Components of emergency department pediatric readiness associated with short- and long-term survival among children: a mixed methods evaluation

建议的方法：我们将使用混合方法研究设计来确定 急诊科(ED)儿科准备情况最能预测短期和长期存活 孩子们。该项目将帮助急诊科优先实施急救准备工作，以拯救儿科生命。我们 将使用现有的研究基础设施、数据科学方法、跟踪儿童一年的能力， 新颖的分析，以及一个跨学科的团队来满足这一关键的公共卫生需求。 重要：伤害和急性疾病是导致儿童死亡的主要原因。我们最近做了 显示美国创伤中心和综合医院的高ED儿科准备是独立的 与提高存活率有关，但ED准备驱动存活率的成分尚不清楚。它 也不清楚其他组织因素或ED护理过程是否提高了 孩子们。对这些问题的回答将指导教育部门优先实施教育准备工作， 特别是在资源和预算有限的较小医院和农村环境中。这个项目是 旨在告知国家创伤中心核查标准、国家现场分诊指南、 国家儿科准备项目和儿童紧急医疗服务计划。 目标：有三个具体目标： 具体目标一：建立两个多州儿童急救和使用机器队列 学习识别ED儿科准备程度预测短期和长期存活率的组成部分。 具体目标2.经验性地制定急诊室儿科准备情况的全球衡量标准，并将其与加权的 预测儿童短期和长期存活期的儿科准备评分。 具体目标3：使用积极的偏离方法来确定急诊科儿科准备因素和进程 与提高接受紧急护理的儿童的存活率相关的护理。 研究设计与环境：我们将在2018年1月1日至2018年1月建立两个使用急救服务的儿童队列 12/31/2022在11个州的928个急救中心(ED队列)和50个州的678个创伤中心(Trauma队列)。我们会 将州生命统计数据、死亡记录与队列相关联，以跟踪一年的结果并评估152个独特的 使用机器学习方法的ED准备的组成部分。我们还将在30个月内进行150次采访 美国各地的医院使用正偏差方法作为定量分析的补充。 参与者：0-17岁使用急救服务的受伤儿童，包括1560万名患有 急诊，606,810名住院儿童，以及264,865名儿童进入美国创伤中心。 观察指标：我们将评估住院死亡率(初级)和1年死亡率(次级)。 在病人层面上。我们还将评估ED级别的观察死亡率和预期死亡率，以 促进正向偏差分析。

Proposed Approach: We will use a mixed methods study design to identify the components of emergency department (ED) pediatric readiness most predictive of short- and long-term survival among children. This project will help EDs prioritize implementation of ED readiness to save pediatric lives. We will use existing research infrastructure, data science methods, the ability to follow children to one year, novel analytics, and an interdisciplinary team to address this critical public health need. Importance: Injury and acute illness are the leading causes of death in children. We have recently shown that high ED pediatric readiness in US trauma centers and general hospitals is independently associated with improved survival, but the components of ED readiness driving survival are unknown. It is also unclear whether other organizational factors or ED processes of care improve survival among children. Answers to these questions will guide EDs in prioritizing the implementation of ED readiness, especially in smaller hospitals and rural settings with limited resources and budgets. This project is designed to inform the national trauma center verification criteria, the national field triage guidelines, the National Pediatric Readiness Project, and the Emergency Medical Services for Children program. Objectives: There are three specific aims: Specific Aim 1: We will build two multi-state cohorts of children receiving emergency care and use machine learning to identify the components of ED pediatric readiness predictive of short- and long-term survival. Specific Aim 2. Empirically develop a global measure of ED pediatric readiness and compare it to the weighted Pediatric Readiness Score for predicting short- and long-term survival in children. Specific Aim 3: Use a positive deviance approach to identify ED pediatric readiness factors and processes of care associated with improved survival among children receiving emergency care. Study Design & Setting: We will build two cohorts of children using emergency services from 1/1/2018 to 12/31/2022 in 928 EDs in 11 states (ED cohort) and 678 trauma centers in 50 states (Trauma cohort). We will link state vital statistics death records to the cohorts to track outcomes to one year and assess 152 unique components of ED readiness using machine learning methods. We will also conduct 150 interviews in 30 hospitals across the US using positive deviance methods as a complement to the quantitative analyses. Participants: Injured children 0–17 years using emergency services, including 15.6 million children with ED visits, 606,810 hospitalized children, and 264,865 children admitted to US trauma centers. Outcome measures: We will evaluate in-hospital mortality (primary) and 1-year mortality (secondary) at the patient-level. We will also evaluate the observed versus expected mortality at the ED-level to facilitate the positive deviance analysis.