Emergency Department Pediatric Readiness and Short-term and Long-term Mortality Among Children Receiving Emergency Care.
Emergency Department Pediatric Readiness and Short-term and Long-term Mortality Among Children Receiving Emergency Care.
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DOI：
10.1001/jamanetworkopen.2022.50941
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发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Mann, N. Clay
中科院分区：
文献类型：
--
作者：
Newgard, Craig D.;Lin, Amber;Malveau, Susan;Cook, Jennifer N. B.;Smith, McKenna;Kuppermann, Nathan;Remick, Katherine E.;Gausche-Hill, Marianne;Goldhaber-Fiebert, Jeremy;Burd, Randall S.;Hewes, Hilary A.;Salvi, Apoorva;Xin, Haichang;Ames, Stefanie G.;Jenkins, Peter C.;Marin, Jennifer;Hansen, Matthew;Glass, Nina E.;Nathens, Avery B.;McConnell, K. John;Dai, Mengtao;Carr, Brendan;Ford, Rachel;Yanez, Davis;Babcock, Sean R.;Lang, Benjamin;Mann, N. Clay
高急诊（艾德）儿科准备（6个准备领域）是否与儿童的短期和长期死亡率降低相关？在这项队列研究中，796937名儿童在983个ED中接受护理，与高准备ED护理相关的院内死亡几率降低了60%至76%;在545921名住院后随访的儿童中，高准备ED的益处持续了1年。如果所有这些急诊室都做好儿科准备，估计可能可以避免1442例儿科死亡。这些研究结果表明，在儿科准备程度较高的急诊室进行护理与儿童的短期和长期死亡率较低相关。本队列研究评估了11个州接受急诊护理的受伤和内科疾病儿童的急诊科（艾德）儿科准备情况、住院死亡率和1年死亡率之间的关系。儿科准备程度高（协调、人员、质量改进、安全、政策和设备）的急诊科（ED）与危重病儿童和创伤中心收治儿童的死亡率较低相关，但临床条件更多样化的儿童的获益尚不清楚。评估11个州接受急诊护理的受伤和内科疾病儿童的艾德儿科准备状态、住院死亡率和1年死亡率之间的关系。这是一项回顾性队列研究，研究对象为2012年1月1日至2017年12月31日期间在11个州的983个急诊室接受急诊护理的儿童，并对一部分儿童进行随访至2018年12月31日。参与者包括18岁以下的儿童入院，转移到另一家医院，或在艾德死亡，分层的伤害与医疗条件。数据分析于2021年11月1日至2022年6月30日进行。初始艾德的艾德儿科准备状态，通过2013年国家儿科准备项目评估的加权儿科准备状态评分（wPRS;范围，0-100）进行测量。主要结局是住院死亡率，次要结局是6个州儿童的死亡时间至1年。儿童796 937人，其中90 963人（11.4%）在损伤队列中（平均[SD]年龄，9.3 [5.8]岁;中位[IQR]年龄，10 [4-15]岁; 33 516 [36.8%]女性; 1820例[2.0%]死亡）和705 974例（88.6%）（平均[SD]年龄，5.8 [6.1]岁;中位[IQR]年龄，3 [0-12]岁; 329 829例[46.7%]女性，7688例[1.1%]死亡）。在983例ED中，中位数（IQR）wPRS为73（59-87）。与艾德准备状态最低四分位数的ED相比（四分位数1，wPRS为0-58），四分位数4艾德的初始治疗（wPRS为88-100）与受伤儿童住院死亡率降低60%相关（调整后的优势比，0.40; 95%CI，0.26-0.60）和76%的死亡率降低医疗儿童（调整后的优势比，0.24; 95%CI，0.17-0.34）。在随访至1年的545921名儿童中，受伤儿童和医疗儿童四分位数4 ED死亡的校正风险比分别为0.59（95%CI，0.42-0.84）和0.34（95%CI，0.25-0.45）。如果所有ED均处于儿科准备状态的最高四分位数，估计可预防288例损伤死亡（95% CI，281-297例损伤死亡）和1154例医疗死亡（95% CI，1150-1159例医疗死亡）。这些研究结果表明，儿童受伤和医疗条件下治疗的急诊科与高儿科准备有较低的死亡率在住院期间和1年。
Is high emergency department (ED) pediatric readiness (6 domains of preparedness) associated with lower short-term and long-term mortality among children? In this cohort study of 796 937 children cared for in 983 EDs, there was 60% to 76% lower odds of in-hospital death associated with care in high-readiness EDs; among a subset of 545 921 children followed up beyond hospitalization, the benefit of high-readiness EDs persisted to 1 year. If all these EDs had high pediatric readiness, an estimated 1442 pediatric deaths may have been prevented. These findings suggest that care in EDs with high pediatric readiness is associated with lower short-term and long-term mortality among children. This cohort study evaluates the association between emergency department (ED) pediatric readiness, in-hospital mortality, and 1-year mortality among injured and medically ill children receiving emergency care in 11 states. Emergency departments (EDs) with high pediatric readiness (coordination, personnel, quality improvement, safety, policies, and