Emergency department pediatric readiness of United States trauma centers in 2021: Trauma center facility characteristics and opportunities for improvement.

Background: Emergency department (ED) pediatric readiness has been associated with lower mortality for injured children but has historically been suboptimal in nonpediatric trauma centers. Over the past decade, the National Pediatric Readiness Project (NPRP) has invested resources in improving ED pediatric readiness. This study aimed to quantify current trauma center pediatric readiness and identify associations with center-level characteristics to target further efforts to guide improvement.

Methods: The study cohort included all centers that responded to the 2021 NPRP national assessment and contributed data to the National Trauma Data Bank (NTDB) the same calendar year. Center characteristics and pediatric (0-15 years) volume from the NTDB were linked to weighted pediatric readiness scores (wPRSs) obtained from the NPRP assessment. Univariate and multivariable analyses were used to determine associations between wPRS and trauma center type as well as center-level facility characteristics.

Results: The wPRS was reported for 77% (749 of 973) of centers that contributed to the NTDB. Emergency department pediatric readiness was highest in American College of Surgeons level 1 pediatric trauma centers, but wPRS in the highest quartile was seen among all adult and pediatric trauma center types. Independent predictors of high wPRS included American College of Surgeons level 1 pediatric trauma center verification, pediatric trauma volume, and the presence of a pediatric intensive care unit. Higher-level adult trauma centers and pediatric trauma centers were more likely to have pediatric-specific physician requirements, pediatric emergency care coordinators, and pediatric quality improvement initiatives.

Conclusion: Emergency department pediatric readiness in trauma centers remains variable and is predictably lower in centers that lack inpatient resources. There is, however, no aspect of ED pediatric readiness that is constrained to high-level pediatric facilities, and a highest quartile wPRS was achieved in all types of adult centers in our study. Ongoing efforts to improve pediatric readiness for initial stabilization at nonpediatric centers are needed, particularly in centers that routinely transfer children out.

Level of evidence: Prognostic and Epidemiological; Level III.