Evaluating pediatric ED readiness and racial, ethnic disparities in mortality

In this Contemporary Pediatrics® interview, Peter C. Jenkins, MD, MSc, associate professor of surgery, Indiana University of Medicine, and primary investigator of the study, “Emergency department (ED) pediatric readiness and disparities in mortality based on race and ethnicity,” published in Jama Network Open, describes the objective, design, and outcomes of the study.

Contemporary Pediatrics:

Can you explain the reason for your study recently published in Jama Network Open, and how pediatric readiness can curb some of the disparities, but not eliminate them, when it comes to pediatric ED care and mortality? 

Peter C. Jenkins, MD, MSc:
In prior studies, we found that increased ED pediatric readiness was associated with decreased mortality for children with both traumatic injuries and acute medical emergencies who presented to emergency departments. We conducted this study, because it was unclear whether children of all races and ethnicities benefited equitably.

Our results suggest that the use of treatment protocols reduced racial and ethnic disparities. Prior studies have demonstrated the existence of racial and ethnic disparities, but few have identified ways to reduce them. We hypothesized that treatment protocols mitigate the impact of racial and ethnic biases by standardizing care. The treatment of traumatic injuries is very protocol-driven, and protocols are integral to ED pediatric readiness. We found no evidence of disparities in mortality among children with traumatic injuries, and the disparity reduced dramatically in children with acute medical emergencies as the level of ED pediatric readiness increased. That being said, for reasons that are unclear, even at EDs with the highest levels of readiness, Black non-Hispanic children died at higher rates than other racial and ethnic groups. Also, it is unclear if treatment protocols are responsible for the reduced disparity or whether it’s the result of some other aspect of ED pediatric readiness such as increased staffing or supplies.

Contemporary Pediatrics:

How was the study designed and where was the information pulled? How was ED readiness measured?

Jenkins:

This cohort study was a secondary analysis of data that we obtained from 11 states, including almost 600 EDs, through the state Departments of Health. We used the weighted Pediatric Readiness Score to provide a measure of readiness for each ED. That score was based on a 2013 survey that was conducted nationally. We performed risk-adjusted analyses of mortality for each cohort of children (i.e., injury and medical), using the readiness score and race and ethnicity as the primary exposure variables.

Contemporary Pediatrics:

Related to race and ethnicity, what associations with ED readiness were observed?

Jenkins:

In terms of survival, we found that children of all races benefitted from increased ED pediatric readiness. That finding applied to both children with traumatic injuries and those with acute medical emergencies. Among the latter group, we also found that increased readiness was associated with a significant decrease in racial and ethnic disparities. In fact, we estimate that if we increased the readiness of all hospitals to the highest level, we would see a 3-fold decrease in the disparity between Black and White children.

Contemporary Pediatrics:

Finally, what conclusions were made because of the study, and what are the biggest takeaways when it comes to attempting to eliminate these disparities?

Jenkins:

Increased ED pediatric readiness is associated with both the improved survival of all children and increased health equity. Organizations dedicated to increasing ED pediatric readiness should consider formal integration of a health equity platform into efforts to improve pediatric emergency care.

Reference:

Jenkins PC, Lin A, Ames SG, et al. Emergency department pediatric readiness and disparities in mortality based on race and ethnicity. JAMA Netw Open. 2023;6(9):e2332160. doi:10.1001/jamanetworkopen.2023.32160