TOPLINE

Loss or persistent lack of emergency department (ED) pediatric readiness and pediatric inpatient services was independently associated with excess in-hospital mortality among children receiving emergency care, a study found.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from 759 hospitals in 11 states that completed the National Pediatric Readiness Project assessments in 2013 and 2021.
• A total of 2,416,030 children aged 0 to 17 years who received emergency care resulting in hospital admission, interhospital transfer, or death from 2012 through 2021 were included.
• The primary outcome was in-hospital mortality, including deaths occurring in the ED or after hospital admission.
• ED pediatric readiness was measured using the weighted Pediatric Readiness Score (wPRS; range, 0-100), with high readiness defined as wPRS ≥ 88.
• Hospitals were categorized separately according to changes in ED readiness and pediatric inpatient services as having sustained, gained, or lost high ED readiness or pediatric inpatient services or as never having had the respective service.

TAKEAWAY

• In-hospital mortality occurred in 4642 of 337,167 children with injuries and 18,576 of 2,078,863 children with medical illnesses, including deaths occurring in the ED or after hospital admission.
• Among EDs, 13% sustained high readiness, 11.2% gained high readiness, 10.3% lost high readiness, and 65.5% never had high readiness. The median wPRS was 71 in 2013 and 72 in 2021.
• For children with injuries, EDs with sustained high readiness had lower adjusted mortality than those with persistently low readiness (adjusted odds ratio [aOR], 0.54; 95% CI, 0.41-0.71). Among children with medical illnesses, EDs with sustained high readiness also had lower mortality (aOR, 0.57; 95% CI, 0.46-0.71).
• Hospitals that sustained pediatric inpatient services had lower mortality among children with injuries than hospitals that never had these services (aOR, 0.51; 95% CI, 0.40-0.65). Among children with medical illnesses, mortality was lower at hospitals that sustained, gained, or lost inpatient services than at those that never had services (aORs, 0.26, 0.49, and 0.60, respectively).
• EDs that lost or never had high readiness were linked to 5504 excess deaths, and hospitals that lost or never had pediatric inpatient services were linked to 5403 excess deaths.

IN PRACTICE

"The findings suggest that high-quality emergency services for children, including acute care admitting units, should be prioritized to optimize survival among children served by the US healthcare system," the authors wrote.

SOURCE

The study was led by Craig D. Newgard, MD, MPH, Zuckerberg San Francisco General Hospital, University of California, San Francisco. It was published online on August 17, 2026, in JAMA Pediatrics.

LIMITATIONS

The study was limited by the inclusion of hospitals that completed both national assessments, the lack of exact timing for changes in ED readiness and inpatient services, pandemic-related changes in hospital staffing and ED volumes, and potential unmeasured confounding. The finding of decreased mortality among hospitals that lost high ED readiness may have been influenced by factors requiring further investigation.

DISCLOSURES

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the US Department of Health and Human Services Health Resources and Services Administration. One author reported receiving grants from Abbott Laboratories, and another reported receiving support from Takeda Pharmaceuticals outside the submitted work; details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.