The National Pediatric Readiness Project is a national multi--phase quality improvement initiative to ensure all U.S. emergency departments have the essential guidelines and resources in place to provide effective emergency care to children 1 . The support for this project is provided by the EMS for Children Program, the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association. In January 2013, the first phase of this project was launched and consisted of an electronic assessment sent to all emergency departments (EDs) across the nation. A total of 5,017 hospitals with EDs were assessed with 4,150 hospitals responding-an 82.7% response rate 2 . Upon completion of the assessment, respondents received a score based on a 100-point scale representing their readiness to care for pediatric patients. The Assessment and the Score This document includes a copy of the assessment as well as the scoring matrix that was used to generate an overall pediatric readiness score for each participating hospital. This information can be helpful for hospitals as they launch quality improvement efforts and want to track changes in their score over time. The total number of points possible was 100. A score of 100 represents the essential components needed to establish a foundation for pediatric readiness, but is in no way inclusive of all the components recommended for pediatric readiness. Hospitals are encouraged to carefully review the Guidelines for Care of Children in the Emergency Department, which served as the basis for the assessment, to develop a comprehensive pediatric readiness program for a hospital 3, 4 . Determining which of the assessment questions would be scored and how heavily they would be scored was done by a group of clinical experts through a modified Delphi approach 5 . In developing the scoring criteria, the experts were asked to consider results of two recently published assessments on pediatric readiness of emergency departments 6, 7 , as well as recommendations from the Institute of Medicine report on the Future of Emergency Care in the United States 8 . How to Read This DocumentThis document contains all the questions from the pediatric readiness assessment. If a question in the assessment was used in the scoring, it will be followed by the number of points allotted to that question as shown in red in the example below:1. www.pediatricreadiness.org/About_PRP 2. www.pedsready.org/nationalResponseRate.aspx 3. Krug S, Gausche--Hill M. Guidelines for care of children in emergency departments.
Objective We tested the hypothesis that a c-reactive protein (CRP) and ferritin based systemic inflammation contingency table can track mortality risk in pediatric severe sepsis. Design Prospective cohort study Setting Tertiary Pediatric Intensive Care Unit Patients Children with 100 separate admission episodes of severe sepsis were enrolled. Interventions Blood samples were attained on day two of sepsis and bi-weekly for biomarker batch analysis. A 2 × 2 contingency table using CRP and ferritin thresholds was developed. Measurements and Main Results A CRP of 4.08 mg/dL and a ferritin of 1,980 ng/mL were found to be optimal cutoffs for outcome prediction at first sampling (n = 100) using the Youden Index. PICU mortality was increased in the ‘High risk’ CRP ≥ 4.08 mg/dL and Ferritin ≥ 1,980 ng/mL category (6/13, 46.15%) compared to the ‘Intermediate risk’ CRP ≥ 4.08 mg/dL and Ferritin < 1,980 ng/mL or CRP < 4.08 mg/dL and Ferritin ≥ 1,980 ng/mL categories (2/43, 4.65%), and the ‘Low risk’ CRP < 4.08 mg/dL and Ferritin < 1,980 ng/mL category (0/44, 0%) (OR 36.43 [95% CI: 6.16–215.21]). The ‘High risk’ category was also associated with the development of Immunoparalysis (OR 4.47 [95% CI 1.34–14.96]) and Macrophage Activation Syndrome (OR 24.20 [95% CI 5.50–106.54]). Sixty three children underwent sequential blood sampling; those who were initially in the ‘Low risk’ category (n = 24) and those who subsequently migrated to (n =19) to the ‘Low risk’ category all survived, whereas those who remained in the ‘At risk’ categories had increased mortality (7/20 = 35%; p < 0.05). Conclusions A CRP and ferritin based contingency table effectively assessed mortality risk. Reduction in systemic inflammation below a combined threshold CRP of 4.08 mg/dL and ferritin of 1,980 ng / mL appeared to be a desired response in children with severe sepsis.
Objective-To investigate relationships between cardiac arrest characteristics, and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial.Design-Secondary analysis of THAPCA-OH trial data.Setting-Thirty-six PICUs in the U.S. and Canada.Patients-All children (n=295) had chest compressions for ≥2 minutes, were comatose, and required mechanical ventilation after return of circulation.Interventions-Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline (reflecting pre-arrest status) and 12 months postarrest. U.S. norms for VABS-II scores are 100 (mean) ±15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival and 12-month survival with VABS-II ≥70. Measurement and MainResults-Cardiac etiology of arrest, initial arrest rhythm of ventricular fibrillation/tachycardia, shorter duration of chest compressions, compressions not required at hospital arrival, fewer epinephrine doses, and witnessed arrest were associated with greater 12-month survival and 12-month survival with VABS-II ≥70. Weekend arrest was associated with lower 12-month survival. Body habitus was associated with 12-month survival with VABS-II ≥70; underweight children had better outcomes and obese children had worse outcomes. On multivariate analysis, acute life threatening event (ALTE)/sudden unexpected infant Conclusions-Many factors are associated with survival and neurobehavioral outcome among children who are comatose and require mechanical ventilation after out-of-hospital cardiac arrest. These factors may be useful for identifying children at risk for poor outcomes, and for improving prevention and resuscitation strategies. HHS Public Access
Cardiac arrest and resuscitation factors are associated with long-term survival and neurobehavioural function among children who are comatose after in-hospital arrest.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.