equipment) are associated with lower mortality among children with critical illness and those admitted to trauma centers, but the benefit among children with more diverse clinical conditions is unknown. To evaluate the association between ED pediatric readiness, in-hospital mortality, and 1-year mortality among injured and medically ill children receiving emergency care in 11 states. This is a retrospective cohort study of children receiving emergency care at 983 EDs in 11 states from January 1, 2012, through December 31, 2017, with follow-up for a subset of children through December 31, 2018. Participants included children younger than 18 years admitted, transferred to another hospital, or dying in the ED, stratified by injury vs medical conditions. Data analysis was performed from November 1, 2021, through June 30, 2022. ED pediatric readiness of the initial ED, measured through the weighted Pediatric Readiness Score (wPRS; range, 0-100) from the 2013 National Pediatric Readiness Project assessment. The primary outcome was in-hospital mortality, with a secondary outcome of time to death to 1 year among children in 6 states. There were 796 937 children, including 90 963 (11.4%) in the injury cohort (mean [SD] age, 9.3 [5.8] years; median [IQR] age, 10 [4-15] years; 33 516 [36.8%] female; 1820 [2.0%] deaths) and 705 974 (88.6%) in the medical cohort (mean [SD] age, 5.8 [6.1] years; median [IQR] age, 3 [0-12] years; 329 829 [46.7%] female, 7688 [1.1%] deaths). Among the 983 EDs, the median (IQR) wPRS was 73 (59-87). Compared with EDs in the lowest quartile of ED readiness (quartile 1, wPRS of 0-58), initial care in a quartile 4 ED (wPRS of 88-100) was associated with 60% lower in-hospital mortality among injured children (adjusted odds ratio, 0.40; 95% CI, 0.26-0.60) and 76% lower mortality among medical children (adjusted odds ratio, 0.24; 95% CI, 0.17-0.34). Among 545 921 children followed to 1 year, the adjusted hazard ratio of death in quartile 4 EDs was 0.59 (95% CI, 0.42-0.84) for injured children and 0.34 (95% CI, 0.25-0.45) for medical children. If all EDs were in the highest quartile of pediatric readiness, an estimated 288 injury deaths (95% CI, 281-297 injury deaths) and 1154 medical deaths (95% CI, 1150-1159 medical deaths) may have been prevented. These findings suggest that children with injuries and medical conditions treated in EDs with high pediatric readiness had lower mortality during hospitalization and to 1 year.
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影响因子：
2.4
作者：
Feudtner C;Feinstein JA;Zhong W;Hall M;Dai D
通讯作者：
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影响因子：
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作者：
Ames, Stefanie G.;Davis, Billie S.;Kahn, Jeremy M.
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DOI：
10.1097/00005373-197403000-00001
发表时间：
1974-01-01
影响因子：
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作者：
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通讯作者：
LONG, WB
影响因子：
2
作者：
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通讯作者：
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影响因子：
16.9
作者：
Newgard, Craig D.;Lin, Amber;Burd, Randall S.
通讯作者：
Burd, Randall S.