Investing in pediatric emergency care could save more than 2,100 children's lives annually, study finds

High pediatric readiness in emergency departments could reduce pediatric mortality by 25%, with modest associated costs

In emergencies, children have distinct needs. But 83% of emergency departments nationwide are not highly prepared to meet those needs. A new study based on National Pediatric Readiness Project data has found that bridging that gap, known as having high levels of “Pediatric Readiness,” could save the lives of 2,143 children each year with an annual cost between $0 to $12 per child resident, depending on the state.

“This study builds on a growing body of research demonstrating that every hospital can and must be ready for children’s emergencies,” says lead author Craig Newgard, MD, MPH, an emergency physician at Oregon Health & Science University. “For the first time, we have comprehensive national and state-by-state data that emphasizes both the urgency and feasibility of this work.”

The research team analyzed data from 4,840 emergency departments, focusing on 669,019 children at risk for death upon seeking care. Using predictive models, they assessed how every emergency department achieving high Pediatric Readiness—defined as scoring at least 88 out of 100 on the National Pediatric Readiness Project assessment—could impact mortality rates.

“The National Pediatric Readiness Project outlines essential pediatric capabilities for EDs, such as the availability of essential pediatric equipment and pediatric-specific training,” says senior author Nathan Kuppermann, MD, Chair of Pediatrics and Chief Academic Officer at Children’s National Hospital. “While a perfect score of 100 is ideal, past research shows a score of 88 or higher can reduce mortality risk by up to 76% for ill children and 60% for injured children.”

By applying the potential reduction in mortality associated with high readiness to the number of children at risk of death, the researchers identified the number of lives that could be saved each year. State-specific estimates, adjusted for population size, ranged from 0 preventable deaths in Delaware to 69 in South Dakota.

“Achieving high readiness levels can be challenging for small emergency departments with fewer resources, typically in more rural areas. The result is significant inequity and large health care deserts in pediatric emergency care across the United States,” Dr. Kuppermann says. “Yet we found the cost of elevating care to the highest quartile of Pediatric Readiness is not very high. Our country can afford it, and we owe it to our children to do it.”

The study authors estimate achieving universal high Pediatric Readiness across the United States would cost approximately $207 million annually. Per-child costs by state to raise emergency department readiness from current levels ranged from $0 to $12 per year.

“This research emphasizes the urgent need for widespread investment in Pediatric Readiness,” says Kate Remick, MD, co-author and an emergency physician with Dell Medical School at the University of Texas at Austin. “The National Pediatric Readiness Project has provided a roadmap for improvement. But we need the full engagement of clinicians, health care administrators, policymakers, and families to make universal Pediatric Readiness a reality.”

The study outlines several strategies to improve pediatric emergency care, such as integrating high Pediatric Readiness into hospital accreditation requirements.

Learn more about the National Pediatric Readiness Project.

Adapted from Oregon Health & Science University and Children’s National Hospital.

This study was funded by a Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Emergency Medical Services for Children Targeted Issue grant (H34MC33243-01-01) and a HHS National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant (R24 HD085927). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HHS, HRSA, NIH, or the U.S. Government.