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Documentation of pediatric vital signs by EMS providers over time
Hilary Hewes1, Shari Hunsaker2, Mathew Christensen2
1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, United States.
Insights
Emergency medical services (EMS) providers in Utah improved pediatric vital sign documentation after educational interventions. Blood pressure remains challenging, especially for young children, highlighting the need for continued efforts in pediatric prehospital care.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Prehospital Services
Background:
- Pediatric patients constitute 10% of national EMS transports.
- Inconsistent vital sign acquisition in prehospital pediatric care is documented.
- Unrecognized hypotension/hypoxia in pediatric trauma/shock increases mortality.
Purpose of the Study:
- To quantify the frequency of vital sign (BP, HR, Po, RR) documentation for pediatric transports in Utah (2007-2014).
- To evaluate the impact of educational interventions on pediatric vital sign documentation rates.
Main Methods:
- Retrospective analysis of pediatric transport data from Utah (2007-2014).
- Assessment of vital sign documentation rates (BP, HR, Po, RR) over time.
- Evaluation of correlation between educational interventions and vital sign attainment.
Main Results:
- A positive trend in documenting all four vital signs was observed over the study period.
- Pulse oximetry measurement showed the most consistent increase across pediatric age groups.
- Blood pressure documentation remained the least consistent, particularly in younger children.
- Educational interventions implemented in late 2010 were associated with improved vital sign documentation.
Conclusions:
- Pediatric vital sign assessment is crucial in prehospital care.
- Utah EMS providers enhanced vital sign documentation following educational initiatives.
- Consistent blood pressure acquisition in young pediatric patients remains a challenge.
- Further efforts are needed to reach the goal of >90% documentation for all pediatric transports.
Background:
Pediatric patients make up approximately 10% of EMS transports nationwide. Previous studies demonstrated that pediatric patients do not consistently have a full set of vitals signs obtained in the prehospital setting [1]. In certain conditions, such as traumatic head injury and shock, unrecognized hypotension and/or hypoxia are associated with increased morbidity and mortality [2,3].
Primary Objective:
To measure how often EMS providers obtain blood pressure (BP), heart rate (HR), pulse oximetry (Po), and respiratory rate (RR) on pediatric transport patients in the state of Utah from 2007 to 2014.
Secondary Objective:
To assess whether educational interventions improved the percentage of pediatric transport patients with a full set of vital signs documented.
Results:
The trend of documenting the four critical vital signs improved over time for all four categories. Measurement of Po increased most consistently across all age groups. Blood pressure remained the most inconsistently obtained vital sign, especially in younger pediatric patients. The educational interventions introduced in late 2010 correlated with an increase in vital sign attainment.
Conclusions:
Assessment of pediatric vitals signs is a critical part of the evaluation and care of pediatric patients in the prehospital setting. Utah EMS providers improved their practice of documenting four pediatric vital signs over time after educational interventions. Obtaining a BP, especially in younger children, continues to be a challenge. More work remains to achieve the state goal of documenting all vital signs in >90% of pediatric transports.
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