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Pediatric emergency department readiness among US trauma hospitals
Katherine Remick1, Barbara Gaines, Michael Ely
1From the Dell Medical School, University of Texas at Austin (K.R.), Austin, Texas; EMS for Children Innovation and Improvement Center (K.R., D.F.), Houston, Texas; Office of the Medical Director, Austin/Travis County EMS System (K.R.), Austin, Texas; San Marcos Hays County EMS System (K.R.), San Marcos, Texas; Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine (B.G.), Pittsburgh, Pennsylvania; National EMSC Data Analysis Resource Center (M.E., R.R.), Salt Lake City, Utah; Maternal Child Health Bureau, Health Resources and Service Administration, Health and Human Services (E.A.E.), Rockville Maryland.
Insights
Pediatric readiness in US trauma hospitals varies. Higher-level trauma centers have better scores, but critical pediatric elements are often missing, highlighting gaps in emergency care for children.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Hospital Quality Improvement
Background:
- Pediatric readiness in U.S. emergency departments is inconsistent.
- Trauma hospitals have standards that may improve daily pediatric emergency care.
Purpose of the Study:
- To assess pediatric readiness in U.S. trauma hospitals.
- To determine if trauma hospital level correlates with pediatric readiness scores.
- To identify gaps in pediatric readiness among trauma hospitals.
Main Methods:
- Utilized data from 4,146 emergency departments in the 2013 National Pediatric Readiness Project (NPRP).
- Linked NPRP data with the American Hospital Association survey to identify 1,247 trauma hospitals (Levels 1-4).
- Analyzed the relationship between trauma hospital level and Weighted Pediatric Readiness Score (WPRS) using Kruskal-Wallis test and modified Poisson regression.
Main Results:
- The overall WPRS for trauma hospitals was 71.8.
- Level 1 and 2 trauma hospitals had higher WPRS (83.5 and 71.8) than Level 3 and 4 (64.9 and 62.6).
- General trauma hospitals, particularly Level 1, lacked critical pediatric elements like transfer agreements and specific quality metrics compared to EDAP-approved centers.
Conclusions:
- Trauma hospital designation alone does not guarantee pediatric readiness.
- Gaps in pediatric readiness exist across all levels of non-pediatric specialty trauma hospitals.
- Emergency departments approved for pediatrics (EDAPs) demonstrate preparedness, suggesting trauma designations should include core pediatric readiness elements.
Background:
Pediatric readiness among US emergency departments is not universal. Trauma hospitals adhere to standards that may support day-to-day readiness for children.
Methods:
In 2013 4,146 emergency departments participated in the NPRP to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association survey found 1,247 self-identified trauma hospitals (levels 1, 2, 3, 4). Relationship between trauma hospital level and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using χ. Adjusted relative risks were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography.
Results:
The overall WPRS among all trauma hospitals (1,247) was 71.8. Among those not self-identified as a children's hospital or emergency department approved for pediatrics (EDAP) (1088), Level 1 and 2 trauma hospitals had higher WPRS than level 3 and 4 trauma hospitals, 83.5 and 71.8, respectively versus 64.9 and 62.6. Yet, compared with EDAP trauma hospitals (median 90.5), level 1 general trauma hospitals were less likely to have critical pediatric-specific elements. Common gaps among general trauma hospitals included presence of interfacility transfer agreements for children, measurement of pediatric weights solely in kilograms, quality improvement processes with pediatric-specific metrics, and disaster plans that include pediatric-specific needs.
Conclusion:
Self-identified trauma hospital level may not translate to pediatric readiness in emergency departments. Across all levels of general non-EDAP, nonchildren's trauma hospitals, gaps in pediatric readiness exist. Nonchildren's hospital EDs (i.e., EDAPs) can be prepared to meet the emergency needs of all children and trauma hospital designation should incorporate these core elements of pediatric readiness.
Level Of Evidence:
Care management, level III.
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