Emergency Department Pediatric Readiness and Mortality in Critically Ill Children
Emergency Department Pediatric Readiness and Mortality in Critically Ill Children
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DOI：
10.1542/peds.2019-0568
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发表时间：
2019-09-01
期刊：
影响因子：
8
通讯作者：
Kahn, Jeremy M.
中科院分区：
文献类型：
--
作者：
Ames, Stefanie G.;Davis, Billie S.;Kahn, Jeremy M.
背景：急诊科（ED）对儿科急诊的准备程度各不相同。我们评估了艾德儿科准备对危重病患儿死亡率的影响。方法：我们在佛罗里达、爱荷华州、马萨诸塞州、内布拉斯加州和纽约进行了一项回顾性队列研究，重点关注0至18岁的危重病患者，定义为需要重症监护入院或在遇到死亡。我们使用了来自医疗保健研究和质量机构的医疗保健成本和利用项目的艾德和住院管理数据，这些数据与2013年国家儿科准备项目的医院特定数据相关联。医院特定的儿科准备和遇到死亡率在整个队列和特定条件的亚组之间的关系进行了评估，通过使用多变量Logistic回归和分数多项式。结果：我们研究了20483危重病患儿提出的426家医院。加权儿科准备评分中位数为74.8（四分位数间距：59.3-88.0;范围：29.6-100）。未校正的住院死亡率随着准备状态评分的增加而降低（最低至最高准备状态四分位数的死亡率：11.1%，5.4%，4.9%和3.4%;趋势P <0.001）。调整年龄、慢性复杂疾病和疾病严重程度后，在最高准备四分位数的医院就诊与院内死亡率的比值降低相关（与最低四分位数相比，调整后的比值比：0.25; 95%置信区间：0.18-0.37; P <0.001）。在特定的亚组中也观察到了类似的结果。结论：儿科准备得分高的医院与死亡率降低相关。努力提高艾德对儿科急诊的准备可能会改善患者的预后。
BACKGROUND:Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children.METHODS:We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials.RESULTS:We studied 20483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3-88.0; range: 29.6-100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P < .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18-0.37; P < .001). Similar results were seen in specific subgroups.CONCLUSIONS:Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes.