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. 2024 Jun;31(6):555-563.
doi: 10.1111/acem.14875. Epub 2024 Mar 18.

Timing and causes of death to 1 year among children presenting to emergency departments

Stefanie G Ames  1 , Apoorva Salvi  2 , Amber Lin  2 , Susan Malveau  2 , N Clay Mann  1 , Peter C Jenkins  3 , Matthew Hansen  2 , Linda Papa  4 , Sabrina Schmitz  2 , Cesar Sabogal  2 , Craig D Newgard  2 ; Pediatric Readiness Study Group
Affiliations

Timing and causes of death to 1 year among children presenting to emergency departments

Stefanie G Ames et al. Acad Emerg Med. 2024 Jun.

Abstract

Background and objectives: A better characterization of deaths in children following emergency care is needed to inform timely interventions. This study aimed to describe the timing, location, and causes of death to 1 year among a cohort of injured and medically ill children.

Methods: We conducted a retrospective cohort study of children <18 years requiring emergency care in six states from January 1, 2012, through December 31, 2017, with follow-up through December 31, 2018, for patients who were not discharged from the emergency department (ED). In this cohort, 1-year mortality, time to death within 1 year, and causes of death were assessed from ED, inpatient, and vital status records.

Results: There were 546,044 children during the 6-year period. The 1-year mortality rate was 2.2% (n = 1356) for injured children and 1.4% (n = 6687) for medically ill children. Matched death certificates were available for 861 (63.5%) of 1356 deaths in the injury cohort and for 4712 (70.5%) of 6687 deaths in the medical cohort. Among deaths in the injury cohort, 1274 (94.0%) occurred in the ED or hospital. The most common causes of death were motor vehicle collisions, firearm injuries, and pedestrian injuries. Among the 6687 deaths in the medical cohort, 5081 (76.0%) children died in the ED or hospital (primarily in the ED) and 1606 (24.0%) occurred after hospital discharge. The most common causes of death were sudden infant death syndrome, suffocation and drowning, and congenital conditions.

Conclusions: The 1-year mortality of children presenting to an ED is 2.2% for injured children and 1.4% for medically ill children with most deaths occurring in the ED. Future interventional trials, quality improvement efforts, and health policy focused in the ED could have the potential to improve outcomes of pediatric patients.

Keywords: mortality; pediatric emergency care; trauma.

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Figures

Figure 1.
Figure 1.
Timing and causes of death* among children presenting to the ED with injury (n = 1,351 deaths) A. Deaths within 0–7 days of ED presentation (n=1,228 deaths). B. Deaths within 8–365 days of ED presentation (n=123 deaths). *Deaths from the injury cohort included in the figures are limited to those where time-to-death was known (1,351 of 1,356 deaths). The causes of death are based on patients with matched death certificates (n = 858 of 1356 deaths). Note change in scale of y axis between panels A and B for clarity.
Figure 1.
Figure 1.
Timing and causes of death* among children presenting to the ED with injury (n = 1,351 deaths) A. Deaths within 0–7 days of ED presentation (n=1,228 deaths). B. Deaths within 8–365 days of ED presentation (n=123 deaths). *Deaths from the injury cohort included in the figures are limited to those where time-to-death was known (1,351 of 1,356 deaths). The causes of death are based on patients with matched death certificates (n = 858 of 1356 deaths). Note change in scale of y axis between panels A and B for clarity.
Figure 2.
Figure 2.
Timing and causes of death* among children presenting to the ED with acute medical illness (n = 6,676 deaths). A. Deaths within 0–7 days of ED presentation (n=5,003 deaths). B. Deaths within 8–365 days of ED presentation (n=1,673 deaths). *Patient deaths included in the figures are limited to those where time-to-death was known (6,676 of 6,687 deaths). The causes of death are based on patients with matched death certificates (n = 4,712 of 6687 deaths). Note change in scale of y axis between panels A and B for clarity. *Causes of death are provided for deaths with a matched death record (X of X deaths, X%). Note change in scale of y axis between panels A and B for clarity.
Figure 2.
Figure 2.
Timing and causes of death* among children presenting to the ED with acute medical illness (n = 6,676 deaths). A. Deaths within 0–7 days of ED presentation (n=5,003 deaths). B. Deaths within 8–365 days of ED presentation (n=1,673 deaths). *Patient deaths included in the figures are limited to those where time-to-death was known (6,676 of 6,687 deaths). The causes of death are based on patients with matched death certificates (n = 4,712 of 6687 deaths). Note change in scale of y axis between panels A and B for clarity. *Causes of death are provided for deaths with a matched death record (X of X deaths, X%). Note change in scale of y axis between panels A and B for clarity.
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