Mortality during hospitalization as well as mortality at one year after discharge is reduced among children with injuries or medical problems, if they receive emergency care in emergency departments (EDs) with high pediatric readiness, according to a retrospective cohort study published in JAMA Network Open.¹ It goes on to suggest that enhancing the level of pediatric readiness of EDs would have prevented a greater number of deaths.

The current study evaluated 983 emergency departments in 11 states in the US involving 796,937 children over a period of 6 years to study if adopting readiness standards would lower the in-hospital mortality and 1-year mortality among children hospitalized in ED for serious injury (90,963; 11.4%) or illness (n=705,974; 88.6%) from January 2012 to December 2017. The follow-up period was one year.

ED Pediatric Readiness was measured through the weighted Pediatric Readiness Score (wPRS) from the 2013 NPRP assessment, with scores ranging from 0 to 100 with higher scores indicative of better readiness. The EDs were grouped into four quartiles depending on the level of implementation of the standards (first quartile, 0-58; second quartile, 59-72; third quartile, 73-87; fourth quartile, 88-100). Among the 983 EDs, the median wPRS was 73. Six domains of preparedness were used to evaluate Readiness viz. coordination, personnel, quality improvement, safety, policies and equipment.

Managing children with medical illnesses in high-readiness EDs (quartile 4) reduced their risk of dying by 76% during hospitalization versus children treated in EDs in the lowest quartile of readiness (quartile 1) with an adjusted odds ratio of 0.24. Likewise, the mortality was 60% lower among children with injuries managed at high-readiness EDs (aOR 0.40).

In a subgroup of around 546,000 children in six states followed up for one year after discharge, the 1-year mortality was reduced by 66% among children with medical problems in the highest quartile of implementation of standards in comparison to children managed in hospitals in the lowest readiness quartile (aOR 0.34). Children with injuries in EDs in the highest quartile had a 41% lower chance of dying within a year (aOR 0.59). “If all these EDs had high pediatric readiness, an estimated 1442 pediatric deaths may have been prevented,” note the authors.

These findings indicate that managing children with injuries or medical illnesses in high-readiness EDs is associated with lower in-hospital mortality, including deaths occurring in the ED, which was the primary outcome of the study. Prevention of early deaths in the ED prevents long-term mortality. These findings have implications for policy makers including accreditation bodies for formulating ED pediatric readiness standards.

The National Pediatric Readiness Project is quality improvement initiative to ensure that all EDs in the US have the necessary guidelines and resources in place to improve the quality and consistency of care for children.^2,3 This includes care coordination, personnel and competencies, quality improvement, patient safety, policies and procedures and availability of key equipment and supplies.²

Reference

1. Newgard CD, et al; Pediatric Readiness Study Group. Emergency department pediatric readiness and short-term and long-term mortality among children receiving emergency care. JAMA Netw Open. 2023 Jan 3;6(1):e2250941. doi: 10.1001/jamanetworkopen.2022.50941.
2. https://www.nih.gov/news-events/news-releases/adopting-pediatric-readiness-standards-improves-survival-hospital-emergency-departments. Dated January 13, 2023, Accessed on January 16, 2023.
3. https://emscimprovement.center/domains/pediatric-readiness-project/.