美国创伤医院儿科急诊准备情况。
Pediatric emergency department readiness among US trauma hospitals.
机构信息
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.
出版信息
J Trauma Acute Care Surg. 2019 May;86(5):803-809. doi: 10.1097/TA.0000000000002172.
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 χ. 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.
背景
美国急诊部门对儿科的准备情况并非普遍存在。创伤医院遵循的标准可能支持日常为儿童提供的准备工作。
方法
2013 年，有 4146 家急诊部门参与了 NPRP，以评估其对 2009 年《儿童在急诊部护理指南》的遵守情况。通过概率链接（90%）到 2009 年美国医院协会的调查，发现了 1247 家自我认定的创伤医院（1 级、2 级、3 级、4 级）。对创伤医院水平与 100 分制加权儿科准备评分（WPRS）之间的关系进行了分析；采用 Kruskal-Wallis 检验评估显著性，采用 χ 检验评估儿科准备要素。采用修正泊松回归控制儿科量、医院配置和地理位置，计算调整后的相对风险。
结果
所有创伤医院的总体 WPRS 为 71.8。在那些没有自我认定为儿童医院或获得儿科批准的急诊部（EDAP）的医院中（1088 家），1 级和 2 级创伤医院的 WPRS 高于 3 级和 4 级创伤医院，分别为 83.5 和 71.8，而 64.9 和 62.6。然而，与 EDAP 创伤医院（中位数为 90.5）相比，1 级普通创伤医院更不可能具备关键的儿科特定要素。普通创伤医院普遍存在的差距包括为儿童制定的设施间转移协议、仅用公斤衡量儿童体重、有针对儿科的质量改进过程以及包含儿科特定需求的灾难计划。
结论
自我认定的创伤医院级别可能不能转化为急诊科的儿科准备情况。在所有非 EDAP、非儿童创伤医院的普通创伤医院各级中，都存在儿科准备方面的差距。非儿童医院急诊部（即 EDAP）可以为满足所有儿童的急诊需求做好准备，而创伤医院的指定应纳入这些儿科准备的核心要素。
证据等级
护理管理，三级。
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