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The Association Between Pediatric Readiness and Mortality for Injured Children Treated at US Trauma Centers
Caroline Melhado1,2, Katherine Remick3, Amy Miskovic4
1Department of Surgery, Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA.
Insights
Achieving a weighted Pediatric Readiness Score (wPRS) of 93 or higher in trauma centers is associated with lower child mortality. Pediatric-specific quality improvement plans are crucial for improving emergency department readiness.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Healthcare Quality Improvement
Background:
- Most children in the U.S. receive initial trauma care at non-pediatric centers.
- The National Pediatric Readiness Project (NPRP) aims to ensure all emergency departments (EDs) are prepared for pediatric patients.
- Previous studies show higher wPRS correlates with lower pediatric trauma mortality.
Purpose of the Study:
- To identify an optimal threshold for pediatric readiness in trauma centers using 2021 wPRS data.
- To assess the relationship between wPRS and pediatric trauma patient mortality.
Main Methods:
- Retrospective analysis of trauma centers from the 2021 NPRP assessment and National Trauma Data Bank (2019-2021).
- Calculation of center-specific observed-to-expected mortality for children (0-15 years) using Pediatric Trauma Quality Improvement Program models.
- Comparison of mortality odds ratios across wPRS quartiles, including linkage for transferred patients.
Main Results:
- Analysis included 66,588 children from 630 centers; median wPRS was 79.
- Centers in the highest wPRS quartile (≥93) had significantly lower observed-to-expected mortality odds (1.02) compared to lower quartiles (1.19-1.28).
- A pediatric-specific quality improvement plan showed the strongest association with reduced mortality (standardized beta -0.095).
Conclusions:
- Trauma centers should prioritize improving pediatric readiness, aiming for a wPRS of 93 or higher.
- Implementing a pediatric-specific quality improvement plan is essential for reducing pediatric trauma mortality.
Objective:
To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness.
Background:
Most children in the United States receive initial trauma care at nonpediatric centers. The aim of the National Pediatric Readiness Project (NPRP) was to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade.
Study Design:
A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) from 2019 to 2021 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15 y) were calculated using Pediatric Trauma Quality Improvement Program models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Center-specific mortality odds ratios were then compared across quartiles of wPRS.
Results:
A total of 66,588 children from 630 centers with a median (interquartile range) wPRS of 79 (66-93) were analyzed. The average observed-to-expected odds of mortality [1.02 (0.97-1.06)] for centers in the highest quartile (wPRS≥93) was lower than any of the lowest 3 wPRS quartiles [1.19 (1.14-1.23) (Q1), 1.29 (1.24-1.33) (Q2), and 1.28 (1.19-1.36) (Q3), all P <0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality [standardized beta -0.095 (-0.146 to -0.044)].
Conclusion:
Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.
