In this episode of Little Big Med, host Jason Woods talks with Dr. Stefanie Ames about the paper she first-authored titled “Emergency Department Pediatric Readiness and Mortality in Critically Ill Children”.

Key Points

* Retrospective study, data from Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, 2013* Included 20483 patients from 426 hospitals in Florida, Iowa, Massachusetts, Nebraska, and New York* Mortality decreased with increasing readiness score* Adjusted OR also showed that the highest “readiness” hospitals had the lowest mortality in this cohort* Some concern remains that the difference is at least partially related to case definition – ICU admission was included as an inclusion criteria, which may have falsely lowered the overall level of illness of patients admitted to an institution with a PICU. HOWEVER – * Cases were also followed through time – so patients that were transferred to a hospital with an ICU from a hospital without one had their data linked together. * In that case the presence or absence of an ICU at the index hospital would not have “counted against” the index hospital, unless that hospital were inappropriately admitting critical ill patients to a general ward instead of transferring to a facility with a PICU* The authors feel they addressed this by also considering PECARN illness severity scores, most of which were 4 or 5 (most severe illness)* Most deaths in this cohort occurred in the ED rather than in the ICU/floor, arguing that the ICU admission criteria itself did not drive mortality rates. * Another analysis of this article from EMA exists but comes to a different conclusion about the impact of this article. I’m linking here so you can listen to the differing viewpoints.

Guest

Stefanie Ames, Assistant Professor, Pediatric Critical Care Medicine, University of Utah

Audio Editor – Kellen Vu

References

* Ames SG, Davis BS, Marin JR, Fink EL, Olson LM, Gausche-Hill M, Kahn JM. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics. 2019 Sep;144(3):e20190568. doi: 10.1542/peds.2019-0568. Erratum in: Pediatrics. 2020 May;145(5): PMID: 31444254; PMCID: PMC6856787.* Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Holubkov R, Gorelick MH; Pediatric Emergency Care Applied Research Network. Developing a diagnosis-based severity classification system for use in emergency medical services for children. Acad Emerg Med. 2012 Jan;19(1):70-8. doi: 10.1111/j.1553-2712.2011.01250.x. PMID: 22251193.