Overcoming unplanned variation in children’s health (OUCH): Maximising the safety and effectiveness of orthopaedic care for children through better evidence.

Background: Until recently, children's trauma and orthopaedic surgery has been untouched by research. This is despite 250,000 childhood fractures annually in the UK and a large burden of non-traumatic disease from birth anomalies, developmental disease and infection. The absence of evidence has propagated uncertainty and widespread variation in care. It is 'normal' to encounter scenarios for which surgeons have diametrically opposed views, i.e. injuries/ disease which some surgeons advocate strongly in favour of surgery, and some strongly against. As a Clinician Scientist, I led UK-wide improvement in children's orthopaedic research. Prior to this there were no multicentre studies and no clear research direction. Now, we have a national cohort that recruited in 143 UK hospitals involving over 500 surgeons, six multicentre NIHR HTA trials, and a clear research agenda through surgeon-consensus and a James Lind Partnership. What is the value of this Professorship? This will enable me to be the international research leader through a growing series of e-Trials, and by developing digitally enabled trials to answer questions previously considered impossible to answer. In particular, this will build the foundation from which to launch data-enabled trials in routine care, to resolve three of the of the top-10 research questions from the research agenda. These questions relate to the screening and treatment of hip dysplasia in newborns. This will build on my methodological expertise, showcase the UK as a leader in trials innovation and inform policy concerning the care of almost every child born around the world. e-Trial Portfolio: Severe radius fractures (CRAFFT): Non-inferiority RCT comparing surgery to non-operative care . Medial epicondyle fractures (SCIENCE): Superiority RCT comparing surgery to non-operative care Slipped Femoral Epiphysis (Big BOSS): Superiority RCT comparing intracapsular reduction to pinning-in-situ. Data Enabled Trials In Developmental Hip Dysplasia (DDH): 1 in 1000 babies are born with a completely dislocated hip, and more with minor dysplasia. Although there is a national screening programme, the national screening committee have acknowledged that two-thirds of dislocated hips are missed by current policy. Even when diagnosed, there is no agreement concerning treatment pathways. Trials are needed to develop the evidence to inform screening and treatment policy. The national screening programme in England has recently launched a database, Smart4NIPE, in which it is mandated that the details of each baby screened is recorded. I am national advisor to the hip screening programme, and have agreement from the Director of Screening at PHE, to develop research within routine care. I will enrich the dataset within Smart4NIPE to collect the key parameters of a newly defined 'core measurement set', ensure the quality of the data collected and develop a module to enable randomisation at the point of screening and treatment. This will enable world-leading observational studies and data-enabled trials through routine care, in a pathway that affects almost every baby born throughout the world. Building Capacity: I will develop the UK Trauma and Orthopaedic Trials (TOTs) for Children Collaborative, lead the development of international clinical trials, and ensure sustainability through the development of new Chief Investigators.