Pediatric Trauma and Critical Illness Branch (PTCIB)

We are interested in applications that align with the following research priorities. For more information about NICHD’s research themes, cross-cutting topics, and aspirational goals, visit the plan’s Scientific Research Themes and Objectives.

Optimal Time Periods for the Prevention and Treatment of Traumatic Injuries

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Cross-Cutting Topic: Disease Prevention

Gap: Injury is the leading cause of morbidity and mortality in children and adolescents, yet it is an understudied public health problem in the United States and around the world with serious effects on health, well-being, and developmental transitions. Research is needed to prevent adverse health outcomes and developmental sequelae by improving early detection and treatment and by identifying optimal time periods for prevention and intervention efforts. 

Priority: Research to develop the most effective prevention, diagnostic, and treatment strategies for the leading causes of traumatic injury in children and adolescents, including all forms of violence against children; unintentional injury, including motor vehicle crashes; critical illness and life-threatening injury; and self-injurious behavior.

Gap: Little is known about multiple forms of trauma in children or about the independent and combined effects of multiple forms of physical and psychological trauma or traumatic stress in children. More research is needed to understand how these forms of trauma affect children’s short- and long-term recovery, as well as overall health and well-being, through key developmental transition points.

Priority: Multidisciplinary research that examines the distinctive aspects of psychological and physical trauma, the complex interplay of those traumas, and the implications for trauma-informed systems of care and treatment of diverse pediatric populations in primary care, community, humanitarian, emergency medical, or critical care contexts.

Collaborative Multidisciplinary Research Across the Continuum of Care

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Aspirational Goal: Facilitate application of precision medicine approaches in children

Gap: The current approach to studying pediatric trauma, injury prevention, and critical illness is often compartmentalized, with each discipline operating independently. This approach is insufficient to advance the science, accelerate discovery, inform clinical practice, and establish the scientific evidence needed for effective treatment of critically ill, injured, or traumatized children. 

Priority: Research involving multidisciplinary and interdisciplinary teams to develop, test, and evaluate effective therapeutic agents and modalities, medical devices, precision medicine interventions, behavioral interventions, and large-scale datasets to optimize outcomes for traumatized, injured, and critically ill children.

Care and Treatment of Critical Illness in Pediatric Populations

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Cross-Cutting Topic: Infectious Disease

Gap: Critical illness in children is an under-recognized major public health problem that accounts for more quality of life years lost than any other medical condition. Critical illness may occur with a wide variety of medical conditions, rare diseases, and life-threatening injuries, making the completion of generalizable studies quite difficult. The impact of these illnesses on the developmental trajectory is poorly understood. Additionally, therapies for these illnesses and rare conditions are most often based on extrapolated adult data. Given that a child’s physiological responses to critical illness differ substantially from those of an adult, there exists a large gap in knowledge regarding optimal therapy for these conditions among children.

Priority: Research that optimizes recovery for children who experience critical illness and/or traumatic injury. This includes research that examines the epidemiology, pathophysiology, diagnosis, prevention, and treatment of all forms of critical illness and life-threatening injury among non-neonatal pediatric populations, as well as identifying sensitive time periods when prevention and treatment strategies are most optimal for children.

Gap: Children with complex medical conditions or rare diseases are frequently dependent upon technology and highly specialized care to survive and thrive, especially during periods of life-threatening illness, such as infections or respiratory distress or failure. Balancing the unique needs of these patients due to their underlying condition or disease with the life-saving measures and technology required can be challenging, at best, yet little research exists to substantiate and direct care. Empirical efforts are needed to develop, test, and evaluate safe and effective solutions that meet the unique needs of critically ill children with complex medical conditions.

Priority: Research designed to determine the optimal use of—and identify patient populations most likely to benefit from—innovative critical care interventions (e.g., extracorporeal membrane oxygenation [ECMO], renal replacement therapy [RRT], etc.), including research that assesses morbidities and functional outcomes related to those treatment modalities.

Psychosocial Issues Related to the Care of Critically Ill and Injured Children and Their Families

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood

Gap: Stress related to critical care illness and injury, as well as the inherent ethical concerns and conflicts that contribute to that stress, create a myriad of psychosocial concerns for the child, family, and healthcare providers, yet these concerns and how they might affect clinical outcomes remain grossly understudied. Similarly, both the short-term and long-term psychological consequences of critical illness and injury on these populations are largely unknown. 

Priority: Research aimed at understanding psychosocial issues in critically ill children and their families, as well as ethical and communication issues that arise in the Pediatric Intensive Care Unit, and approaches to reducing the negative sequelae of these issues. Also prioritized is research aimed at understanding the effect of environmental and palliative care interventions in critically ill or injured children on functional outcomes and the psychological consequences of critical stress.