency medical services for children in general. Key Words: PECARN, research infrastructure, multicenter collaboration (Pediatr Emer Care 2015;31: 70–76) T he Pediatric Emergency Care Applied Research Network (PECARN) is a research collaboration of pediatric emergency departments (EDs) across the United States, focusing on the care of acutely ill and injured children. Recognizing the need to gen- erate definitive evidence to inform the treatment of acutely ill and injured children, PECARN was established in 2001. 1 Led by experienced investigators with expertise in pediatric emergency care and with the support and oversight of the Emergency Medical Services for Children (EMSC) program of the Health Resources and Services Administration (HRSA), PECARN is the first re- search network of pediatric EDs funded by the Federal Govern- ment of the United States. The network is committed to conducting high-quality research in all phases of emergency care in children, including prevention, prehospital and ED treatment, and rehab- ilitation. PECARN leverages a combined population of more than one million children treated annually in 18 EDs throughout the United States to overcome many of the barriers inherent to pediatric emergency care research. BACKGROUND Previously, the ability to generate scientific evidence regard- ing the optimal care of acutely ill and injured children in EDs was limited by several barriers. 1,2 The rarity of adverse outcomes in many pediatric conditions makes it difficult, if not impossible, to enroll a sufficiently large patient population at a single center to achieve the necessary statistical power to answer pressing clinical questions definitively. In addition, it can be difficult to obtain high-quality data when enrolling patients in research studies in busy EDs because ED clinicians have multiple competing demands on their time. Obtaining informed consent from the patient’s family may be difficult under the stressful con- ditions of the ED or even impossible if the patient’s guardian is absent or also injured. The results of research findings per- formed in tertiary care (research) centers may be difficult to generalize to community hospitals, where most acutely ill and injured children are cared for. Finally, translating research results into the daily practice of clinicians working in acute care settings can be challenging. The infrastructure of PECARN supports collaboration on large multicenter studies and the sharing of experiences and best practices with communities of physicians, thus overcoming many of the barriers to per- forming pediatric emergency care research and then translating it into practice. Organization and Infrastructure PECARN is composed of 7 research node centers (RNCs), located throughout the United States. Figure 1 depicts the PECARN structure, and Figure 2 illustrates the locations of current PECARN sites. Funding from the US Federal Government is directed to each RNC through the Emergency Medical Services for Children (EMSC) program, established under HRSA, Maternal Child Health Bureau (MCHB). An independent data coordinating center (DCC) is also funded by EMSC and works collaboratively with the RNCs. The principal investigators (PIs) of the RNCs (the nodal PIs), the PI of the DCC, and a representative from the federal funding agency form PECARN's executive committee. Six of the RNCs each coordinate and provide oversight of 3 academic children’s EDs, known as hospital ED affiliates (HEDAs), for a total of 18 ED sites within the network. The sev- enth RNC was recently established and coordinates 3 emergency medical service agencies, instead of EDs, to focus on prehospi- tal research. Each HEDA agrees formally to participate in any PECARN research study appropriate for its facility. Members of the PECARN steering committee loosely include investigators and research coordinators from each HEDA, as well as DCC staff and research administrators from the RNCs. Only 1 representative from each HEDA and 1 representative from the DCC, however, comprise the PECARN steering committee voting membership, which acts as the primary governing body and arbitrator of the network. All nodal PIs are voting members of the steering committee, as is the PI of the DCC. One nodal PI also serves as the chair of the PECARN steering committee, a position that rotates every 3 years to share opportunities for lead- ership and to ensure equity among the RNCs. Early in the de- velopment of the network, the PECARN steering committee established bylaws, which describe its structure and membership, its policies and procedures, and its code of ethics and conduct. PECARN's subcommittees were also established early in the network's development to advise the steering committee and perform specific tasks for the network. These subcommittees have evolved over time, to serve the ever-changing needs of the net- work. Currently, the 4 subcommittees are as follows: From the Departments of *Emergency Medicine and †Pediatrics, University of California, Davis School of Medicine, Sacramento, CA. Disclosure: The authors declare no conflict of interest. Reprints: Leah Tzimenatos, MD, University of California, Davis Medical Center, Department of Emergency Medicine, 2315 Stockton Blvd, PSSB Suite 2100, Sacramento, CA 95817 (e‐mail: leah.tzimenatos@ucdmc.ucdavis.edu). This article was published in the December 2014 issue of Clinical and Experimental Emergency Medicine (CEEM), a new Korean emergency medicine journal. Copyright © 2015 by Lippincott Williams & Wilkins ISSN: 0749-5161 SPECIAL FEATURE 70 www.pec-online.com Pediatric Emergency Care • Volume 31, Number 1, January 2015 Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.