Written by Michael Wolf*
In-hospital mortality was decreased in critically ill children presenting to the ED in hospitals with higher weighted pediatric readiness scores (WPRS).
Why does this matter?
Children account for 20% of ED visits in the United States, with pediatric EDs accounting for a minority of these visits. We know that “pediatric readiness” varies between hospitals. What does this mean for children presenting with critical illness?
Ready or not…
Over 20,000 episodes of pediatric critical illness were identified in two databases representing 426 hospitals in five diverse U.S. states. Pediatric readiness was calculated using the WPRS, a validated scale noting the presence or absence of key hospital factors. In broad strokes, these included pediatric-specific physician and nurse coordinators, periodic competency evaluation programs, a formal quality improvement review process, the practice of recording temperature, heart rate, respiratory rate and weight in kilograms for every child, availability of pediatric-specific airway, IV, and other equipment, and formal transfer protocols. Hospitals with lower WPRS tended to be smaller, non-teaching, located in smaller communities, and were less likely to have a pediatric ED or PICU. Unadjusted mortality was 3.4% for the highest, and 11.1% for the lowest WPRS quartile. Adjusting for age, severity, and complexity of presentation, presenting to a hospital with WPRS in the highest quartile was associated with lower in-hospital mortality (aOR 0.25, p <0.001). Inter-hospital collaboration, education, and appointment of coordinators might help to address gaps in pediatric readiness.
Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics. 2019 Sep;144(3). pii: e20190568. doi: 10.1542/peds.2019-0568.
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Reviewed by Thomas Davis
*Dr. Wolf was a fellow at Pitt with Dr. Ames, lead author of this study. He is now back in Music City helping the critically ill children of Nashville. Welcome back and welcome to JF!