{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:39:41Z","timestamp":1792654781818,"version":"4.5.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objectives:<\/jats:title>\n To examine individual, hospital, and community-level determinants of in-hospital mortality\u2014defined as death during the emergency department visit or after hospitalization at the same hospital\u2014among critically ill pediatric emergency patients in South Korea.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We analyzed data from the National Emergency Department Information System, comprising 26,206 pediatric patients (aged \u226418\u00a0y, 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Overall, in-hospital mortality was 2.3%. At the individual level, compared with self-transport, patients arriving by 119 ambulance (\n OR<\/jats:italic>\n =2.73, 95% CI: 1.85-4.05) and private ambulance patients (\n OR<\/jats:italic>\n =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:\n OR<\/jats:italic>\n =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 (\u226510%:\n OR<\/jats:italic>\n =0.43), while hospitals with \u226545 combined pediatric and neonatal intensive care beds had higher odds (\n OR<\/jats:italic>\n =2.43), likely reflecting case-mix concentration. At the community level, metropolitan cities showed higher odds (\n OR<\/jats:italic>\n =1.64), while a higher Timely Relevance Index (TRI; percentage of residents accessing care within 60\u00a0min) was associated with lower mortality (\u226595%:\n OR<\/jats:italic>\n =0.55).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000003743","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:00:13Z","timestamp":1792652413000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Specialization and Geographic Access as Determinants of Pediatric Emergency Mortality"],"prefix":"10.1097","author":[{"given":"Myoung Hwa","family":"Lee","sequence":"first","affiliation":[{"name":"National Emergency Medical Center, National Medical Center, Seoul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Wook","family":"Ryoo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4478-6127","authenticated-orcid":false,"given":"Jong-Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"R1-20261022","doi-asserted-by":"crossref","first-page":"34","DOI":"10.22470\/pemj.2017.00171","article-title":"Prehospital transport of critically ill children via 119 emergency medical service providers: problems and improvement plan","volume":"4","author":"Noh","year":"2017","journal-title":"Pediatr Emerg Med J"},{"key":"R2-20261022","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/10903127.2016.1258097","article-title":"Resource document: coordination of pediatric emergency care in EMS 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