RT Journal Article
SR Electronic
T1 Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E956
OP E968
DO 10.9778/cmajo.20210337
VO 11
IS 5
A1 Harper, Jessica A.
A1 Coyle, Amanda C.
A1 Tam, Clara
A1 Skakum, Megan
A1 Ragheb, Mirna
A1 Wilson, Lucy
A1 Lê, Mê-Linh
A1 Klassen, Terry P.
A1 Aregbesola, Alex
YR 2023
UL http://www.cmajopen.ca/content/11/5/E956.abstract
AB 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 I2 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; I2 = 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.