Emergency Care for Children in the United States: Epidemiology and Trends Over Time

Whitfill, Travis; Auerbach, Marc; Scherzer, Daniel; Shi, Junxin; Xiang, Henry; Stanley, Rachel

doi:10.1016/j.jemermed.2018.04.019

Cited by 86 publications

(103 citation statements)

References 58 publications

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“…scale between 2003 and 2013, 3,6 but there remain significant gaps and disparities in pediatric readiness across the spectrum of EDs in the US. [6][7][8] After the NPRP assessment, numerous tools and resources were created to facilitate and test improvements in pediatric readiness. 2 One tool is the Facility Categorization Toolbox designed to equip hospitals and EDs with resources to prepare for pediatric emergencies.…”

mentioning

confidence: 99%

Statewide Pediatric Facility Recognition Programs and Their Association with Pediatric Readiness in Emergency Departments in the United States

Whitfill

Remick

Olson

et al. 2020

The Journal of Pediatrics

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Objective To describe the relationship between statewide pediatric facility recognition (PFR) programs and pediatric readiness in emergency departments (EDs) in the US. Study design Data were extracted from the 2013 National Pediatric Readiness Project assessment (4083 EDs). Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) based on a 100-point scale. Descriptive statistics were used to compare WPRS between recognized and nonrecognized EDs and between states with or without a PFR program. A linear mixed model with WPRS was used to evaluate state PFR programs on pediatric readiness. Results Eight states were identified with a PFR program. EDs in states with a PFR program had a higher WPRS compared with states without a PFR program (overall a 9.1-point higher median WPRS; P < .001); EDs recognized in a PFR program had a 21.7-point higher median WPRS compared with nonrecognized EDs (P < .001); and between states with a statewide PFR program, there was high variability of participation within the states. We found state-level PFR programs predicted a higher WPRS compared with states without a PFR program (b = 5.49; 95% CI 2.76-8.23). Conclusions Statewide PFR programs are based on national guidelines and identify those EDs that adhere to a standard level of readiness for children. These statewide PFR initiatives are associated with higher pediatric readiness. As scalable strategies are needed to improve emergency care for children, our study suggests that statewide PFR programs may be one way to improve pediatric readiness and underscores the need for further implementation and evaluation.

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confidence: 99%

Statewide Pediatric Facility Recognition Programs and Their Association with Pediatric Readiness in Emergency Departments in the United States

Whitfill

Remick

Olson

et al. 2020

The Journal of Pediatrics

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“…Instead, most children in cardiac arrest are cared for in the ED closest to their home that likely cares for both children and adults . These community EDs vary in terms of the total volume of pediatric patients, and many children present to EDs that care for fewer than five children per day . These lower‐pediatric‐volume EDs have been noted to be less “pediatric ready” when measured by a national survey .…”

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confidence: 99%

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

Auerbach

Brown

Whitfill

et al. 2018

Academic Emergency Medicine

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This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.

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“…Children with atraumatic out‐of‐hospital cardiac arrest have higher survival in pediatric EDs than general EDs (33.8% vs. 18.9%, p < 0.001) with an adjusted OR of survival in pediatric ED compared to general EDs of 2.2 (95% CI = 1.7–2.8) . Other studies have shown similar findings, with halved mortality rates in very high pediatric volume EDs (≥50,000 annual pediatric visits per year) compared with low‐pediatric‐volume EDs …”

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confidence: 63%

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

Barata

Auerbach

Badaki-Makun

et al. 2018

Academic Emergency Medicine

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This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.

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Emergency Care for Children in the United States: Epidemiology and Trends Over Time

Cited by 86 publications

References 58 publications

Statewide Pediatric Facility Recognition Programs and Their Association with Pediatric Readiness in Emergency Departments in the United States

Statewide Pediatric Facility Recognition Programs and Their Association with Pediatric Readiness in Emergency Departments in the United States

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

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