Comparison of care quality between pediatric and general emergency departments: secondary analysis of a national database
Abstract
OBJECTIVE
To compare the quality of care between French pediatric emergency departments (PEDs) and general emergency departments (GEDs) to identify targets for training and quality improvement.
METHODS
Secondary analysis of a cross-sectional study that included each visit from 731 EDs on June 11th, 2013 (URGENCE 2013). We included all visits of patients younger than 18 years old. A panel of pediatric emergency medicine experts created a list of 10 care quality measures. Care quality measures (i.e., general and condition-specific measures) were compared between PEDs and GEDs using multilevel analyses.
RESULTS
Out of 14,711 included visits, 8944 (60.8%) occurred in GEDs. Compared with PEDs, GEDs had a higher proportion of visits by children older than 2 years (88.0% vs 71.4%, p 6 h (OR: 0.56, 95% CI: 0.41-0.78), lower proportion of hospitalizations (OR: 0.36, 95% CI: 0.28-0.45), lower proportion of patients who left against medical advice (OR: 0.27, 95% CI: 0.09-0.76), and a higher proportion of transfers (OR: 2.25, 95% CI: 1.38-3.67). There were no significant differences in care quality for the 3 condition-specific measures.
CONCLUSION
Differences in care quality measures between PEDs and GEDs may be explained by the characteristics of the included visits. A more precise analysis of those differences is required to improve the quality of care for children in EDs. It would be possible in the recent French cross-sectional study using the same methodology.
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, 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.
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