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Route less travelled? Ambulance use for children with high-acuity acute illness
Timothy Hopgood1, Michael Shepherd
1Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Insights
Many critically ill children, especially infants, do not use ambulance transportation to reach Auckland hospitals. This underutilization may negatively impact health outcomes, necessitating further research into causes and solutions for emergency medical services access.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Transportation Safety
Background:
- Ambulance services provide critical pre-hospital care, but their utilization by pediatric populations, particularly for severe conditions, requires investigation.
- Children may underutilize ambulance services when private transportation is an option, potentially affecting timely access to definitive care.
Purpose of the Study:
- To quantify the proportion of critically ill children (triage categories 1 and 2) transported by ambulance to a major children's hospital in Auckland.
- To identify if specific demographic groups exhibit lower rates of ambulance use for emergency pediatric hospital presentations.
Main Methods:
- Retrospective analysis of data for children under 15 presenting to Starship Children's Health between January and December 2011.
- Inclusion criteria: self-referrals, triage category 1 or 2, and data on transportation mode, demographics, and outcomes.
Main Results:
- Out of 1047 eligible presentations, 75.1% of triage 1 and 30.7% of triage 2 patients used ambulance transport.
- Ambulance use increased with age (P < 0.001), but no significant associations were found with gender, ethnicity, or area deprivation.
- Illness severity, admission rates, and length of stay did not differ significantly based on transportation mode.
Conclusions:
- A substantial number of acutely unwell children, particularly infants under one year, did not arrive by ambulance, posing a risk to health outcomes.
- No demographic factors were linked to lower ambulance use, indicating a need for further research to understand and address this issue.
Aim:
Ambulance transportation offers important supportive care and treatment en route to definitive treatment. However, children may be at risk of under-utilising ambulance transportation, where private vehicle is possible. This study aims to determine how many of the sickest children present to hospitals in Auckland via ambulance and whether certain population groups are lower users of ambulance services.
Methods:
Transportation, demographic and outcome data were collected and analysed for children presenting to Starship Children's Health (Starship) from 1 January to 31 December 2011), who were 'self referrals' to hospital, less than 15 years of age, and assigned triage category 1 and 2 on presentation.
Results:
There were 1047 presentations to Starship identified that met inclusion criteria. Of these, 256 of the 341 triage one presentations (75.1%) and 217 of the 706 triage two presentations (30.7%) were transported by ambulance.Ambulance use was higher among older children (P < 0.001). Severity of illness or injury, as estimated by admission rates (56.7% vs. 43.3%, P = 0.21) and length of hospital stay (median = 1 day, P = 0.92), did not differ significantly by mode of transportation. There was no observed relationship with gender, ethnicity or area deprivation index score.
Conclusion:
A significant proportion of acutely unwell children presenting to hospital were not transported by ambulance, particularly those aged less than 1 year. This has the potential to result in worse health outcomes. There were no identified associations with patient demographics, and further research is required to better understand this problem and develop solutions.
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