Department of Pediatrics, Center for Health and Technology, University of California Davis, Sacramento, California, USA.
Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
J Rural Health. 2022 Jan;38(1):293-302. doi: 10.1111/jrh.12566. Epub 2021 Mar 18.
Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California.
Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross-sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient-level confounders.
A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33-0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the "policies, procedures, and protocols" section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31-0.91).
Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.
儿科准备评分可能是衡量医院照顾儿童能力的有用指标。然而，将这些评分与患者结局或其他指标（包括需要进行院内转科）联系起来的证据有限。本研究旨在确定儿科准备评分与加利福尼亚州小型农村医院急诊科（ED）就诊的非创伤性儿童（<18 岁）进行院内转科的几率之间的关联。
将国家儿科准备项目评估的数据与加利福尼亚州全州卫生规划和发展办公室的 ED 和住院患者数据库相关联，对儿科院内转科进行横断面研究。在这些数据集之间手动匹配医院。对医院进行随机截距的逻辑回归，并对患者水平混杂因素进行调整。
共有 54 家医院和 135388 次就诊符合纳入标准。儿科准备评分较高（>70）的 ED 进行院内转科的调整后几率较低（aOR：0.55，95%CI：0.33-0.93），而儿科准备评分较低（≤70）的 ED 进行院内转科的调整后几率较高。与转科最相关的儿科准备部分是“政策、程序和方案”部分；与评分最低的 quartile 相比，评分最高的 quartile 的 ED 转科几率较低（aOR：0.54，95%CI：0.31-0.91）。
在小型农村医院就诊的儿科准备评分较高的儿科患者可能不太可能转科。建议进行更多研究，以调查与医院 ED 儿科准备相关的其他儿科结局。
