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Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review
BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments’ readiness for pediatric patients. The aim of this study was to determine whether a higher...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
CMA Impact Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586495/ https://www.ncbi.nlm.nih.gov/pubmed/37848258 http://dx.doi.org/10.9778/cmajo.20210337 |
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author | Harper, Jessica A. Coyle, Amanda C. Tam, Clara Skakum, Megan Ragheb, Mirna Wilson, Lucy Lê, Mê-Linh Klassen, Terry P. Aregbesola, Alex |
author_facet | Harper, Jessica A. Coyle, Amanda C. Tam, Clara Skakum, Megan Ragheb, Mirna Wilson, Lucy Lê, Mê-Linh Klassen, Terry P. Aregbesola, Alex |
author_sort | Harper, Jessica A. |
collection | PubMed |
description | BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments’ readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. METHODS: We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle–Ottawa Scale to assess for quality and bias of the included studies. The I(2) statistic was calculated to quantify study heterogeneity. RESULTS: We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I(2) = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β −0.36 days, 95% CI −0.61 to −0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. INTERPRETATION: The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROTOCOL REGISTRATION: PROSPERO-CRD42020191149. |
format | Online Article Text |
id | pubmed-10586495 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | CMA Impact Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105864952023-10-20 Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review Harper, Jessica A. Coyle, Amanda C. Tam, Clara Skakum, Megan Ragheb, Mirna Wilson, Lucy Lê, Mê-Linh Klassen, Terry P. Aregbesola, Alex CMAJ Open Research BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments’ readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. METHODS: We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle–Ottawa Scale to assess for quality and bias of the included studies. The I(2) statistic was calculated to quantify study heterogeneity. RESULTS: We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I(2) = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β −0.36 days, 95% CI −0.61 to −0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. INTERPRETATION: The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROTOCOL REGISTRATION: PROSPERO-CRD42020191149. CMA Impact Inc. 2023-10-17 /pmc/articles/PMC10586495/ /pubmed/37848258 http://dx.doi.org/10.9778/cmajo.20210337 Text en © 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Research Harper, Jessica A. Coyle, Amanda C. Tam, Clara Skakum, Megan Ragheb, Mirna Wilson, Lucy Lê, Mê-Linh Klassen, Terry P. Aregbesola, Alex Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title | Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title_full | Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title_fullStr | Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title_full_unstemmed | Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title_short | Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
title_sort | readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586495/ https://www.ncbi.nlm.nih.gov/pubmed/37848258 http://dx.doi.org/10.9778/cmajo.20210337 |
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