Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review.

CMAJ open Pub Date : 2023-10-17 Print Date: 2023-09-01 DOI:10.9778/cmajo.20210337
Jessica A Harper, Amanda C Coyle, Clara Tam, Megan Skakum, Mirna Ragheb, Lucy Wilson, Mê-Linh Lê, Terry P Klassen, Alex Aregbesola
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Abstract

Background: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization.

Methods: We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I 2 statistic was calculated to quantify study heterogeneity.

Results: We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I 2 = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization.

Interpretation: The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings.

Protocol registration: PROSPERO-CRD42020191149.

Abstract Image

Abstract Image

急诊科对儿科患者和儿科死亡率的准备情况:一项系统综述。
背景:大多数需要紧急护理的儿童都会去普通急诊科和紧急护理中心;加权儿科准备程度评分(WPRS)目前用于评估急诊部门对儿科患者的准备程度。本研究的目的是确定较高的WPRS是否与降低死亡率、改善医疗保健结果和利用率有关。方法:我们对护理儿童(年龄≤21岁)的急诊科的队列和横断面研究进行了系统回顾。从成立到2022年7月29日,我们搜索了MEDLINE(Ovid)、Embase(Ovid)、Cochrane图书馆(Wiley)、CINAHL(EBSCO)、Global Health(Ovids)和Scopus。2名独立评审员对已鉴定的文章进行了筛选,以供纳入。主要结果是死亡率,次要结果是卫生保健结果和利用率。我们使用纽卡斯尔-渥太华量表来评估纳入研究的质量和偏倚。计算I2统计量以量化研究异质性。结果:我们鉴定了1789篇文章。最后分析了八篇文章。三项研究显示,在随机效应荟萃分析中,最高WPRS四分位数与儿童死亡率呈负相关(合并优势比[OR]0.45,95%置信区间[CI]0.26-0.78;I2=89%,证据确定性低)。同样地1项未纳入荟萃分析的研究也报告了与WPRS增加1个百分点呈负相关(OR 0.93,95%CI 0.88至0.98)。一项研究报告称,WPRS最高的四分位数与住院时间较短有关(β-0.36天,95%CI-0.61至-0.10)。三项研究得出结论,WPRS最高的四分位位数与较少的种族间转移有关。死亡率的证据确定性较低,研究的医疗保健结果和利用率的证据确定性中等。解释:数据表明,急诊科的WPRS与儿童死亡率之间存在潜在的负相关。需要更多的研究来反驳或证实这些发现。协议注册:PROSPERO-CRD42020191149。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
5.40
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