Improving pediatric readiness in EDs may decrease deaths by nearly half

Key takeaways:

• Improving ED pediatric preparedness would reduce mortality rates by almost half.
• Upgrading EDs to high pediatric readiness would also cost less than $20,000 per QALY.

Upgrading pediatric readiness in EDs would reduce the deaths of pediatric patients by almost half, according to study results published in Health Affairs.

The upgrades required could be done at a price that is far less than the industry-accepted standard for cost-effectiveness, according to researchers.

“Delivering appropriate, timely care to kids with injuries or acute illnesses can make the difference between complete recovery and many years of disability or childhood death,” Jeremy Goldhaber-Fiebert, PhD, a professor of health policy at Stanford University, said in a press release. “We found that the cost of being ready was well below the threshold that people think of as ‘value for money’ in health care.”

According to Goldhaber-Fiebert and colleagues, around 20% of children in the U.S. visit the ED each year, accounting for over 30 million visits.

Healio previously reported that pediatric readiness in EDs was tied to decreased mortality in youth with both acute medical emergencies and traumatic injuries.

Despite the positive associations, high pediatric preparedness “requires an investment of money and other resources that policymakers, health care systems, and hospital administrators may feel would be better allocated to other priorities,” the researchers wrote.

In the analysis, they assessed data from 747 EDs in Arizona, California, Florida, Iowa, Maryland, Minnesota, New Jersey, New York, North Carolina, Rhode Island and Wisconsin.

Goldhaber-Fiebert and colleagues scored these EDs’ preparedness to treat pediatric patients on a scale of 0 to 100, with a score of 88 indicative of a high level of pediatric readiness.

Overall, 80% of the EDs had scores below 88.

The researchers then used data from 7.9 million pediatric patients who received care for traumatic injuries or acute medical emergencies in the less-prepared EDs, building a model to predict how pediatric readiness would impact health outcomes, like quality-adjusted life years (QALYs) and life expectancy, for patients.

They also estimated the costs for improving pediatric readiness based on factors like the type of hospital and number of pediatric patients the hospitals saw each year to determine the cost-effectiveness of upgrades, according to the release.

Goldhaber-Fiebert and colleagues found that improving pediatric readiness would decrease ED and hospital mortality from 78.03 to 33.47 per 100,000 children, for a reduction of 42%.

Among the 7.9 million youth, this reduction would increase:

• discounted life expectancy by 76,800 years; and
• discounted QALYs by 69,100.

Additionally, the improvement of ED pediatric readiness would cost $9,300 per QALY gained, while the cost per life saved would be $244,000.

The researchers pointed out that upgrading EDs to high pediatric readiness would cost less than $20,000 per QALY gained in all subgroups, significantly below the “most conservative of commonly used willingness-to-pay” threshold of $50,000.

“Thankfully, most of the time, kids bounce back from illness and injury,” Goldhaber-Fiebert said in the release. “But our work shows that readying the ED specifically for children can really make a difference in terms of whether certain young patients leave their emergency department alive — and this does not cost that much money.”

Ultimately, the results are “actionable and could have broad impact,” he added. “Interventions that can move the needle on pediatric deaths are rare, and when they are both effective and not costly, it makes sense to use them.”

References:

• Better-prepared emergency departments could save kids’ lives cost-effectively, Stanford Medicine-led study finds. Available at: https://med.stanford.edu/news/all-news/2024/10/pediatric-emergency.html. Published Oct. 7, 2024. Accessed Oct. 15, 2024.
• Weyant C, et al. Health Aff. 2024;doi:10.1377/hlthaff.2023.01489.