Study shows emergency department preparedness reduces risk of infant mortality

(SACREMENTO)

A new study funded by the National Institutes of Health shows that emergency rooms that are better equipped to care for children have lower infant mortality rates.

The child is sitting in a chair, and the nurse is doing an ultrasound of the right hand
The study shows that children in emergency departments with high standards of pediatric readiness have lower infant mortality rates.

The six-year study was co-authored by Nathan Kuppermann, director of emergency medicine at the University of California, Davis. It was attended by about 800,000 children receiving emergency care in 11 states.

The project was led by Craig Newgard of the Oregon Health Sciences University. The researchers studied the relationship between high pediatric readiness and mortality. They looked at both in-hospital mortality and annual mortality among acutely ill and traumatized children receiving emergency care.

“The care a child receives in the emergency room may or may not set them on the path to survival,” Kuppermann explained. “The purpose of this study was to show the importance of preparing emergency departments to care for critically ill and injured children and to ensure that every child has access to high-quality emergency care.”

Pediatric emergency department readiness was measured using a weighted pediatric readiness scale (range 0 to 100) with six readiness areas. These include:

  1. Quality improvement
  2. Care coordination
  3. Personnel and competencies
  4. Policies and Procedures
  5. Patient safety
  6. Availability of basic equipment and consumables

The researchers found that traumatized children in high-availability emergency departments had a 60% lower chance of dying in the hospital. Those with acute illnesses had a 76% reduction. The team calculated that if all emergency departments on low alert were switched to high alert, lives could be saved: 288 lives among the injured and 1,154 lives among those with acute illness.

Nathan Kuppermann posing in a white coat.

The purpose of this study was to show the importance of preparing emergency departments to care for critically ill and injured children and to ensure that every child has access to high-quality emergency care.” Nathan Kuppermann

The team was able to measure outcomes up to one year in 545,921 children. During this time, there were 1,316 deaths in the trauma group, 693 of which occurred in the emergency department, 477 in the hospital, and 146 after hospital discharge. For comparison, there were 6,635 deaths in the medical group during this time: 4,150 in the emergency department, 759 in the hospital, and 1,726 after discharge.

Child mortality in emergency departments with low pediatric readiness occurred at a shorter time (within two days) than in departments with the highest readiness.

A total of 90.6% of injury deaths and 88.5% of medical deaths occurred within two days in low-availability hospitals. This is compared to 72.5% of injury deaths and 56.8% of medical deaths in emergency hospitals.

Children treated in high-availability emergency departments had the lowest risk of dying within one year.

The authors of the study believe that these results have implications for national policy. National hospital accreditation organizations could consider adopting high standards of pediatric emergency department readiness for all hospitals caring for children, with similar accreditation practices at the state level.

“Our results show that children in emergency departments with high standards of pediatric readiness have a lower risk of death after a critical illness or injury,” Kuppermann said. “Therefore, it is critical that all emergency departments implement robust pediatric preparedness standards so that they can be prepared to help save the lives of the children they serve.”

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