Objectives: (1) To measure the concordance of patient demographic data in the electronic health record (EHR); and (2) to determine the level of agreement for patient demographic data between patient report-EHR and patients-caregivers. Study Design: We conducted a prospective observational survey of 295 patients (age 12 to 17 years) and caregiver dyads presenting to a pediatric emergency department. The primary outcome was concordance, reporting kappa statistics with 95% CI, of caregiver-reported patient race, ethnicity, and sex and the EHR. Secondary outcomes were concordance between: (1) patient report and EHR and (2) patient and caregiver report, including gender identity and preferred language. We surveyed dyads on the perceived impact of demographic characteristics on emergency care and caregivers on preferences for reporting data. Results: For caregiver and EHR report of race, there was substantial agreement for Asian (κ=0.65, 95% CI: 0.44-0.86), Black/African American/African (κ=0.76, 95% CI: 0.66-0.86), and White (κ=0.66, 95% CI: 0.58-0.75) race and moderate agreement for Hispanic/Latino ethnicity (κ=0.53, 95% CI: 0.44-0.61). Patient report and the EHR had similar concordance for race and poor agreement for Hispanic/Latino ethnicity (κ=−0.17, 95% CI: −0.22 to −0.12). For patients and caregivers, there was strong concordance for race, ethnicity, language, and gender identity. Caregivers were more likely than pediatric patients to report that demographic factors affected emergency care. Most caregivers did not have preferences about demographic data reporting methods. Conclusions: Concordance of patient race and ethnicity data in the EHR was variable and should be interpreted cautiously.
Objectives: To examine individual, hospital, and community-level determinants of in-hospital mortality—defined as death during the emergency department visit or after hospitalization at the same hospital—among critically ill pediatric emergency patients in South Korea. Methods: We analyzed data from the National Emergency Department Information System, comprising 26,206 pediatric patients (aged ≤18 y, triage levels 1 to 2) at emergency medical centers in 2021, using multilevel logistic regression. The null model confirmed substantial between-hospital [intraclass correlation coefficient (ICC)=0.17] and between-community (ICC=0.01) variation, justifying the multilevel approach. Results: Overall, in-hospital mortality was 2.3%. At the individual level, compared with self-transport, patients arriving by 119 ambulance ( OR =2.73, 95% CI: 1.85-4.05) and private ambulance patients ( OR =3.14, 95% CI: 1.72-5.73) had higher odds. Intentional and unintentional injuries showed 2.06-fold and 2.97-fold higher odds versus noninjury, respectively. Consciousness level showed a dose-response association (coma: OR =228.64). Severe illness was associated with a 4.94-fold higher odds ratio. At the hospital level, higher critically ill proportions were associated with lower mortality (≥10%: OR =0.43), while hospitals with ≥45 combined pediatric and neonatal intensive care beds had higher odds ( OR =2.43), likely reflecting case-mix concentration. At the community level, metropolitan cities showed higher odds ( OR =1.64), while a higher Timely Relevance Index (TRI; percentage of residents accessing care within 60 min) was associated with lower mortality (≥95%: OR =0.55). Conclusions: Pediatric emergency mortality was associated with factors across all 3 levels. Risk-adjusted performance metrics are needed for tiered systems, and timely geographic access supports distributed initial stabilization capacity.
AIM This study evaluated whether a human factors-driven, integrated, color-coded resuscitation system that combines equipment standardization and prefilled-medication cognitive aids improves workflow efficiency and accuracy compared with a conventional crash cart during simulated pediatric resuscitations. METHODS A prospective, randomized, crossover simulation study was conducted with 28 health care professionals. Each team participated in 2 pediatric resuscitation scenarios using either the SCC or the CCCC in random order. All sessions were video-recorded to measure equipment retrieval and medication preparation times. Statistical comparisons were made using paired statistical tests appropriate for crossover designs, with significance set at P<0.05. RESULTS Use of the CCCC significantly reduced the time to locate airway devices (13.1±6.9 vs. 41.7±22 s, P<0.001) and airway adjuncts (13.8±11.9 vs. 30.8±17.4 s, P=0.03). Prefilled color-coded syringes significantly reduced medication preparation time (median: 16 vs. 19 s; absolute reduction 3 s, P=0.04), with no dosing errors observed. Teams using the CCCC demonstrated more consistent workflow and fewer procedural delays. CONCLUSIONS In this randomized crossover simulation study, the integrated color-coded system reduced equipment retrieval and medication preparation times for selected pediatric resuscitation tasks. These findings are limited to the simulation setting and should be interpreted in light of the Broselow framework's use for both cart organization and assessment of correct equipment selection. Further research is needed to evaluate the feasibility of color-coded prefilled syringes and determine whether the observed workflow benefits translate to real-world pediatric patient care.
