THE JOURNAL OF PEDIATRICS � www.jpeds.com ryptorchidism is one of the commonest indications for elective surgery in C young boys. Current guidelines call for recognition and surgical management — Thomas R. Welch,MD of the condition before the age of one year. We do not, however, have good population- based data on the condition, speciﬁcally the ages at which surgery is generally occurring. In the current volume of The Journal, Bergbrant et al provide very comprehensive data from Sweden addressing these questions. They provide us with information from every boy in the country in whom the diagnosis of cryptorchidism was made over a 15 year period—over 20,000 children in all. One of the most striking pieces of information is that over 94% of children had their surgery beyond the guideline-recommended age of one year. Even though Sweden is a country with near-universal health care for its children, there was considerable varia- tion from region to region in the timeliness of surgery. Not all of these delays can be attributed to late recognition or referral; the bimodal age distribution, with another peak in school age likely reﬂects acquired cryptorchidism. Fortunately, there were few complications of surgery and no deaths. The study was not designed to address such long term questions such as fertility. Article page 197 ▶ medical emergency requires timely, immediate care. With that in mind, the notion Not all emergency A that certain conditions require special expertise is not new, nor the concept that departments are alike outcomes are improved when emergent care is provided in speciﬁed centers rather than in the closest available emergency department (ED). The result is the creation of trauma — Denise M. Goodman, centers, stroke centers, and the like. MD, MS The same could be said for the ability to render appropriate care to children. A prior project, the National Pediatric Readiness Project, surveyed EDs nationwide for avail- ability of pediatric-speciﬁc equipment, personnel, and processes, and created a weighted score for pediatric readiness. A score of 100 indicates that essential requirements are met for pediatric readiness. A prior study showed that the median score nationally is 68.9 (JAMA Pediatr 2015;169:527-34). In this volume of The Journal, Ray et al address the issue of geographic accessibility to emergency care for children. The authors examined the percentage of children living within 30 minutes of a pediatric-ready ED as deﬁned by the National Pediatric Readi- ness Project. The results are striking—while 93.7% live within 30 minutes of any ED, only one-third live within 30 minutes of an ED scoring 100, and a little over one-half live within 30 minutes of those scoring in the 90th percentile of readiness; 70% live within an ED scoring within the 75th percentile. The policy implications are clear—the gaps were not in availability of an ED, but in lack of EDs with high pediatric readiness. This means that children presenting to those EDs may not have access to age-appropriate equipment, personnel, or pro- cesses, a concern for both families and providers. Fortunately there are already pro- grams aimed at improving pediatric readiness, such as the quality improvement efforts of the Emergency Medical Services for Children (EMSC) program (https:// emscimprovement.center/). When considering the well-being of our children, this sort of geographical analysis may permit focused, effective investment, and improved outcomes. Article page 225 ▶ Volume 194
The Journal of Pediatrics – Elsevier
Published: Mar 1, 2018
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