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Published on: November 9, 2016
Usage of emergency medical services by children with special health care needs
A Suruda1, D D Vernon, E Diller
1Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City 84112, USA. asuruda@dfpm.utah.edu
Insights
Children with special health care needs (CSHCN) utilize emergency medical services (EMS) more frequently for advanced care and inter-facility transfers. A clear definition of CSHCN is needed for better data analysis.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Public Health
Background:
- Children with special health care needs (CSHCN) represent a vulnerable population with unique healthcare requirements.
- Understanding their utilization of emergency medical services (EMS) is crucial for optimizing care delivery and resource allocation.
Purpose of the Study:
- To characterize the patterns of EMS usage among CSHCN.
- To compare EMS utilization between CSHCN and children without special health care needs.
- To evaluate the accuracy of different diagnostic criteria for identifying CSHCN within EMS data.
Main Methods:
- Linked EMS and hospital records for children aged 0-17 in Utah (1991-92).
- Defined CSHCN status using three ICD-9 diagnosis-based methods.
- Compared EMS usage, hospital admissions, and prehospital procedures between CSHCN and non-CSHCN groups.
- Validated ICD-9 definitions against expert chart review for a subset of patients.
Main Results:
- CSHCN status varied significantly (2%-24%) based on the definition used.
- CSHCN were more likely to be hospitalized, require inter-facility transfers, and receive prehospital procedures (e.g., IV therapy) via EMS.
- One ICD-9-based definition showed the highest agreement with expert clinical determination of CSHCN status.
Conclusions:
- CSHCN utilizing EMS are more likely to receive advanced life support, prehospital procedures, and inter-facility transfers.
- A precise and measurable definition of CSHCN is essential for accurate application to existing health datasets.
- Improved data definitions can enhance the understanding and support of CSHCN within emergency medical systems.
Objective:
To describe the usage of emergency medical services (EMS) by children with special health care needs (CSHCN).
Methods:
All EMS runs and related hospital records for children aged 0-17 years in Utah in 1991-92 were linked. The CSHCN status was determined from ICD-9 diagnoses using three available definitions. The amounts of EMS usage were compared between CSHCN and other children. A pediatric intensive care practitioner determined CSHCN status by chart review for 915 children transported by EMS to a pediatric tertiary care hospital, and his classification was compared with the CSHCN status assigned by the three ICD-9-based definitions.
Results:
The three definitions assigned CSHCN status for 2% to 24% of children using EMS. When compared with other children, CSHCN were more likely to be admitted to the hospital, more likely to use EMS for transfer between health care facilities, and more likely to receive prehospital procedures such as intravenous therapy. In the group of children whose charts were reviewed individually, one ICD-9-based definition most closely agreed to determination of CSHCN status by a pediatric intensive care practitioner.
Conclusions:
Children with special health care needs who use EMS are more likely to receive advanced life support service, to receive prehospital procedures, and to be transferred from one health care facility to another. There is need for a specific and measurable definition of CSHCN that can be applied to existing health data.
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