Variation in Emergency Department Experience With Pediatric Critical Illness
Abstract
Study objective: We sought to describe variation in emergency department (ED) volume of pediatric critical illness encounters, and to assess the geographic proximity of encounters at low-volume EDs relative to high-volume EDs.
Methods: We conducted a retrospective cohort study of the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases for 5 states from 2018 to 2022. Critical illness was defined as death, cardiopulmonary resuscitation, or endotracheal intubation in the ED or on hospital day 0 or 1 or ED critical care time billing. We calculated the ED-level incidence of critical illness and dichotomized EDs into low- or high-volume at the 75th percentile of volume for each state and year. We determined how many encounters at low-volume EDs occurred within a 15-minute drive of a high-volume ED.
Results: Of 14,313,896 pediatric ED encounters across 569 EDs, 40,483 (0.3%) were critical. The median ED managed 1,932 pediatric visits each year (interquartile range [IQR] 680 to 5,068) and 5 (IQR 1 to 14) with critical illness. We identified 181 (31.8%) EDs with a calendar year with no pediatric critical illness. We found 1,557 (16.8%) critically ill children were managed in low-volume EDs within a 15-minute drive of a high-volume ED.
Conclusion: Most EDs infrequently care for critically ill children, and a minority of these encounters could be realistically diverted to high-volume EDs. Direct transport to high-volume centers is unlikely to be a…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.