The Association between Pediatric Readiness and Mortality for Injured Children Treated at US Trauma Centers.

Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
26 Oct 2023
Historique:
pubmed: 13 10 2023
medline: 13 10 2023
entrez: 13 10 2023
Statut: aheadofprint

Résumé

To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness. Most children in the US receive initial trauma care at non-pediatric centers. The National Pediatric Readiness Project (NPRP) aims to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade. A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) in 2019-21 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15y) were calculated using Pediatric TQIP models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Center-specific mortality odds ratios were then compared across quartiles of wPRS. 66,588 children from 630 centers with a median [IQR] wPRS of 79 [66-93] were analyzed. The average observed-to-expected odds of mortality (1.02 [0.97-1.06]) for centers in the highest quartile (wPRS≥93) was lower than any of the lowest three wPRS quartiles (1.19 [1.14-1.23](Q1), 1.29 [1.24-1.33](Q2), and 1.28 [1.19-1.36](Q3), all P <0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality (standardized beta -0.095 [-0.146--0.044]). Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.

Sections du résumé

OBJECTIVE OBJECTIVE
To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness.
SUMMARY BACKGROUND DATA BACKGROUND
Most children in the US receive initial trauma care at non-pediatric centers. The National Pediatric Readiness Project (NPRP) aims to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade.
STUDY DESIGN METHODS
A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) in 2019-21 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15y) were calculated using Pediatric TQIP models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Center-specific mortality odds ratios were then compared across quartiles of wPRS.
RESULTS RESULTS
66,588 children from 630 centers with a median [IQR] wPRS of 79 [66-93] were analyzed. The average observed-to-expected odds of mortality (1.02 [0.97-1.06]) for centers in the highest quartile (wPRS≥93) was lower than any of the lowest three wPRS quartiles (1.19 [1.14-1.23](Q1), 1.29 [1.24-1.33](Q2), and 1.28 [1.19-1.36](Q3), all P <0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality (standardized beta -0.095 [-0.146--0.044]).
CONCLUSION CONCLUSIONS
Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.

Identifiants

DOI: 10.1097/SLA.0000000000006126 PMID: 37830240
pubmed: 37830240
doi: 10.1097/SLA.0000000000006126
pii: 00000658-990000000-00671
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Auteurs

Caroline Melhado (C)

Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, and UCSF Benioff Children's Hospitals, San Francisco, CA.

Katherine Remick (K)

Departments of Pediatrics and Surgery and Perioperative Medicine, Dell Medical School at the University of Texas at Austin, Austin, TX.

Amy Miskovic (A)

The American College of Surgeons Trauma Quality Programs, Chicago, IL.

Bhavin Patel (B)

The American College of Surgeons Trauma Quality Programs, Chicago, IL.

Hilary A Hewes (HA)

Division of Pediatric Emergency Medicine, Department Pediatrics, University of Utah School of Medicine, and Intermountain Primary Children's Hospital, Salt Lake City, UT.

Craig D Newgard (CD)

Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.

Avery B Nathens (AB)

Department of Surgery, University of Toronto, Toronto, ON.

Charles Macias (C)

Division of Pediatric Emergency Medicine, University Hospitals Rainbow Babies & Children's Hospital, and College of Medicine, Case Western Reserve University, Cleveland, OH.

Lisa Gray (L)

Emergency Medical Services for Children Innovation and Improvement Center, University of Texas at Austin, Austin, TX.

Brian K Yorkgitis (BK)

Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.

Michael W Dingeldein (MW)

Division of Pediatric Surgery, Rainbow Babies & Children's Hospital, and College of Medicine, Case Western Reserve University, Cleveland, OH.

Aaron R Jensen (AR)

Classifications MeSH