Improving Pediatric Readiness Scores of General Emergency Departments: A Systematic Review

BACKGROUND: Preparedness of general emergency departments (EDs) to manage pediatric patients varies widely, with gaps in quality affecting outcomes. Weighted Pediatric Readiness Scores (WPRSs) quantify readiness, yet evidence on interventions to improve WPRSs is limited. OBJECTIVE: To systematically evaluate the impact of interventional measures on improving WPRSs of general EDs. DATA SOURCES: MEDLINE (Ovid), Embase, PsycINFO, Evidence-Based Medicine Reviews, and CINAHL were searched from inception through April 2025. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Non-randomized controlled (pre and post designs and/or studies with comparison groups) English-language studies conducted in general EDs serving pediatric patients that implemented interventions to improve WPRSs were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers conducted eligibility screening, quality assessments, data extraction, and risk of bias evaluation using ROBINS-I and GRADEpro certainty assessments. A third reviewer resolved discrepancies. RESULTS: Of the 5635 papers screened, 5 met the eligibility criteria. Five key interventions were identified-customized performance reports, online resources, simulations, expert consultations, and a pediatric toolkit. Across studies, the WPRSs increased from 12.9% to 17.1%, representing a rise from a baseline of 53.8% to 80%. Evidence certainly was rated as moderate. LIMITATIONS: The key limitations include heterogeneity of interventions, non-randomized designs, absence of interventions repeated across studies, and potential selection and publication biases. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Multicomponent strategies (customized performance reports, in-situ simulations, expert consultations) were associated with moderate improvements in WPRSs in general EDs. The small number of heterogeneous non-randomized studies limits the certainty of findings. Future research should focus on randomized controlled trials to establish robust pediatric readiness strategies and assess impacts on clinical outcomes and effectiveness. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42022354667.