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.
Pediatrics. 2019 Sep;144(3). doi: 10.1542/peds.2019-0568.
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%; < .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; < .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.
急诊科在儿科急救准备方面存在差异。我们评估了急诊科儿科急救准备情况对危重病儿童死亡率的影响。
我们在佛罗里达州、爱荷华州、马萨诸塞州、内布拉斯加州和纽约州进行了一项回顾性队列研究，研究对象为年龄在 0 至 18 岁之间的危重病患者，定义为需要入住重症监护病房或在就诊期间死亡的患者。我们使用了医疗保健研究和质量局医疗保健成本和利用项目的 ED 和住院管理数据，并与 2013 年国家儿科准备项目的医院特定数据进行了关联。使用多变量逻辑回归和分数多项式评估了整个队列和特定疾病亚组中医院特定儿科准备情况与就诊死亡率之间的关系。
我们研究了 20483 名危重病儿童，他们就诊于 426 家医院。加权儿科准备评分中位数为 74.8（四分位距：59.3-88.0；范围：29.6-100）。未调整的院内死亡率随准备评分的增加而降低（死亡率由最低到最高准备四分位数依次为：11.1%、5.4%、4.9%和 3.4%；趋势检验<0.001）。在调整年龄、慢性复杂疾病和疾病严重程度后，就诊于准备评分最高四分位的医院与降低院内死亡率的可能性相关（与最低四分位数相比，调整后的优势比：0.25；95%置信区间：0.18-0.37；<0.001）。在特定亚组中也观察到了类似的结果。
就诊于儿科急救准备程度高的医院与死亡率降低相关。增加急诊科儿科急救准备的努力可能会改善患者的预后。
