Elsevier

Resuscitation

Volume 84, Issue 4, April 2013, Pages 488-491
Resuscitation

Clinical Paper
The association between hospital type and mortality among critically ill children in US EDs

https://doi.org/10.1016/j.resuscitation.2012.07.032Get rights and content

Abstract

Study aim

Little is known about the setting of care for critically ill children and whether differences in outcomes are related to the presenting hospital type. This study describes the characteristics of hospitals to which critically ill children present and explores the associations between hospital factors and mortality.

Methods

This is a retrospective cohort study using data from the 2007 Healthcare Cost and Utilization Project National Emergency Department Sample, representative of all US ED visits. Subjects include children aged 0–18 with ICD9 codes for cardiac arrest, respiratory arrest and/or respiratory failure. Predictor variables include: age, sex, presence of chronic illness, self-pay, public insurance, trauma diagnosis, major trauma center, urban hospital, ED volume and teaching hospital. Multivariate logistic regression estimates predictors of mortality. Analyses integrate clusters, strata, and weights from the probability sample.

Results

There were an estimated 29 million pediatric ED visits in 2007 including 42,036 (0.1%) visits for cardiac or respiratory failure. Teaching hospitals (OR 0.57, 95% CI 0.50–0.66), trauma centers (OR 0.76, 95% CI 0.67–0.86), and urban hospitals (OR 0.78, 95% CI 0.63–0.97) were associated with lower mortality odds. Presence of a chronic illness (OR 14.5, 95% CI 10.5–20.1), diagnosis of an injury (OR 1.2, 95% CI 1.1–1.4) and self-pay status (OR 3.6, 95% CI 2.9–4.4) were associated with increased mortality odds.

Conclusions

The majority of children with cardiac and respiratory arrest present to urban teaching hospitals and trauma centers. After accounting for important confounders, mortality is lower at teaching hospitals and/or major trauma centers.

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.

References (19)

There are more references available in the full text version of this article.

Cited by (40)

  • Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA

    2021, The Lancet Child and Adolescent Health
    Citation Excerpt :

    There are also known regional differences in the magnitude of racial disparities in health-care outcomes across the USA, with such differences being more pronounced in particular regions, and therefore racial disparities in illness severity are likely to be highly context dependent.38 Higher mortality in the PICU has consistently been shown in uninsured than in insured children,24–26,50 and in children living in areas with a lower median income by zip code.51 There is conflicting evidence on racial or ethnic differences in mortality in children admitted to the PICU.

View all citing articles on Scopus

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

View full text