Changes in Emergency Department Pediatric Readiness and Mortality Article Swipe
Craig D. Newgard
,
Shauna Rakshe
,
Apoorva Salvi
,
Amber Lin
,
Jennifer N. B. Cook
,
Marianne Gausche‐Hill
,
Nathan Kuppermann
,
Jeremy D. Goldhaber‐Fiebert
,
Randall S. Burd
,
Susan Malveau
,
Peter C. Jenkins
,
Caroline Q. Stephens
,
Nina E. Glass
,
Hilary A. Hewes
,
Nelia Mann
,
Stefanie G. Ames
,
Mary E. Fallat
,
Aaron R. Jensen
,
Rachel Ford
,
Angela Child
,
Brendan G. Carr
,
Kendrick Lang
,
Kyle Buchwalder
,
Katherine Remick
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.22107
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.22107
Importance High emergency department (ED) pediatric readiness is associated with improved survival, but the impact of changes to ED readiness is unknown. Objective To evaluate the association of changes in ED pediatric readiness at US trauma centers between 2013 and 2021 with pediatric mortality. Design, Setting, and Participants This retrospective cohort study was performed from January 1, 2012, through December 31, 2021, at EDs of trauma centers in 48 states and the District of Columbia. Participants included injured children younger than 18 years with admission or injury-related death at a participating trauma center, including transfers to other trauma centers. Data analysis was performed from May 2023 to January 2024. Exposure Change in ED pediatric readiness, measured using the weighted Pediatric Readiness Score (wPRS, range 0-100, with higher scores denoting greater readiness) from national assessments in 2013 and 2021. Change groups included high-high (wPRS ≥93 on both assessments), low-high (wPRS <93 in 2013 and wPRS ≥93 in 2021), high-low (wPRS ≥93 in 2013 and wPRS <93 in 2021), and low-low (wPRS <93 on both assessments). Main Outcomes and Measures The primary outcome was lives saved vs lost, according to ED and in-hospital mortality. The risk-adjusted association between changes in ED readiness and mortality was evaluated using a hierarchical, mixed-effects logistic regression model based on a standardized risk-adjustment model for trauma, with a random slope–random intercept to account for clustering by the initial ED. Results The primary sample included 467 932 children (300 024 boys [64.1%]; median [IQR] age, 10 [4 to 15] years; median [IQR] Injury Severity Score, 4 [4 to 15]) at 417 trauma centers. Observed mortality by ED readiness change group was 3838 deaths of 144 136 children (2.7%) in the low-low ED group, 1804 deaths of 103 767 children (1.7%) in the high-low ED group, 1288 deaths of 64 544 children (2.0%) in the low-high ED group, and 2614 deaths of 155 485 children (1.7%) in the high-high ED group. After risk adjustment, high-readiness EDs (persistent or change to) had 643 additional lives saved (95% CI, −328 to 1599 additional lives saved). Low-readiness EDs (persistent or change to) had 729 additional preventable deaths (95% CI, −373 to 1831 preventable deaths). Secondary analysis suggested that a threshold of wPRS 90 or higher may optimize the number of lives saved. Among 716 trauma centers that took both assessments, the median (IQR) wPRS decreased from 81 (63 to 94) in 2013 to 77 (64 to 93) in 2021 because of reductions in care coordination and quality improvement. Conclusions and Relevance Although the findings of this study of injured children in US trauma centers were not statistically significant, they suggest that trauma centers should increase their level of ED pediatric readiness to reduce mortality and increase the number of pediatric lives saved after injury.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2024.22107
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2821279/newgard_2024_oi_240706_1720631645.50439.pdf
- OA Status
- gold
- Cited By
- 5
- References
- 45
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4400882791
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4400882791Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamanetworkopen.2024.22107Digital Object Identifier
- Title
-
