High emergency department pediatric readiness associated with decreased mortality

1. In this retrospective cohort study, emergency departments (EDs) in the United States with high levels of ED pediatric readiness were associated with lower short-term and long-term mortality among a heterogenous group of hospitalized children receiving emergency care.

Evidence Rating Level: 2 (Good)

There are more than 30 million ED visits by children each year in the United States, and more than 97% of emergency departments caring for children are nonchildren’s hospitals, accounting for approximately 83% of pediatric ED visits. The National Pediatric Readiness Project (NPRP) was created as a national quality improvement initiative to improve the quality and consistency of pediatric care in EDs in the United States. High levels of ED pediatric readiness are associated with lower mortality among children with critical illness. Previous research has found an association between high ED pediatric readiness and survival to 1 year in trauma centers but not in other pediatric populations. This retrospective cohort study aims to evaluate the association between ED pediatric readiness and in-hospital and 1-year mortality among injured and medically ill patients receiving emergency care in the United States. Included were pediatric patients receiving emergency care in 983 Eds from January 1, 2012, to December 31, 2017. The primary outcome studied was in-hospital mortality including deaths in the ED. Overall, 796937 pediatric patients were hospitalized and met the inclusion criteria within the previously stated time. With respect to the primary outcome, the adjusted odds of dying in the hospital were 60% lower among children cared for in high-readiness EDs in the injury cohort (wPRS quartile 4 vs 1, adjusted odds ratio [aOR], 0.40; 95% CI, 0.26-0.60) and 76% lower in the medical cohort (aOR, 0.24; 95% CI, 0.17-0.34). The benefit of care in high pediatric readiness EDs was evident across all age groups. Even after accounting for ED structure, pediatric volume, ED admission volume, hospital type, and trauma level, the association between high pediatric readiness EDs and lower mortality remained. Overall, the findings of this cohort study suggest that a high level of ED pediatric readiness was associated with lower short-term and long-term mortality among a heterogenous group of hospitalized children receiving emergency care, A limitation of the study is the inclusion of only 11 states and the exclusion of low-volume EDs, which may have affected the findings. This study shows evidence of the consequences of low ED pediatric readiness and is an important step toward improving ED pediatric readiness across the United States.

Click to read the study in JAMA Network Open

Image: PD

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