Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland.
Department of Health Policy, School of Medicine, Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, California.
JAMA Netw Open. 2024 Nov 4;7(11):e2442154. doi: 10.1001/jamanetworkopen.2024.42154.
High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown.
To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024.
EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness).
Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness.
A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.
In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children's lives each year.
高急诊部（ED）儿科准备情况与接受紧急护理的儿童的生存率提高有关，但达到高 ED 准备情况的州和国家成本以及可能挽救的生命数量尚不清楚。
估计将所有 ED 提高到高儿科准备情况的州和国家年度成本，以及每年可能挽救的儿科生命数量。
设计、设置和参与者：这项队列研究使用了 2012 年至 2022 年来自美国 50 个州和哥伦比亚特区的 ED 数据。合格的儿童为 0 至 17 岁，在接受美国 ED 紧急服务并需要入院、转院入院或在 ED 死亡（统称为高危儿童）。数据于 2023 年 10 月至 2024 年 5 月进行分析。
被认为具有高准备情况的 ED，加权儿科准备分数为 88 或以上（范围为 0 至 100，数字越高表示准备情况越高）。
达到高 ED 准备情况的年度医院支出以及通过普遍实现高 ED 准备情况可能挽救的儿科生命数量。
共有 842 家（17.4%；按州范围为 2.9%至 100%）的 4840 家 ED 中有高儿科准备情况。所有 ED 从目前水平提高到高儿科准备情况的年度美国成本为 207335302 美元（95%CI，188401692-226268912 美元），按州范围从每个儿童 0 美元到 11.84 美元不等。在每年出现的 7619 名儿童死亡中，2143 名（28.1%；95%CI，678-3608）可通过普遍实现高 ED 儿科准备情况来预防，人口调整后的州估计值从每年 0 到 69 名儿科死亡不等。
在这项队列研究中，估计将所有 ED 提高到高儿科准备情况将预防接受紧急服务的儿童中超过四分之一的死亡，这只需要适度的财政投资。提高 ED 儿科准备情况的州和国家政策每年可能挽救数千名儿童的生命。