Changes in Emergency Department Pediatric Readiness and MortalityWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-07-22Full publication date if available
- Authors
-
Craig D. Newgard, Shauna Rakshe, Apoorva Salvi, Amber Lin, Jennifer N. B. Cook, Marianne Gausche‐Hill, Nathan Kuppermann, Jeremy D. Goldhaber‐Fiebert, Randall S. Burd, Susan Malveau, Peter C. Jenkins, Caroline Q. Stephens, Nina E. Glass, Hilary A. Hewes, Nelia Mann, Stefanie G. Ames, Mary E. Fallat, Aaron R. Jensen, Rachel Ford, Angela Child, Brendan G. Carr, Kendrick Lang, Kyle Buchwalder, Katherine RemickList of authors in order
- Landing page
-
https://doi.org/10.1001/jamanetworkopen.2024.22107Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2821279/newgard_2024_oi_240706_1720631645.50439.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2821279/newgard_2024_oi_240706_1720631645.50439.pdfDirect OA link when available
- Concepts
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Medicine, Emergency department, Logistic regression, Emergency medicine, Random effects model, Cohort, Multilevel model, Pediatrics, Demography, Internal medicine, Meta-analysis, Computer science, Psychiatry, Machine learning, SociologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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5Total citation count in OpenAlex
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2025: 5Per-year citation counts (last 5 years)
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45Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.0-100, | 124 |
| abstract_inverted_index.2021), | 156, 166 |
| abstract_inverted_index.Change | 110, 138 |
| abstract_inverted_index.Injury | 254 |
| abstract_inverted_index.Score, | 256 |
| abstract_inverted_index.change | 270, 329, 348 |
| abstract_inverted_index.cohort | 50 |
| abstract_inverted_index.deaths | 274, 286, 298, 311, 354 |
| abstract_inverted_index.group, | 284, 296, 308 |
| abstract_inverted_index.group. | 321 |
| abstract_inverted_index.groups | 139 |
| abstract_inverted_index.higher | 126, 372 |
| abstract_inverted_index.impact | 14 |
| abstract_inverted_index.median | 244, 252, 389 |
| abstract_inverted_index.number | 376, 455 |
| abstract_inverted_index.random | 221 |
| abstract_inverted_index.reduce | 450 |
| abstract_inverted_index.sample | 235 |
| abstract_inverted_index.saved. | 379 |
| abstract_inverted_index.scores | 127 |
| abstract_inverted_index.should | 441 |
| abstract_inverted_index.states | 69 |
| abstract_inverted_index.trauma | 35, 65, 91, 97, 263, 382, 430, 439 |
| abstract_inverted_index.years; | 251 |
| abstract_inverted_index.−328 | 338 |
| abstract_inverted_index.−373 | 357 |
| abstract_inverted_index.Design, | 44 |
| abstract_inverted_index.January | 55, 107 |
| abstract_inverted_index.Results | 232 |
| abstract_inverted_index.account | 225 |
| abstract_inverted_index.because | 407 |
| abstract_inverted_index.between | 37, 195 |
| abstract_inverted_index.center, | 92 |
| abstract_inverted_index.centers | 36, 66, 383, 431, 440 |
| abstract_inverted_index.changes | 16, 28, 196 |
| abstract_inverted_index.greater | 129 |
| abstract_inverted_index.initial | 230 |
| abstract_inverted_index.injured | 77, 426 |
| abstract_inverted_index.injury. | 461 |
| abstract_inverted_index.low-low | 168, 282 |
| abstract_inverted_index.outcome | 180 |
| abstract_inverted_index.primary | 179, 234 |
| abstract_inverted_index.quality | 414 |
| abstract_inverted_index.saved). | 343 |
| abstract_inverted_index.suggest | 437 |
| abstract_inverted_index.through | 58 |
| abstract_inverted_index.trauma, | 218 |
| abstract_inverted_index.younger | 79 |
| abstract_inverted_index.Although | 419 |
| abstract_inverted_index.December | 59 |
| abstract_inverted_index.District | 72 |
| abstract_inverted_index.Exposure | 109 |
| abstract_inverted_index.Measures | 177 |
| abstract_inverted_index.Observed | 265 |
| abstract_inverted_index.Outcomes | 175 |
| abstract_inverted_index.Setting, | 45 |
| abstract_inverted_index.Severity | 255 |
| abstract_inverted_index.[64.1%]; | 243 |
