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Is Trauma Designation Predictive of Readiness to Care for Children?
Elizabeth A. Edgerton, MD, MPH1, Diana G. Fendya, RN, MSN2, Michael Ely, MHRM3, Rachel Richards, MStat3, Barbara A Gaines, MD4,5.1Maternal Child Health Bureau, Health Resources and Service Administration, Health and Human Services, Rockville, MD, USA, 2EMSC National Resource Center, Silver Spring, MD,USA, 3National EMSC Data Analysis Resource Center, Salt Lake, UT, USA, 4Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; 5University of Pittsburgh School of Medicine; Pittsburgh, PA, USA.

In 2013, over 4000 hospitals responded to the National Pediatric Readiness Project (NPRP) assessment evaluating emergency department readiness to care for children. Probabilistic linkage (90%) to the 2009 American Hospital Association (AHA) survey identified 1247 self-identified trauma centers (levels 1, 2, 3). 49 centers treating only children were excluded, leaving 1198 for analysis. Relationship between trauma center designation and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using chi-square. Adjusted relative risks (ARR) were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography. Median WPRS ranged from 86.9 L1; 75.0 L2; 64.8 L3 (p<0.001). Presence of essential elements of pediatric readiness was found to be associated with trauma center level (see table). Additionally, higher level centers demonstrated improved ARR for key elements of pediatric readiness. Level 1 and 2 centers are 1.17 times as likely to have a QI process and 1.28 more likely to have a disaster plan when compared to Level 3 centers. In conclusion, trauma center designation demonstrates a strong foundation towards pediatric readiness. Even when centers that care only for children are excluded, trauma center designation is predictive of pediatric readiness. Though higher levels of trauma centers are better prepared, opportunities exist in all levels of trauma centers for improved pediatric readiness.


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