1 in 4 Child Deaths After E.R. Visits Are Preventable, Study Finds
More than 80 percent of emergency departments in United States hospitals are not fully prepared for pediatric cases, a new study finds, despite the fact that children make up about 20 percent of visits each year.
The new analysis, published Friday in the journal JAMA Network Open, estimated that if every emergency department in the United States had the core features of “pediatric readiness,” more than a quarter of the child deaths that follow E.R. visits could be prevented, a figure that equates to thousands of young lives each year.
Even in the most ill-prepared states, the cost to ready every emergency room would be less than $12 per child living there, the researchers found.
“You can now find your state and see: How many children who would otherwise die could we expect to save if we implemented universal pediatric readiness at a high level?” said Dr. Craig Newgard, who was the lead author on the paper, and is the director of the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University.
“The numbers are nontrivial, and I think they’re pretty compelling at a state-by-state level — enough to motivate people to want to raise readiness,” he said.
The Cost of Status Quo
The checklist for so-called readiness, established by the National Pediatric Readiness Project, includes stocking child-size equipment and supplies and establishing protocols and trainings for youth-specific care, such as optimal vital signs for children and resuscitation techniques. From a public health perspective, those preparations are considered extremely cost-effective — even more so than several routine childhood vaccines.
Clinicians who study the effects of hospital readiness say the checklist is achievable regardless of the hospital’s size or financial resources: Most general emergency departments stock more than 90 percent of the supplies that are that needed to properly care for children, and an on-staff nurse or doctor can undergo training and double as a specialized pediatric care coordinator, for example.
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A small emergency entrance on a rainy day with a single person walking towards it.
A hospital in Kosciusko, Miss., this year. Even in the most ill-prepared states, the cost to ready every emergency room would be less than $12 per child resident.Credit...Rory Doyle for The New York Times
“Even a tiny, little five-bed emergency department in a rural or frontier setting can reach the same level of readiness as a large tertiary care hospital in an urban setting,” Dr. Newgard said. “If they saw this paper and decided, ‘Hey, this is something we should really do,’ there are resources to walk them through and figure out where best to start.”
Still, those preparations can be low on the priority list of struggling health centers, and large, mostly rural swaths of the country have become deserts for specialized pediatric emergency care. In a national assessment, overall “pediatric readiness” scores for emergency rooms decreased slightly between 2013 and 2021, and an ongoing consolidation of pediatric care to large urban tertiary care centers has forced families to travel even farther for treatment.
Only a third of children live near an emergency department that is considered highly “pediatric-ready,” and among them, nine out of 10 live closer to a less-prepared one. Data shows that those families pay a harsh price: Critically ill children are four times as likely to die in hospitals and twice as likely to die in trauma centers that score low in “pediatric readiness.”
1 in 4 Child Deaths After E.R. Visits Are Preventable, Study Finds - The New York Times