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Pediatrics. 2019 Sep;144(3). pii: e20190568. doi: 10.1542/peds.2019-0568.

Emergency Department Pediatric Readiness and Mortality in Critically Ill Children.

Author information

Division of Pediatric Critical Care, Departments of Pediatrics and.
Critical Care Medicine and The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, School of Medicine and.
Departments of Pediatrics.
Emergency Medicine, and.
Division of Critical Care and Department of Pediatrics, National Emergency Medical Services for Children Data Analysis Resource Center, School of Medicine, The University of Utah, Salt Lake City, Utah.
Emergency Medicine and Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, California; and.
Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California.
Critical Care Medicine and The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, School of Medicine and
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.



Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children.


We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials.


We studied 20 483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3-88.0; range: 29.6-100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P < .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18-0.37; P < .001). Similar results were seen in specific subgroups.


Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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