Critically ill children treated at emergency departments (EDs) that are well prepared to handle young patients have the best odds of survival, a new study found.
However, researchers said most children don’t live near such a facility.
“Efforts are needed to improve the pediatric readiness of EDs that care for children, ensuring critically ill children have access to timely, well-resourced, and effective emergency care,” they wrote in “Emergency Department Pediatric Readiness and Mortality in Critically Ill Children,” (Ames SG, et al. Pediatrics. Aug, 23, 2019, https://doi.org/10.1542/peds.2019-0568).
The team looked at the relationship between pediatric readiness and mortality using data on a nationally representative sample of 20,483 critically ill children treated at 426 hospitals.
Data on how ready each ED was to handle these patients came from the 2013 National Pediatric Readiness Project. The assessment consists of a 55-item questionnaire and is supported by the AAP, Emergency Medical Services for Children program, Emergency Nurses Association and American College of Emergency Physicians. Hospitals in the study had an average weighted readiness score of 74.8 on a scale of 29.6 to 100.
Unadjusted mortality rates ranged from 3.4% at EDs in the highest readiness quartile to 11.1% at EDs in the lowest readiness quartile, according to the study. Results adjusted for patient characteristics like age and illness severity also showed the highest readiness quartile was associated with the lowest mortality rates.
Hospitals with extremely low scores did not see this same association, however this group had a small number of hospitals and patients, authors noted.
“Primarily, our findings suggest that patient outcomes may be improved by increasing the readiness of hospitals to care for pediatric emergencies,” they wrote.
Small hospitals in small communities tended to have lower readiness scores. Some common features they lacked were policies specific to children, pediatric resuscitation equipment, a pediatric care coordinator, resources for pediatric medication dosing and written guidelines on transferring children to other facilities, according to the study.
Authors suggested facilities collaborate to share resources.
“Although these efforts are difficult and resource intensive, our findings suggest that they have the potential to improve clinical outcomes, particularly for children at high risk,” they wrote.
They also recommended using telemedicine and regionalized systems of transporting children to facilities better equipped to handle their needs.
“More work is needed to identify the barriers to adopting these approaches,” authors wrote, “and to develop strategies to effectively incorporate them into the pediatric emergency care landscape.”
