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. 2023 Sep 1;278(3):e580-e588.
doi: 10.1097/SLA.0000000000005741. Epub 2022 Nov 1.

Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival

Craig D Newgard  1 , Sean R Babcock  1 , Xubo Song  2 , Katherine E Remick  3 , Marianne Gausche-Hill  4 , Amber Lin  1 , Susan Malveau  1 , N Clay Mann  5 , Avery B Nathens  6 , Jennifer N B Cook  1 , Peter C Jenkins  7 , Randall S Burd  8 , Hilary A Hewes  5 , Nina E Glass  9 , Aaron R Jensen  10 , Mary E Fallat  11 , Stefanie G Ames  5 , Apoorva Salvi  1 , K John McConnell  1   12 , Rachel Ford  13 , Marc Auerbach  14 , Jessica Bailey  1 , Tyne A Riddick  15 , Haichang Xin  1 , Nathan Kuppermann  16 ; Pediatric Readiness Study Group
Affiliations

Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival

Craig D Newgard et al. Ann Surg. .

Abstract

Objective: We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers.

Background: ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown.

Methods: This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival.

Results: There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present.

Conclusions: ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Percent increase in survival when emergency department pediatric readiness components were implemented together versus separate (n = 274,756). *Results are from a model of the 50 highest impact predictor variables (patient, ED pediatric readiness, and hospital) for in-hospital survival. The 9 predictors included in the figure are the components of ED pediatric readiness that predicted increased survival with statistical significance, in order of decreasing impact on survival.
Figure 2.
Figure 2.
Bundling each of the five high impact components of emergency department pediatric readiness with other supporting components to optimize survival (n = 274,756). *Results are from a model of the 50 highest impact predictor variables (patient, ED pediatric readiness, and hospital) for in-hospital survival. The figure shows the predicted percent increase in survival for each of the 5 highest impact components of ED pediatric readiness (in order of decreasing impact on survival) and the additional percent increase in survival when the four next most important ED readiness components were added.
See this image and copyright information in PMC

References

    1. Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System. Emergency care for children: growing pains Washington DC: National Academy Press. 2006.
    1. The National Pediatric Readiness Project, Emergency Medical Services for Children (EMSC) National Resource Center Washington, DC: [Available from: https://emscimprovement.center/domains/pediatric-readiness-project/.
    1. 10 Leading Causes of Death by Age Group, United States - 2018: National Center for Injury Prevention and Control, Center for Disease Control and Prevention; 2017. [Available from: https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_gr....
    1. Borse NN, Rudd RA, Dellinger AM, et al. Years of potential life lost from unintentional child and adolescent injuries--United States, 2000–2009. J Safety Res 2013;45:127–131. - PubMed
    1. Remick K, Gaines B, Ely M, et al. Pediatric Emergency Department Readiness Among US Trauma Hospitals. The journal of trauma and acute care surgery 2018. - PubMed

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