• Annals of surgery · Oct 2023

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

    • Caroline Melhado, Katherine Remick, Amy Miskovic, Bhavin Patel, Hilary A Hewes, Craig D Newgard, Avery B Nathens, Charles Macias, Lisa Gray, Brian K Yorkgitis, Michael W Dingeldein, and Aaron R Jensen.
    • Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, and UCSF Benioff Children's Hospitals, San Francisco, CA.
    • Ann. Surg. 2023 Oct 26.

    ObjectiveTo use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness.Summary Background DataMost 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 DesignA 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.Results66,588 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]).ConclusionTrauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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