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. 2024 Nov 4;7(11):e2442154.
doi: 10.1001/jamanetworkopen.2024.42154.

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

Craig D Newgard  1 , Amber Lin  1 , Jeremy D Goldhaber-Fiebert  2 , Katherine E Remick  3 , Marianne Gausche-Hill  4 , Randall S Burd  5 , Susan Malveau  1 , Jennifer N B Cook  1 , Peter C Jenkins  6 , Stefanie G Ames  7 , N Clay Mann  7 , Nina E Glass  8 , Hilary A Hewes  7 , Mary Fallat  9 , Apoorva Salvi  1 , Brendan G Carr  10 , K John McConnell  1   11 , Caroline Q Stephens  12 , Rachel Ford  13 , Marc A Auerbach  14 , Sean Babcock  1 , Nathan Kuppermann  15
Affiliations

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

Craig D Newgard et al. JAMA Netw Open. .

Abstract

Importance: High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown.

Objective: To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year.

Design, setting, and participants: This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024.

Exposure: EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness).

Main outcomes and measures: Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness.

Results: A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.

Conclusions and relevance: In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children's lives each year.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mann reported grants from National Highway Traffic Safety Administration outside the submitted work. Dr McConnell reported grants from the National Institutes of Health (NIH) during the conduct of the study; he reported receiving personal fees from Genesis Research Group for survey review and Massachusetts Medical School for review of an evaluation report outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Current Annual Investment in ED Pediatric Readiness and the Annual Cost to Reach High Readiness by State
Figure 2.
Figure 2.. Annual Cost per Child Resident to Reach Universal High ED Pediatric Readiness by State
Costs per child were calculated based on the total pediatric (ages 0-17 years) population in each state.
Figure 3.
Figure 3.. Population-Adjusted Estimates of the Annual Number of Pediatric Deaths Under Current Levels of ED Pediatric Readiness vs Universal High ED Readiness by State
Washington, DC is excluded because many children cared for in District hospitals came from outside the District, creating an artificially high population-adjusted estimate based on children residing in the District.
Figure 4.
Figure 4.. Population-Adjusted Estimates for the Annual Number of Pediatric Lives Saved Through Universal High ED Pediatric Readiness by State
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2024.42139

References

    1. Emergency Medical Services for Children (EMSC) National Resource Center . National Pediatric Readiness Project. Accessed April 18, 2022. https://emscimprovement.center/domains/pediatric-readiness-project
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    1. Newgard CD, Lin A, Olson LM, et al. ; Pediatric Readiness Study Group . Evaluation of emergency department pediatric readiness and outcomes among US trauma centers. JAMA Pediatr. 2021;175(9):947-956. doi:10.1001/jamapediatrics.2021.1319 - DOI - PMC - PubMed
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