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Pediatric emergency department readiness among US trauma hospitals

Remick, Katherine, MD; Gaines, Barbara, MD; Ely, Michael; Richards, Rachel, MStat; Fendya, Diana, MSN; Edgerton, Elizabeth A., MD

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 803–809
doi: 10.1097/TA.0000000000002172
ORIGINAL ARTICLES
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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 NPRP to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association 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 χ2. Adjusted relative risks 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 hospitals had higher WPRS than level 3 and 4 trauma hospitals, 83.5 and 71.8, respectively versus 64.9 and 62.6. Yet, compared with 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 interfacility 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, nonchildren's trauma hospitals, gaps in pediatric readiness exist. Nonchildren'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 Care management, level III.

From the Dell Medical School, University of Texas at Austin (K.R.), Austin, Texas; EMS for Children Innovation and Improvement Center (K.R., D.F.), Houston, Texas; Office of the Medical Director, Austin/Travis County EMS System (K.R.), Austin, Texas; San Marcos Hays County EMS System (K.R.), San Marcos, Texas; Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine (B.G.), Pittsburgh, Pennsylvania; National EMSC Data Analysis Resource Center (M.E., R.R.), Salt Lake City, Utah; Maternal Child Health Bureau, Health Resources and Service Administration, Health and Human Services (E.A.E.), Rockville Maryland.

Submitted: October 14, 2016, Revised: October 18, 2018, Accepted: December 14, 2018, Published online: December 26, 2018.

Meeting Presentations: 3rd Annual Meeting of the Pediatric Trauma Society, November 11-12, 2016 in Nashville, TN.

Address for reprints: Katherine Remick, MD, Department of Emergency Medicine, Dell Children's Medical Center, 4900 Mueller Blvd., Austin, TX 78723; email: kate.remick@austintexas.gov.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2019 Lippincott Williams & Wilkins, Inc.