Dr. Katherine Remick from Dell Medical School at the University of Texas at Austin, who wrote an accompanying editorial, told Reuters Health by email, “No parent will bypass an ‘EMERGENCY’ sign when their child is critically ill or injured. It is, therefore, essential that all EDs maintain high levels of readiness for critically ill children of all ages. The more we triage children away from rural and suburban EDs, the less competent they will become at treating children.”

“Regionalization (transfer of children to pediatric-specialty centers) and/or telemedicine may decrease morbidities and further mortality in children, but would best be utilized only after initial stabilization,” she said. “Regionalization and/or telemedicine may be especially advantageous for high-risk conditions and/or diagnoses requiring intensive care inpatient services.”

“Adherence to specialized systems of care with specific designated resources (e.g., trauma, stroke, ST-elevation myocardial infarction) are associated with decreased morbidity and mortality for the populations impacted and have led to the establishment of national standards of care,” Dr. Remick added. “Children, representing a minority (20 percent) ED population with time-dependent emergencies, deserve, at the very least, a standard level of readiness to ensure all children can be adequately stabilized in the event of an emergency, and, at best, that they have access to high-quality emergency care.”

Dr. Isabel A. Barata of Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and North Shore University Hospital in Manhasset, New York, who has researched various aspects of ED pediatric readiness, told Reuters Health by email, “Even though the better outcomes were associated with hospitals with better emergency department readiness scores, it is possible that this is not simply a reflection of the actual emergency department, but also of the actual preparedness of the entire system within that hospital.”

“Emergency departments need to be prepared to care for children, but also having the regional support from other hospitals would be very helpful,” said Dr. Barata, who was not involved in the study. “Telemedicine may play a very significant role in the future, in terms of patient management, and perhaps in some cases avoiding unnecessary transfers to other facilities.”

“We need to engage smaller emergency departments in understanding the need for this preparation but also the support of larger, teaching institutions to provide the safety net,” she said.