The Cost of Emergency Care For Children Across Differing Levels of Emergency Department Pediatric Readiness

Abstract Background and Objective High ED pediatric readiness is associated with improved survival in children, but the cost is unknown. We evaluated the costs of emergency care for children across quartiles of ED pediatric readiness. Methods This was a retrospective cohort study of children 0 to 17 years receiving emergency services in 747 EDs in 9 states from 1/1/2012 through 12/31/2017. We measured ED pediatric readiness using the weighted Pediatric Readiness Score (wPRS, range 0-100). The primary outcome was the total cost of acute care (ED and inpatient) in 2022 dollars, adjusted for ED case mix and hospital characteristics. Results 15,138,599 children received emergency services, including 27.6% with injuries and 72.4% with medical illness. The average adjusted per-patient cost by quartile of ED pediatric readiness ranged from $991 (quartile 1) to $1,064 (quartile 4) for injured children and $1,104 to $1,217 for medical children. The resulting cost differences were $72 (95% CI -$6 to $151) and $113 (95% CI $20 to $206), respectively. Conclusions Receiving emergency care in high-readiness EDs was not associated with marked increases in the cost of delivering services.