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

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-12-01 Epub Date: 2023-10-26 DOI:10.1097/SLA.0000000000006126
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, Aaron R Jensen
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Abstract

Objective: To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness.

Background: Most children in the United States receive initial trauma care at nonpediatric centers. The aim of the National Pediatric Readiness Project (NPRP) was 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 design: A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) from 2019 to 2021 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15 y) were calculated using Pediatric Trauma Quality Improvement Program 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.

Results: A total of 66,588 children from 630 centers with a median (interquartile range) 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 3 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 to -0.044)].

Conclusion: Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.

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在美国创伤中心接受治疗的受伤儿童的儿科准备情况与死亡率之间的关系。
目的:使用更新的2021年加权儿科准备程度评分(wPRS)数据来确定创伤中心急诊科(ED)儿科准备程度的阈值水平。背景数据摘要:美国大多数儿童在非儿科中心接受初步创伤护理。国家儿科准备项目(NPRP)旨在确保所有急诊科做好为儿童提供优质护理的准备。在2013年的国家评估中,创伤中心报告的wPRS最高四分位数已被证明死亡率较低。在过去的十年里,已经投入了大量的努力来提高儿科的准备程度。研究设计:对2019-21年完成NPRP 2021国家评估并向国家创伤数据库(NTDB)捐款的创伤中心的回顾性队列进行了分析。使用儿科TQIP模型计算儿童(0-15y)的中心特异性观察到的预期死亡率估计值。转移患者在最初的接收中心使用确定性联系来解释wPRS。然后在wPRS的四分位数之间比较中心特异性死亡率比值比。结果:分析了来自630个中心的66588名儿童,平均[IQR]wPRS为79[66-93]。最高四分位数(wPRS≥93)的中心观察到的平均死亡率与预期死亡率(1.02[0.97-1.06])低于最低三个wPRS四分位数中的任何一个(1.19[1.14-12.3](Q1)、1.29[1.24-13.3](Q2)和1.28[1.19-1.36](Q3),所有结论:创伤中心应解决儿科准备工作的差距,包括儿科特定的质量改进计划,并旨在实现wPRS≥93。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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