ED pediatric readiness key to children’s survival one year out from injury

A new study has found that injured children have a 30 percent lower mortality risk out to one year after receiving initial care at EDs with high pediatric readiness. The study, led by Principal Investigator Craig D. Newgard, MD, MPH, of Oregon Health and Science University, is based on data from the 2013 National Pediatric Readiness Project (NPRP) assessment. The NPRP is a multiphase quality improvement initiative of EMSC in partnership with American College of Emergency Physicians, the Emergency Nurses Association, and the American Academy of Pediatrics.

The study, published Feb. 2 in JAMA Surgery, analyzed outcomes for 88,071 injured children cared for in 146 EDs of trauma centers in 15 states. The decreased risk was specifically associated with EDs in the top 25 percent of pediatric readiness nationwide, as defined by their pediatric readiness score, which is determined on a scale of 0-100 (lowest to highest readiness) by the NPRP assessment. The median readiness score of EDs in the study was 88.

This is the first study to examine pediatric readiness and survival out to one year; Newgard and his colleagues published a paper last year in JAMA Pediatrics that linked in-hospital survival with high pediatric readiness.

The new research comes just a few months after the American College of Surgery announced new pediatric standards for all verified trauma centers, including a standard that will require trauma centers to complete the NPRP assessment and identify a plan to address any gaps.

“Having the assessment woven into that process is a big win for pediatric readiness and it's a big win for injured kids,” says Newgard.

Opportunities for improving readiness—right now

To help trauma centers prepare for the new standards, the EMSC Innovation and Improvement Center is hosting a Trauma Improvement Sprint as part of its Pediatric Emergency Care Coordinator (PECC) Workforce Development Collaborative. The sprint enrolled more than 500 participants and met for the first time on Feb. 23; the next session is March 2.

But participating in a collaborative is not the only way to improve pediatric readiness.

“If a person, this afternoon, decided that they wanted to improve their level of readiness, there are tools immediately available that they could start with,” says Newgard, who suggests beginning by exploring the NPRP toolkit.

In the pediatric readiness research pipeline

Newgard and his team have forthcoming papers that will delve further into pediatric readiness among U.S. trauma centers. One will examine the highest-impact areas of pediatric readiness (there are approximately 80 total).

“We’d like to come up with a rank order to help people decide: if you want to move the needle and you don't have unlimited resources, which readiness factors really drive pediatric survival? For example, if you’re a hospital administrator or ED manager and funding – say $50,000 – was allocated to improving pediatric readiness in your ED, how would you prioritize spending it?”

He and other researchers in the pediatric emergency space also eagerly anticipate the results of the 2021 NPRP assessment, which are expected to be published in the late spring or early summer.

“We’re looking not just in terms of how has readiness shifted from 2013 to 2021, but really, what has been the impact on children and lives saved?” says Newgard. “Can we quantify that so when we put forth a national policy and national quality improvement program to raise the level of readiness among all hospitals, what is the impact? … Another piece of that project is if we expect the level of readiness will have improved a certain amount, is there a way we could make it even better?”

Newgard points to intentional hospital selection by EMS crews or by parents as areas for further investigation.

“Pediatric readiness is not simply completing a one-time checklist or assessment,” says Kate Remick, MD, Co-Director of the EIIC and the NPRP. “It requires continuous quality improvement, and it’s an ever-evolving area of research – as Dr. Newgard’s work reflects. We are grateful to him and all the researchers working to shed light on the impact of pediatric readiness and how we can keep moving the needle for ill and injured children.”

Newgard and his colleagues work is funded through an EMSC Targeted Issues Grant. To learn more about pediatric readiness, visit the NPRP webpage. For more information on Targeted Issues grants, visit the EIIC website.