• Annals of surgery · Sep 2023

    Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated with Survival.

    • Craig D Newgard, Sean R Babcock, Xubo Song, Katherine E Remick, Marianne Gausche-Hill, Amber Lin, Susan Malveau, N Clay Mann, Avery B Nathens, CookJennifer N BJNBDepartment of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR., Peter C Jenkins, Randall S Burd, Hilary A Hewes, Nina E Glass, Aaron R Jensen, Mary E Fallat, Stefanie G Ames, Apoorva Salvi, K John McConnell, Rachel Ford, Marc Auerbach, Jessica Bailey, Tyne A Riddick, Haichang Xin, Nathan Kuppermann, and Pediatric Readiness Study Group.
    • Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR.
    • Ann. Surg. 2023 Sep 1; 278 (3): e580e588e580-e588.

    ObjectiveWe used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers.BackgroundED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown.MethodsThis was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival.ResultsThere were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present.ConclusionsED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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