Analysis of the Characteristics and Quality Indicators of Pediatric Patients at Pediatric Specialized Emergency Medical Centers

Abstract

Background: Despite a declining pediatric population due to reduced birth rates, the demand for pediatric emergency medical services continues to increase. Pediatric patients require age-specific care that differs considerably from adult emergency care. To address this need, Pediatric Specialized Emergency Medical Centers (PSEMCs) have been operational in Korea since 2016. Objectives: This study aimed to evaluate the effectiveness of PSEMCs by analyzing the impact of their designation on patient characteristics and emergency care quality indicators. Methods: This cross-sectional study utilized 2022 data from the National Emergency Department Information System (NEDIS), including patients under 18 years of age with Korean Triage and Acuity Scale (KTAS) levels 1 - 3 who were diagnosed with severe pediatric diseases. Patient demographics and emergency care quality indicators were compared between PSEMC-designated and non-designated emergency institutions using cross-tabulation, logistic regression, the Mann-Whitney test, and proportion tests. Results: Pediatric Specialized Emergency Medical Centers treated a higher proportion of younger patients (aged 0 - 11 years; 85.6%), high-acuity cases (KTAS levels 1 - 2; 33.6%), and illness-related visits (94.0%) compared with general emergency institutions. Pediatric Specialized Emergency Medical Centers utilization was significantly associated with visits via other vehicles (76.9%), more frequent face-to-face care from pediatric specialists (94.1%), higher discharge rates (46.0%), and lower inter-hospital transfer rates (1.6%). These factors were significantly associated with increased PSEMC utilization. Although PSEMCs showed a longer median emergency department (ED) length of stay (4.5 hours) and a higher proportion of patients staying in the ED for over 24 hours (1.8%), they demonstrated better clinical outcomes, including lower transfer rates (1.6%) and higher final treatment provision rates (46.2%). Conclusions: Pediatric Specialized Emergency Medical Centers play a critical role in the care of severely ill pediatric patients and are associated with improved treatment outcomes. However, the high volume of patients with less severe conditions may limit optimal resource utilization. Enhancing severity-based triage, care delivery systems, and targeted policy interventions may further improve the effectiveness of PSEMCs.