Pediatric Hospital Capabilities Have Declined Over Past 2 Decades: Study

Lower quality of pediatric care at local hospitals may results in critical treatment delays, as children often need to be transported to better equipped facilities.

Children with serious and complex medical conditions are increasingly being treated farther from home, as access to advanced pediatric hospital care continues to shrink throughout the United States.

According to findings published in the journal Pediatrics on December 10, researchers found that the number of hospitals equipped to provide high-level pediatric care declined by nearly 40% over the past 22 years, while hospitals offering only the lowest level of pediatric services increased by nearly 140%.

The declining level of pediatric care that hospitals offer has been under scrutiny for years. Past research indicates 25% of childhood emergency room deaths could be avoided if hospitals raised their pediatric care standards, while another study published in 2021 indicated children treated in ERs with high pediatric readiness scores have a 42% lower risk of dying from complex causes or injuries.

Additional data published by the National Pediatric Readiness Project has suggested that improving the pediatric readiness of emergency rooms would increase the likelihood a child will survive a severe injury by nearly three-fold.

In the new study, researchers at the Ann & Robert Lurie Children’s Hospital in Chicago analyzed data for U.S. acute care hospitals from 2003 to 2022. They used the Healthcare Cost and Utilization Project Kids’ Inpatient Database to investigate findings on more than 3,900 hospitals per year.

Led by Dr. Kenneth A. Michelson, the team compared the number of hospitals with varying levels of pediatric care capability from 1 to 4. Level 1 was the highest rating with the most pediatric care services and level 4 was the lowest rating with the least services for children. 

The data indicated that the number of hospitals with the highest level of pediatric services dropped by 38% from 2003 to 2022, while the number of hospitals with the lowest level of pediatric care increased by 137% during that period.

The researchers also point out that 27% of hospitals were rated level 4 care in 2003. However, by 2022 more than 65% were rated level 4 care. Even the number of level 2 and 3 rated hospitals decreased across the study period by 54% and 48% respectively.

As a result, more families now live farther away from hospitals with adequate pediatric medical care services, researchers warned.

Hospitals were ranked for 24 different capabilities and for 70% of those, the care levels declined over the two decade period. The largest declines were seen for appendectomy services, which dropped by 50%, pneumonia hospitalization care, which declined by 42%, and asthma hospitalization care, which declined by 41%.

In addition, many emergency rooms in the U.S. are ill-equipped to treat pediatric injuries or complex pediatric conditions. These deficiencies result in delays in transporting patients to trauma centers, reducing a child’s chance of survival.

Researchers concluded the potential contributing factors include lower reimbursement for pediatric inpatient care from health insurance companies and Medicaid, as well as higher Medicaid enrollments, and difficulty maintaining pediatric staffing especially after the COVID-19 pandemic.

Michelson’s team determined that it is important to fund research investigating solutions to fill the large gaps in pediatric care seen across the U.S.

Sign up more more health and legal news that could affect you or your children.