Understanding pediatric ED readiness: Quartiles, disparities, and cost

Nathan Kuppermann, MD, MPH, executive vice president and chief academic officer at Children’s National Hospital, emphasized the critical importance of pediatric readiness in emergency departments (EDs) and its potential to significantly improve outcomes for children.

“If you look at the topic of pediatric readiness, [it’s a] super important issue. The lay public will think that every emergency department is the same,” Kuppermann said. “However, their ability and preparedness to care for children is quite variable.”

Kuppermann noted that freestanding children’s hospitals, such as Children’s National, represent the highest levels of readiness, prepared to manage any pediatric emergency. Conversely, most children—approximately 85%—receive care in community EDs, where readiness levels vary widely, stated Kuppermann. Previous research categorized these EDs into 4 quartiles of preparedness, with significant differences in outcomes based on readiness level.

“They involve things like having a pediatric emergency care coordinator, making sure that they have protocols in place, [and] that all the tube sizes and equipment are ready for neonates all the way to adolescents,” Kuppermann said. “On average, it would cost the United States [$11.84] per child per year to raise all emergency departments to the high level of readiness.”

That figure was part of the results demonstrated in a study published in early November 2024 in JAMA Network Open, conducted by Kuppermann, Craig Newgard, MD, MPH, et al.¹

According to results from the study, of the 7619 child deaths that occur annually after ED presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.¹

Kuppermann also underscored the role of high readiness in reducing health inequities. A recent study—led by Kuppermann's colleague Peter Jenkins, MD, MSc—demonstrated that as pediatric readiness improves, racial and ethnic disparities in care diminish.

“Raising to the highest bar of pediatric readiness not only improves outcomes for children, [but] it also serves to diminish or decrease inequities of care,” said Kuppermann.

The cohort study found that of 633,536 children treated in 586 EDs across 11 states, the mortality of Black children was greater than that of White children at all quartile levels of readiness. This was observed among individuals with acute medical emergencies, but not traumatic injuries.²

"Increased readiness was associated with decreased mortality overall, and it decreased most for Black children with acute medical emergencies," wrote Jenkins, Kuppermann, et al, according to study results.²

In conclusion, Kuppermann urged systemic changes to ensure all EDs meet the highest readiness standards.

“It’s not very expensive," he said. "We can certainly afford it in this country, and we certainly owe it to the children of this country and their families to make sure that every ED meets that highest standard.”

References:

1. Newgard CD, Lin A, Goldhaber-Fiebert JD, et al. State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved. JAMA Netw Open. 2024;7(11):e2442154. doi:10.1001/jamanetworkopen.2024.42154

2. Jenkins PC, Lin A, Ames SG, et al. Emergency Department Pediatric Readiness and Disparities in Mortality Based on Race and Ethnicity. JAMA Netw Open. 2023;6(9):e2332160. doi:10.1001/jamanetworkopen.2023.32160