ED pediatric readiness decreases racial and ethnic disparities in mortality

Key takeaways:

• Pediatric ED readiness reduced mortality overall but especially so among Black children presenting with acute medical emergencies.
• Researchers suggested ED pediatric readiness can promote health equity.

ED pediatric readiness was associated with decreased mortality among children with both acute medical emergencies and traumatic injuries, a study published in JAMA Network Open showed.

However, despite the overall reduction in deaths, racial disparities persisted among children presenting with acute medical emergencies.

According to Peter C. Jenkins, MD, MSc, an assistant professor of surgery at Indiana University School of Medicine, and colleagues, “evidence that increased ED pediatric readiness is associated with improved survival in children with both acute medical emergencies and traumatic injuries underscores its importance.”

The researchers noted pediatric readiness treatment protocols could also be associated with racial and ethnicity disparities within youth health outcomes, “presumably by mitigating the effects of biases.”

“Because treatment protocols are an essential component of ED pediatric readiness, increased readiness may reduce such disparities through standardization of care,” they wrote in JAMA Network Open.

The researchers aimed to determine whether pediatric readiness eliminated racial inequities by evaluating a cohort of 633,536 children who required emergency care, either for acute medical emergencies or traumatic injuries, at 586 EDs from Jan. 1, 2012, to Dec. 31, 2017.

The cohort included 557,537 children who were hospitalized for acute medical emergencies and 75,999 children hospitalized for traumatic injuries.

Jenkins and colleagues found that the adjusted mortality of Black children with acute medical emergencies was substantially higher compared with that of Hispanic children, white children and children of other races and ethnicities (OR = 1.69; 95% CI, 1.59-1.79) across all ED pediatric readiness quartiles.

Notability, there were no racial or ethnic disparities in mortality present within the traumatic injury cohort.

Meanwhile, compared with hospitals in the lowest quartile of pediatric readiness, children treated at hospitals in the highest quartile had lower mortality in both:

• the acute medical emergency cohort (OR = 0.24; 95% CI, 0.16-0.36); and
• the traumatic injury cohort (OR = 0.39; 95% CI, 0.25-0.61).

Jenkins and colleagues noted that mortality among Black children in the medical cohort decreased more than children of other races and ethnicities in higher levels of pediatric readiness.

“As a result, the racial disparity in mortality narrowed with increased ED pediatric readiness but was not eliminated, even at the highest pediatric readiness level,” they wrote.

The researchers said the findings had several implications for programs aimed at improving pediatric readiness.

“Thus far, such programs have largely focused on the survival benefit associated with ED pediatric readiness,” they wrote. “Our results suggest that ED pediatric readiness may serve to promote health equity among children as well.”

Ultimately, “with incorporation of health equity into such initiatives, organizations may begin to address racial disparities both as a moral imperative as well as a measure of health care quality,” Jenkins and colleagues wrote.