Association of Emergency Department Pediatric Readiness With Mortality to 1 Year Among Injured Children Treated at Trauma Centers
Association of Emergency Department Pediatric Readiness With Mortality to 1 Year Among Injured Children Treated at Trauma Centers
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DOI：
10.1001/jamasurg.2021.7419
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发表时间：
2022-02-02
期刊：
影响因子：
16.9
通讯作者：
Burd, Randall S.
中科院分区：
文献类型：
--
作者：
Newgard, Craig D.;Lin, Amber;Burd, Randall S.
重要性有很大的差异，急诊科（ED）在他们准备照顾急性病和受伤的儿童，包括美国创伤中心。虽然高艾德儿科准备与在创伤中心治疗的儿童的住院存活率的提高有关，但高艾德准备与长期结果之间的关联尚不清楚。目的评估在146个创伤中心就诊的受伤儿童中，艾德儿科准备与1年存活率之间的关联。18岁以下的受伤儿童，他们是8个州的居民，在146个参与的创伤中心之一住院、转移或与伤害有关的死亡。包括在居住国内外被照料的儿童。亚组包括损伤严重度评分（ISS）为16或以上的患者;任何简化损伤量表（AIS）评分为3或以上的患者;头部AIS评分为3或以上的患者;以及需要早期关键资源的患者。数据收集时间为2012年1月至2017年12月，随访至2018年12月。对2021年1月至7月的数据进行了分析。EXPOSURES艾德儿科对初始艾德的准备情况，使用加权儿科准备情况评分进行测量（wPRS;范围，0-100）来自2013年国家儿科准备项目评估。主要结果和指标365天内死亡的时间。（34.8%）为女性; 2114（2.4%）为亚洲人，16730（10.0%）为黑人，49496（56.2%）为白色人;中位（IQR）年龄为11（5-15）岁。共有1974例（2.2%）在初次艾德访视后1年内死亡，包括1768例（2.0%）住院期间和206例（0.2%）出院后。亚组包括ISS ≥ 16分的12752例（14.5%）、任何AIS评分≥ 3分的28402例（32.2%）、头部AIS ≥ 3分的13348例（15.2%）和需要早期关键资源的9048例（10.3%）。与最低wPRS四分位数（32-69）中的ED相比，在最高wPRS四分位数（95-100）中接受护理的儿童1年内的死亡风险较低（校正风险比[aHR]，0.70; 95% CI，0.56-0.88）。排除早期死亡的补充分析结果相似（aHR，0.75; 95% CI，0.56-0.996）。调查结果是一致的亚组和多个敏感性analysis.CONCLUSIONS和RELEVANCE儿童治疗高准备创伤中心急诊科受伤后死亡的风险较低，持续到1年。高艾德准备与受伤儿童的长期生存独立相关。
IMPORTANCE There is substantial variability among emergency departments (EDs) in their readiness to care for acutely ill and injured children, including US trauma centers. While high ED pediatric readiness is associated with improved in-hospital survival among children treated at trauma centers, the association between high ED readiness and long-term outcomes is unknown.OBJECTIVE To evaluate the association between ED pediatric readiness and 1-year survival among injured children presenting to 146 trauma centers.DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, injured children younger than 18 years who were residents of 8 states with admission, transfer to, or injury-related death at one of 146 participating trauma centers were included. Children cared for in and outside their state of residence were included. Subgroups included those with an Injury Severity Score (ISS) of 16 or more; any Abbreviated Injury Scale (AIS) score of 3 or more; head AIS score of 3 or more; and need for early critical resources. Data were collected from January 2012 to December 2017, with follow-up to December 2018. Data were analyzed from January to July 2021.EXPOSURES ED pediatric readiness for the initial ED, measured using the weighted Pediatric Readiness Score (wPRS; range, 0-100) from the 2013 National Pediatric Readiness Project assessment.MAIN OUTCOMES AND MEASURES Time to death within 365 days.RESULTS Of 88 071 included children, 30 654 (34.8%) were female; 2114 (2.4%) were Asian, 16 730 (10.0%) were Black, and 49 496 (56.2%) were White; and the median (IQR) age was 11 (5-15) years. A total of 1974 (2.2%) died within 1 year of the initial ED visit, including 1768 (2.0%) during hospitalization and 206 (0.2%) following discharge. Subgroups included 12 752 (14.5%) with an ISS of 16 or more, 28 402 (32.2%) with any AIS score of 3 or more, 13 348 (15.2%) with a head AIS of 3 or more, and 9048 (10.3%) requiring early critical resources. Compared with EDs in the lowest wPRS quartile (32-69), children cared for in the highest wPRS quartile (95-100) had lower hazard of death to 1 year (adjusted hazard ratio [aHR], 0.70; 95% CI, 0.56-0.88). Supplemental analyses removing early deaths had similar results (aHR, 0.75; 95% CI, 0.56-0.996). Findings were consistent across subgroups and multiple sensitivity analyses.CONCLUSIONS AND RELEVANCE Children treated in high-readiness trauma center EDs after injury had a lower risk of death that persisted to 1 year. High ED readiness is independently associated with long-term survival among injured children.