Pediatric Emergency Department Readiness Among US Trauma Hospitals

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 National Pediatric Readiness Project to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association (AHA) 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 chi-square. Adjusted relative risks (ARR) 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 centers had higher WPRS than level 3 and 4 trauma centers, 83.5 and 71.8 respectively versus 64.9 and 62.6. Yet, compared to 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 inter-facility 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, non-Children’s trauma hospitals, gaps in pediatric readiness exist. Non-children’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 Prognostic and epidemiological study, level III. Corresponding Author: Katherine Remick, MD, Department of Emergency Medicine, Dell Children’s Medical Center, 4900 Mueller Blvd., Austin, TX 78723, Phone: (512)393-1496, Email: kate.remick@austintexas.gov Conflicts of Interest: The authors report no conflicts of interest. Meeting Presentations: 3rd Annual Meeting of the Pediatric Trauma Society, November 11-12, 2016 in Nashville, TN Funding: This project was also partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U03MC00008 - Emergency Medical Service for Children Network Development. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. © 2018 Lippincott Williams & Wilkins, Inc.

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