Pediatric Emergency Department Readiness Among US Trauma Hospitals.

BACKGROUND: Pediatric readiness among US emergency departments is not universal. Trauma hospitals adhere to standards that may support day-to-day readiness for children.

METHODS: In 2013 4,146 emergency departments participated in the National Pediatric Readiness Project to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association (AHA) survey found 1,247 self-identified trauma hospitals (levels 1, 2, 3, 4). Relationship between trauma hospital level and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using chi-square. Adjusted relative risks (ARR) were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography.

RESULTS: The overall WPRS among all trauma hospitals (1,247) was 71.8. Among those not self-identified as a children's hospital or emergency department approved for pediatrics (EDAP) (1088), Level 1 and 2 trauma centers had higher WPRS than level 3 and 4 trauma centers, 83.5 and 71.8 respectively versus 64.9 and 62.6. Yet, compared to EDAP trauma hospitals (median 90.5), level 1 general trauma hospitals were less likely to have critical pediatric-specific elements. Common gaps among general trauma hospitals included presence of inter-facility transfer agreements for children, measurement of pediatric weights solely in kilograms, quality improvement processes with pediatric-specific metrics, and disaster plans that include pediatric-specific needs.

CONCLUSION: Self-identified trauma hospital level may not translate to pediatric readiness in emergency departments. Across all levels of general non-EDAP, non-Children's trauma hospitals, gaps in pediatric readiness exist. Non-children's hospital EDs (i.e. EDAPs) can be prepared to meet the emergency needs of all children and trauma hospital designation should incorporate these core elements of pediatric readiness.

LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.