A recent study suggested that improvements in pediatric readiness in emergency departments might be associated with reduced child mortality rates at trauma centers, though the findings were not statistically significant. The study examined changes in emergency departments pediatric readiness from 2013 to 2021 and their association with pediatric mortality rates across U.S. trauma centers.

This retrospective cohort study, published in JAMA Network Open, conducted from January 1, 2012, through December 31, 2021, included 467,932 injured children treated at 417 trauma centers across 48 states and the District of Columbia. Pediatric readiness was measured using the weighted Pediatric Readiness Score (wPRS), which ranged from 0 to 100, with higher scores indicating greater readiness. The wPRS assessed various aspects of emergency departments (EDs) readiness, including care coordination, personnel, quality improvement, safety, policies and procedures, and equipment.

The study categorized EDs into four readiness change groups based on their wPRS in 2013 and 2021: high-high (wPRS ≥93 in both years), low-high (wPRS <93 in 2013 and ≥93 in 2021), high-low (wPRS ≥93 in 2013 and <93 in 2021), and low-low (wPRS <93 in both years).

Observed mortality rates varied among these groups:

• High-high: 1.7% (2,614 deaths among 155,485 children)
• Low-high: 2.0% (1,288 deaths among 64,544 children)
• High-low: 1.7% (1,804 deaths among 103,767 children)
• Low-low: 2.7% (3,838 deaths among 144,136 children)

After risk adjustment, the study estimated that trauma centers with high readiness levels (persistent or improved) were associated with 643 additional lives saved (95% CI, -328 to 1,599). Conversely, low-readiness EDs (persistent or decreased) were associated with an estimated 729 additional preventable deaths (95% CI, -373 to 1,831). However, it was crucial to note that these estimates were not statistically significant, as the confidence intervals included zero.

Among 716 trauma centers that completed both assessments, the median wPRS decreased from 81 in 2013 to 77 in 2021, primarily due to reductions in care coordination and quality improvement. This decline was largely attributed to the loss of pediatric emergency care coordinators.

A secondary analysis suggested that a threshold of wPRS ≥90 might optimize the number of lives saved. When using this threshold, the study estimated 973 lives saved (95% CI, -499 to 2,445) for high-readiness hospitals and 618 lives lost (95% CI, 1 to 1,235) for low-readiness hospitals.

The study had some limitations, including potential bias toward higher-performing hospitals, which might have limited the statistical power to show differences. Additionally, the dichotomous definition of high vs. low ED readiness might have grouped hospitals with varying levels of readiness, potentially further reducing statistical power.

Despite these limitations, the findings suggested that changes in pediatric readiness in trauma centers might be associated with variations in mortality rates among injured children. The authors concluded that trauma centers should consider increasing their level of ED pediatric readiness to potentially reduce mortality and increase the number of pediatric lives saved after injury.

Full disclosures could be found in the published study.