Table 5:

Summary of findings, high WPRS compared with low WPRS in health care outcomes and utilization

Patient or population: Health care outcomes and utilization Setting: Emergency departments Intervention: High WPRS Comparison: Low WPRS
Outcome	Impact	No. of participants	Certainty of the evidence (GRADE)^*
Length of stay assessed with: days	Pediatric readiness in the ED was associated with shorter ICU length of stay, shorter hospital length of stay, and lower 6-month mortality.	254	⊕⊕øø^† Low^‡,^§,^¶
Access to an ED within a 30-min drive	1 in 3 children can reach an ED with a WPRS score of 100. 90.9% of children lived closer to at least 1 alternative ED with a WPRS below the maximum.	NA	⊕⊕øø^† Low^‡,^§,^¶
Proportion of high-risk children transported by ambulances to EDs within a 30-min drive	Approximately 50% of children transported by emergency medical services were taken to high WPRS EDs and an additional 25% could have been transported to such an ED, with a measurable effect on survival.	808 536	⊕⊕øø^† Low^‡,^§,^¶
Interfacility transfer	Pediatric patients presenting to EDs at small rural hospitals with high WPRS may be less likely to be transferred.	135 388	⊕⊕øø^† Low^‡,^§,^¶
Potentially avoidable transfers	High WPRS of EDs is associated with lower odds of a potentially avoidable transfers.	25 601	⊕⊕øø^† Low^‡,^§,^¶

Note: ED = emergency department; GRADE = Grading of Recommendations Assessment, Development and Evaluation; ICU = intensive care unit; NA = not applicable.
↵* GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
↵† Commonly used symbols to describe certainty in evidence in evidence profiles: high certainty ⊕⊕⊕⊕, moderate certainty ⊕⊕⊕ø, low certainty ⊕⊕øø and very low certainty ⊕øøø.
↵‡ We downgraded by 1 level for risk of bias. The contributing study was high.
↵§ We upgraded by 1 level for plausible confounding. There are residual confounders in the estimate.
↵¶ We upgraded by 1 level for dose response gradient. We observed a change in the point estimate for every increase in WPRS.