Table 3:
Secondary outcome: health care outcomes and utilization
| Publication | Intervention v. comparator | Secondary outcome | Secondary outcome effect estimate | Secondary outcome results (unadjusted) | Variables used to adjust secondary outcome | Secondary outcome results (adjusted) | Conclusion |
|---|---|---|---|---|---|---|---|
| Ray et al.,18 2018 | High WPRS v. no WPRS | Access to EDs within a 30-min drive | Percentage | NA | ED characteristics (pediatric ED, trauma centre level, total volume, triage system) Hospital characteristics (bed size, inpatient pediatric ward, pediatric ICU, neonatal ICU, pediatric cardiology, CT scanner, MRI) Accreditations (The Joint Commission, Accreditation Council for Graduate Medical Education) Geographic characteristics (rural/urban status, state) |
National proportion of pediatric population (%) within 30-min drive to ED with: WPRS ≥ 83.6 (at 75th percentile) = 70.20 WPRS ≥ 94.3 (at 90th percentile) = 55.30 WPRS 100 = 33.70 No WPRS specified threshold = 93.70 |
This study nationally quantified geographic access to EDs, in the US, with high pediatric readiness for children, and indicated major gaps in access are due to the lack of an ED with high pediatric readiness. One in 3 children can reach an ED with a max WPRS score. 90.9% of children lived closer to at least 1 alternative ED with a WPRS below the maximum. |
| Lieng et al.,20 2021a | High WPRS v. low WPRS | Potentially avoidable transfers (PATs) | OR | 10-point increase in WPRS associated with PATs, OR (95% CI): Injured children PATs: OR 0.93 (0.90–0.96) Noninjured children PATs: OR 0.90 (0.88–0.93) |
Patient demographics, injury/illness severity, complex chronic condition, pediatric volume, trauma centre designation, pediatric admitting capability | 10-point increase in WPRS associated with PATs, OR (95% CI): Injured children PATs: OR 0.92 (0.86–0.98) Noninjured children PATs: OR 0.94 (0.88–1.00) |
Hospital ED pediatric readiness is associated with lower odds of a PAT. Having a nurse pediatric emergency care coordinator and a quality improvement plan are modifiable risk factors that EDs may target to reduce PATs. |
| Lieng et al.,21 2021b | High WPRS v. low WPRS | Interfacility transfer | OR | High pediatric readiness score > 70 associated with inter-facility transfers, OR (95% CI), p value: OR 0.64 (0.55 to 0.74), p < 0.01 | Patient demographics, insurance, severity of illness, complex chronic condition, pediatric inpatient capabilities, pediatric volume, proportion Medicaid, index hospital-level | High pediatric readiness score > 70 associated with interfacility transfers, OR (95% CI), p value: OR 0.55 (0.33–0.93), p < 0.05 | Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. |
| Newgard et al.,23 2023 | High WPRS v. low WPRS | Proportion of high-risk children transported by ambulances to EDs within a 30-min drive | Percentage | NA | Day, time, and traffic | High-risk children transported to EDs, n (%), by WPRS: Q1 (WPRS 22–57): 26 757 (10.55) Q2 (WPRS 58–70): 39 908 (15.74) Q3 (WPRS 71–85): 50 336 (19.85) Q4 (WPRS 86–100): 136 540 (53.85) High-risk children transported to lower WPRS EDs but within 30-min to high WPRS EDs, n (%): 58 981 (23.26) |
Approximately half of children transported by emergency medical services were taken to high-readiness EDs and an additional one quarter could have been transported to such an ED, with a measurable effect on survival. |
| Balmaks et al.,24 2020 | High WPRS v. Low WPRS | Patient length of stay | Regression (β) coefficient | WPRS associated with PICU length of stay and hospital length of stay, β (95% CI), p value: PICU length of stay (d): β −0.01 (−0.02 to 0.01), p = 0.41 Hospital length of stay (d): β −0.03 (−0.15 to 0.09), p = 0.61 |
Nesting of patients in each ED, and patient demographics | WPRS associated with PICU length of stay, hospital length of stay, β (95% CI), p value: PICU length of stay (days): β −0.06 (−0.10 to −0.01), p = 0.02 Hospital length of stay (days): β −0.36 (−0.61 to −0.10), p = 0.01 |
This study nationally assessed that pediatric readiness in the ED was associated with shorter ICU length of stay, shorter hospital length of stay, and lower 6-mo mortality. |
Note: CI = confidence interval, CT = computed tomography, ED = emergency department, ICU = intensive care unit, MRI = magnetic resonance imaging, NA = not available, OR = odds ratio, PAT = potentially avoidable transfers, PICU = pediatric intensive care unit, Q = quartile, SD = standard deviation, WPRS = weighted pediatric readiness score.