Does the readiness of emergency services impact mortality?

Not all emergency departments have the staff and equipment necessary to provide optimal care to children. A new study examines whether a high degree of readiness for pediatric patients in hospital emergency departments is linked to an improvement in the long-term outcomes for children who are treated in them.¹

Investigators ran a retrospective cohort study that examined injured children aged younger than 18 years who lived in 8 states and had either admission, transfer to, or injury-related death at 1 of 146 trauma centers that were participated. Children were included in the study, regardless of whether treatment occurred in their state of residence. They created subgroups for children such as Injury Severity Score (ISS) of 16 or more; any Abbreviated Injury Scale (AIS) score of 3 or more; head AIS score of 3 or more; and need for early critical resources. Data were from January 2012 to December 2017 and follow-up occurred through December 2018. The initial readiness of the emergency departments was assessed using the weighted Pediatric Readiness Score (range, 0-100) from the 2013 National Pediatric Readiness Project assessment.

There were 88,071 children included in the study who had a median age of 11 years. The investigators found that 1974 of them died within a year of the first emergency department visit, which included 1768 who died during the course of hospitalization and 206 who died after being discharged. The subgroups included 12,752 (14.5%) with an ISS of 16 or more, 28 402 (32.2%) with any AIS score of 3 or more, 13,348 (15.2%) with a head AIS of 3 or more, and 9048 (10.3%) requiring early critical resources. When compared to emergency departments in the lowest weighted Pediatric Readiness Score quartile, children who were cared for in emergency departments in the highest quartile had lower hazard of death to 1 year (adjusted hazard ratio, 0.70; 95% CI, 0.56-0.88).

The investigators concluded that being treated in a trauma center emergency department with a high degree of readiness was linked to a lower risk of death that lasted to 1 year. Furthermore, a high level of readiness was independently linked to long-term survival among children with injuries. The findings continue to confirm that care tailored to children’s needs leads to better outcomes.

Reference

1. Newgard C, Lin A, Goldhaber-Fiebert J, et al. Association of emergency department pediatric readiness with mortality to 1 year among injured children treated at trauma centers. JAMA Surg. February 2, 2022.Epub ahead of print. doi:10.1001/jamasurg.2021.7419