Rice Amber, Dudek Jennifer, Gross Toni, St Mars Tomi, Woolridge Dale
Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.
Arizona Department of Health Services, Phoenix, Arizona.
J Emerg Med. 2017 Jun;52(6):894-901. doi: 10.1016/j.jemermed.2017.02.011. Epub 2017 Mar 22.
The Emergency Medical Services for Children State Partnership Program, as well as the Institute of Medicine report on pediatric emergency care, encourages recognition of emergency departments (EDs) through categorization and verification systems. Although pediatric verification programs are associated with greater pediatric readiness, clinical outcome data have been lacking to track the effects and patient-centered outcomes by implementing such programs.
To describe pediatric mortality rates prior to and after implementation of a pediatric emergency facility verification system in Arizona.
This was a cross-sectional study conducted using data from ED visits between 2011 and 2014 recorded in the Arizona Hospital Discharge Database. The primary outcome measure was the mortality rate for ED visits by patients under 18 years old. Rates were compared prior to and after facility certification by the Arizona Pediatric Prepared Emergency Care program.
The total number of ED visits by children during the study period was 1,928,409. Of these, 1,127,294 were at facilities undergoing certification. For hospitals becoming certified, overall ED mortality rates were 35.2 deaths/100,000 ED visits (95% confidence interval [CI] 29.5-41.7) in the precertification analysis and 34.4 deaths/100,000 ED visits (95% CI 30.4-38.9) in the postcertification analysis. The injury-related ED visit mortality rate for certified hospitals showed a decrease from 40.0 injury-related deaths/100,000 ED visits (95% CI 28.6-54.4) in the precertification analysis to 25.8 injury-related deaths/100,000 ED visits (95% CI 18.7-34.8) in the postcertification analysis.
The implementation of the Arizona pediatric ED verification system was associated with a trend toward lower mortality. These results offer a platform for further research on pediatric ED preparedness efforts and their effects on improved patient outcomes.
儿童紧急医疗服务州合作项目以及医学研究所关于儿科急诊护理的报告，鼓励通过分类和核查系统来认可急诊科（ED）。尽管儿科核查项目与更高的儿科应急准备相关，但一直缺乏临床结局数据来追踪实施此类项目的效果及以患者为中心的结局。
描述亚利桑那州实施儿科急诊设施核查系统前后的儿科死亡率。
这是一项横断面研究，使用亚利桑那州医院出院数据库中记录的2011年至2014年急诊科就诊数据。主要结局指标是18岁以下患者急诊科就诊的死亡率。对亚利桑那州儿科应急准备急诊护理项目进行机构认证前后的死亡率进行比较。
研究期间儿童急诊科就诊总数为1,928,409次。其中，1,127,294次是在接受认证的机构就诊。对于获得认证的医院，在认证前分析中，急诊科总体死亡率为每100,000次急诊科就诊35.2例死亡（95%置信区间[CI] 29.5 - 41.7），在认证后分析中为每100,000次急诊科就诊34.4例死亡（95% CI 30.4 - 38.9）。获得认证医院与损伤相关的急诊科就诊死亡率显示从认证前分析中的每100,000次急诊科就诊40.0例损伤相关死亡（95% CI 28.6 - 54.4）降至认证后分析中的每100,000次急诊科就诊25.8例损伤相关死亡（95% CI 18.7 - 34.8）。
亚利桑那州儿科急诊科核查系统的实施与死亡率降低趋势相关。这些结果为进一步研究儿科急诊科应急准备工作及其对改善患者结局的影响提供了一个平台。
