Hospital Choice can Affect Pediatric Mortality During Emergencies

Child death rate is higher in hospitals which have emergency departments with lower pediatric readiness, reports a new study.

Child's chance of survival in an emergency may depend on the hospital where they receive care, reports a new study. The findings of the study are published in the journal Pediatrics.

Critically ill children brought to hospital emergency departments that are ill-prepared to care for pediatric emergencies have more than three times the odds of dying compared to those brought to hospitals well-equipped to care for them, according to an analysis led by the University of Pittsburgh and University of California-Los Angeles physician-scientists.

Infant and Child Mortality Rates Fall in Madhya Pradesh
Madhya Pradesh witnesses a decline in the infant and child mortality rates during the 2005-2016 period.

‘Emergency department with lower pediatric readiness is associated with increased death rate in children with critical illness. ’

The findings are the first to provide evidence from multiple states linking the readiness of hospital emergency departments to care for critically ill or injured children with outcomes and could guide a variety of policy responses.

"Pediatric care requires specialized equipment, training, and protocols to provide the best care to children. Obtaining that kind of preparedness is costly and time-consuming," said senior author Jeremy Kahn, M.D., M.S., a professor in the Department of Critical Care Medicine at Pitt's School of Medicine and the Department of Health Policy and Management at Pitt's Graduate School of Public Health. "Our study suggests that efforts to better prepare hospitals to care for pediatric emergencies save lives."

Kahn and his colleagues obtained data from 426 hospitals in Florida, Iowa, Massachusetts, Nebraska, and New York, on 20,483 critically ill patients age 18 or younger who were brought to the hospital emergency department. They cross-referenced the patient outcomes with the "pediatric readiness" of the hospital's emergency department.

Child Mortality Rate in the US Needs To Go Down
Infants in the U.S. were 76% more likely to die and children 1 to 19 years old were 57% more likely to die than their counterparts in peer nations.

Pediatric readiness is indicated by a score assigned following assessment by the National Pediatric Readiness Project, a quality improvement effort of several federal governments and non-profit advocacy organizations. Hospitals receive higher scores based on several factors, including whether they have equipment designed for use on children, pediatric-specific protocols for medical procedures and care, and educational programming to keep clinicians up-to-date on the latest guidelines in pediatric care. The standardized readiness score ranges from 0 to 100.

The team divided the hospitals into four groups based on their pediatric readiness score, with the lowest quartile's scores ranging from 29.6 to 59.3, and the highest from 88.2 to 99.9. Hospitals in the lowest quartile had a pediatric mortality rate for critically ill children of 11.1%, compared to 3.4% for the highest quartile.

India has to Step Up in Reducing Child Mortality, Says Venkaiah Naidu
Vice President M. Venkaiah Naidu on Sunday said the country has to step up efforts to reduce children's mortality and achieve the UN's Sustainable Developmental Goals.

"Our findings indicate that it matters which hospital a critically ill or injured child is brought to in an emergency," said co-author Jennifer Marin, M.D., M.Sc., an emergency physician at UPMC Children's Hospital of Pittsburgh and associate professor of pediatrics and emergency medicine in Pitt's School of Medicine. "A hospital's pediatric readiness should be a factor in determining which hospital a critically ill child should be transported."

There likely isn't one perfect solution to the disparity in outcomes, noted lead author Stefanie Ames, M.D., M.S., a pediatrician specializing in critical care medicine at UCLA Mattel Children's Hospital and assistant professor in the Division of Pediatric Critical Care at UCLA David Geffen School of Medicine.

Remarkable Progress in Reducing Child Mortality and Improving Maternal Health: Report
In relatively little time, rapid expansion of programs to prevent HIV transmission to babies and vaccinate children can be achieved.

"Should we focus only on improving the pediatric readiness of all hospitals, potentially investing money and resources in hospitals that rarely see children? Or should we do more to direct pediatric emergencies to hospitals well-equipped to care for them, potentially increasing transport times?" she asked.

"Some combination will likely be needed, and potential solutions also could incorporate telemedicine and processes to promote quick recognition and transfer of pediatric emergencies to more prepared hospitals."

Source-Eurekalert