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J Trauma Acute Care Surg. 2018 Dec 26. doi: 10.1097/TA.0000000000002172. [Epub ahead of print]

Pediatric Emergency Department Readiness Among US Trauma Hospitals.

Author information

1
Dell Medical School, University of Texas at Austin.
2
EMS for Children Innovation and Improvement Center.
3
Office of the Medical Director, Austin/Travis County EMS System.
4
San Marcos Hays County EMS System.
5
Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine.
6
National EMSC Data Analysis Resource Center.
7
Maternal Child Health Bureau, Health Resources and Service Administration, Health and Human Services.

Abstract

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 National Pediatric Readiness Project to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association (AHA) 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 chi-square. Adjusted relative risks (ARR) 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 centers had higher WPRS than level 3 and 4 trauma centers, 83.5 and 71.8 respectively versus 64.9 and 62.6. Yet, compared to 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 inter-facility 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, non-Children's trauma hospitals, gaps in pediatric readiness exist. Non-children'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:

Prognostic and epidemiological study, level III.

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