1 in 4 Child Deaths During ER Visits Are Preventable

Researchers estimated that more than a quarter of child deaths could be prevented if all EDs in the United States were pediatric-ready.
They also found that the cost of achieving and maintaining a high level of readiness—which means EDs have doctors and nurses trained in pediatric care, have protocols for treating children, and have medication and equipment for children of all ages and sizes—would cost up to $11.84 per child.
“Less than 20 percent of emergency departments across the U.S. are fully ready to care for children. So … in the context of pediatric emergency care in the country, it means that we have a lot of work to do,” Dr. Craig Newgard, lead author and director of the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University, told The Epoch Times in an interview.
Only around 17 percent of EDs across the United States were prepared for pediatric emergencies.
The analysis included newborns to children aged 17 who were treated at EDs. Researchers found that every year, EDs receive 669,000 “at-risk” children. These at-risk children are those who need to be transferred to another hospital or die in emergency rooms. These children can do worse or better depending on how well-staffed and equipped the EDs are.
The researchers estimated that at current readiness levels, about 7,600 at-risk children, or about 1 percent, will die during their ED visit.
But if all EDs achieved high readiness, 2,100 lives, or more than a quarter, can be saved.
The estimated cost to reach this level of readiness nationwide is $207 million. However, it varies significantly by state—from $0 in Delaware (which already meets high-readiness standards) to over $18 million in Texas.
Dr. Jared Ross, an experienced emergency physician who was not part of the study, explained, “Due to the consolidation of pediatric specialty services combined with aggressive marketing by children’s hospitals, many parents prefer that their children be seen at these facilities, even when it is not medically necessary.” This may reduce pediatric patient volumes in community and rural hospitals, giving them less reason and fewer resources to maintain pediatric readiness.
Additionally, with lower reimbursement rates for pediatric care and fewer diagnostic procedures for children, many smaller hospitals have closed pediatric units in favor of higher-revenue areas like cardiology and oncology. This has made critically ill pediatric cases in EDs much rarer, resulting in less experience and reduced comfort for physicians and nurses in treating them.
“I think in terms of costs and effort, it’s definitely very feasible for even a small, relatively under-resourced hospital to reach a high level of readiness,” said Newgard.
EDs have a narrow window to act, as a significant portion of children who visit die within about three hours. Having EDs prepared to treat children rather than transferring them to specialized pediatric centers could result in over 30 minutes lost—time critical for treatment.
If small EDs in rural areas became pediatric-ready, they could provide the same level of high-quality emergency care as large tertiary hospitals and reduce the burden in larger hospitals, according to the researchers.
This preparedness would also enhance the emergency care system’s capacity to respond to crises that strain resources, including pandemics, natural disasters, and mass casualty incidents such as school shootings.
Newgard said that one of the biggest barriers is lack of awareness, and the first step EDs could take is recognizing the route they must take to get there.
He explains that there are six domains of pediatric readiness, including categories such as personnel, competencies, and safety and quality improvement. Among these, he identifies care coordination as the most critical.
This requires doctors and nurses to become pediatric emergency care coordinators and take on additional part-time duties to implement policies, safety programs, and quality improvement related to ED pediatric readiness.
“When we look at the overall costs, over 95 percent of the costs are in person-time,” he explained, noting that people often assume reaching pediatric readiness would be costly due to the need for new supplies and equipment. However, most general EDs already stock over 90 percent of the required equipment, so the primary expense lies in personnel time.
To make this readiness effective, both community practices and hospital culture play a role. “Parents must be willing to seek care in community hospital settings and have their children admitted there rather than be transferred. Hospitals must maintain pediatric in-patient units to drive and sustain a culture of pediatric readiness,” said Ross.
Encouraging parents to seek care in community hospitals and have their children admitted there could increase pediatric experience and improve readiness in these local facilities.
These resources enable hospitals to begin right away, even on a limited budget, without the need for new infrastructure or additional space, said Newgard.