Clinical PaperThe association between hospital type and mortality among critically ill children in US EDs☆
Section snippets
Background
According to a report by the American Academy of Pediatrics (AAPs), fewer than 10% of EDs nationally have pediatric emergency departments or critical care services, however 76% admit children to their facilities and 25% of hospitals without trauma services admit critically injured children.1 It has been reported that only 6% of EDs have the recommended necessary equipment to care for pediatric emergencies despite 59% of ED managers being aware of existence of guidelines for pediatric emergency
Study setting and patient population
This is a retrospective cohort study using data from the 2007 Healthcare Cost and Utilization Project National Emergency Department Sample (NEDS), a 20% stratified sample of EDs representative of all United States (US) ED visits collected from 27 states.5 These states include: AZ, CA, CT, FL, GA, HI, IA, IN, KS, MA, MD, ME, MN, MO, NC, NE, NH, NJ, NY, OH, RI, SC, SD, TN, UT, VT, and WI. NEDS is a publicly available database which tracks US ED visits. The database includes patient
Results
There were 6,271,710 total pediatric visits in the raw data with 8666 visits for cardiac and/or respiratory failure. This yielded national estimates of 29 million pediatric ED visits in 2007 including 42,036 (0.1%) visits for cardiac and/or respiratory arrest/failure. Table 1 summarizes statistics for these visits. Of note, 87% of patients in the cardiac/respiratory failure group had chronic medical conditions compared to 16% overall. In addition, more than 49–66% of patients in the
Discussion
This is one of the first studies to explore the hospital characteristics and individual demographic factors related to the outcome of critically ill children. One of the strengths of this study is its large sample size and the availability of weights to determine nationally representative statistics. These factors make our findings broadly generalizable.
Our study found that children with cardiac and respiratory arrest tend to present to urban teaching hospitals and trauma centers, but are seen
Conclusions
The majority of children with cardiac and respiratory arrest present to urban teaching hospitals and trauma centers, but are seen at a wide range of hospital types. After accounting for important confounders, and attempting to control for survival bials, mortality is lower at teaching hospitals and/or major trauma centers.
Conflict of interest statement
The above authors of have no conflicts of interest to disclose. The work did not have any financial sponsors. The manuscript is not under consideration elsewhere and has not been published previously.
Acknowledgement
We would like to acknowledge the AHRQ for collecting and providing this data for research.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.07.032