| abstract_inverted_index.analysis | 100, 363 |
| abstract_inverted_index.centers. | 98, 264 |
| abstract_inverted_index.children | 78, 239, 278, 290, 302, 315, 427 |
| abstract_inverted_index.deaths). | 361 |
| abstract_inverted_index.denoting | 128 |
| abstract_inverted_index.evaluate | 24 |
| abstract_inverted_index.findings | 421 |
| abstract_inverted_index.high-low | 157, 294 |
| abstract_inverted_index.improved | 10 |
| abstract_inverted_index.included | 76, 140, 236 |
| abstract_inverted_index.increase | 442, 453 |
| abstract_inverted_index.logistic | 208 |
| abstract_inverted_index.low-high | 147, 306 |
| abstract_inverted_index.measured | 115 |
| abstract_inverted_index.national | 132 |
| abstract_inverted_index.optimize | 374 |
| abstract_inverted_index.unknown. | 21 |
| abstract_inverted_index.weighted | 118 |
| abstract_inverted_index.Columbia. | 74 |
| abstract_inverted_index.Objective | 22 |
| abstract_inverted_index.Pediatric | 119 |
| abstract_inverted_index.Readiness | 120 |
| abstract_inverted_index.Relevance | 418 |
| abstract_inverted_index.Secondary | 362 |
| abstract_inverted_index.according | 186 |
| abstract_inverted_index.admission | 84 |
| abstract_inverted_index.decreased | 392 |
| abstract_inverted_index.emergency | 2 |
| abstract_inverted_index.evaluated | 203 |
| abstract_inverted_index.high-high | 141, 319 |
| abstract_inverted_index.including | 93 |
| abstract_inverted_index.intercept | 223 |
| abstract_inverted_index.mortality | 201, 266, 451 |
| abstract_inverted_index.pediatric | 5, 31, 42, 113, 447, 457 |
| abstract_inverted_index.performed | 53, 102 |
| abstract_inverted_index.readiness | 6, 19, 32, 199, 269, 448 |
| abstract_inverted_index.suggested | 364 |
| abstract_inverted_index.survival, | 11 |
| abstract_inverted_index.threshold | 367 |
| abstract_inverted_index.transfers | 94 |
| abstract_inverted_index.Importance | 0 |
| abstract_inverted_index.additional | 333, 341, 352 |
| abstract_inverted_index.associated | 8 |
| abstract_inverted_index.clustering | 227 |
| abstract_inverted_index.department | 3 |
| abstract_inverted_index.mortality. | 43, 191 |
| abstract_inverted_index.readiness) | 130 |
| abstract_inverted_index.readiness, | 114 |
| abstract_inverted_index.reductions | 409 |
| abstract_inverted_index.regression | 209 |
| abstract_inverted_index.(persistent | 327, 346 |
| abstract_inverted_index.Conclusions | 416 |
| abstract_inverted_index.adjustment, | 324 |
| abstract_inverted_index.assessments | 133 |
| abstract_inverted_index.association | 26, 194 |
| abstract_inverted_index.in-hospital | 190 |
| abstract_inverted_index.preventable | 353, 360 |
| abstract_inverted_index.Participants | 47, 75 |
| abstract_inverted_index.assessments, | 387 |
| abstract_inverted_index.coordination | 412 |
| abstract_inverted_index.improvement. | 415 |
| abstract_inverted_index.significant, | 435 |
| abstract_inverted_index.standardized | 214 |
| abstract_inverted_index.Low-readiness | 344 |
| abstract_inverted_index.assessments), | 146 |
| abstract_inverted_index.assessments). | 173 |
| abstract_inverted_index.hierarchical, | 206 |
| abstract_inverted_index.mixed-effects | 207 |
| abstract_inverted_index.participating | 90 |
| abstract_inverted_index.retrospective | 49 |
| abstract_inverted_index.risk-adjusted | 193 |
| abstract_inverted_index.statistically | 434 |
| abstract_inverted_index.&amp;lt;93 | 149, 164, 170 |
| abstract_inverted_index.high-readiness | 325 |
| abstract_inverted_index.injury-related | 86 |
| abstract_inverted_index.slope–random | 222 |
| abstract_inverted_index.risk-adjustment | 215 |
| cited_by_percentile_year.max | 98 |
| cited_by_percentile_year.min | 97 |
| corresponding_author_ids | https://openalex.org/A5023972779 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 24 |
| corresponding_institution_ids | https://openalex.org/I165690674 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8799999952316284 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.94403328 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |