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Research Snapshot Theater: Pediatric IV

Rural Disparities in Emergency Room Pediatric Readiness and Mortality in Critically Ill Children

Sunday, March 22, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 07
  • DM

    Dawn Maxey, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SA

    Stefanie Ames, MD, MS

    Associate Professor
    University of Utah, Department of Pediatrics, Division of Critical Care Medicine

    Disclosure information not submitted.

  • HH

    Hilary Hewes, MD

    Professor, Pediatric Emergency Medicine
    University of Utah

    Disclosure information not submitted.

  • HM

    Huong Meeks, MPH, MSTAT, PhD

    Assistant Professor
    University of Utah, Department of Pediatrics, Division of Critical Care

    Disclosure information not submitted.

  • HH

    Hilary Hickingbotham, N/A

    Biostatistician
    University of Utah

    Disclosure information not submitted.

Introduction: Rural pediatric hospitals are closing due to lack of funding and centralization of pediatric hospital care to urban areas. This reduction in access may increase the risk of adverse outcomes. Pediatric Readiness, a metric defined by the National Pediatric Readiness Project (NPRP), details the equipment, training, and procedures needed for pediatric care and has been associated with increased survival. We sought to evaluate the association of pediatric readiness and mortality for children requiring intensive care following presentation to a rural hospital. We hypothesize that pediatric readiness can mitigate the impact of rurality on survival for children with critical illness.


Methods: This is a retrospective cohort study of children admitted to a regional pediatric intensive care unit (PICU) following transfer from an outside emergency department (ED) between 2014-2023. Demographic characteristics including age, pediatric risk of mortality (PRISM) score and complex chronic conditions (CCC) were collected. Pre-hospital characteristics such as hospital type, presence of dedicated pediatric services, NPRP score and dichotomized location (urban, population ≥ 50,000 or rural, population < 50,000) were collected from NPRP and American Hospital Association data. The primary outcome was child mortality in the PICU. Multivariable logistic regression was used to evaluate the association of the NPRP score on child mortality, adjusting for hospital location.


Results: Of 1591 transfers, 1339 (84%) originated from an urban ED. The mean (SD) of NPR scores was 81.5 (11.4) out of 100 for urban hospitals and 71.5 (9.8) for rural hospitals. The overall mortality rate was 8.5% (n=135). Children who died were more likely to have a higher PRISM score compared to survivors (mean (SD): 11.9 (12.1) vs 3.2 (4.2), p< 0.001) and have a CCC (n=35/135 (25.9%) vs n=125/1456 (8.6%), p < 0.001)) Importantly, children transferred from a rural location had a higher mortality rate (n=29/237 (12.2%)) than those from urban locations (104/1339 (7.8%)) (p=0.02).


Conclusions: There are disparities in survival for children who require initial emergency care in rural settings. Quality initial care for pediatric patients in rural settings, especially where access to dedicated pediatric care is limited, is crucial to improving outcomes.