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Emergency Medical Services Utilization by Children
Parul Dayal1, Timothy Horeczko2, Cheryl Wraa3
1From the Departments of Pediatrics, University of California, Davis.
Insights
Children arriving at emergency departments by emergency medical services (EMS) are older, sicker, and require more resources than those arriving by other means. This highlights disparities in pediatric emergency care access and utilization in rural areas.
Area of Science:
- Pediatric Emergency Medicine
- Rural Health
- Healthcare Access
Background:
- Emergency medical services (EMS) play a critical role in transporting critically ill patients.
- Understanding patient demographics and resource utilization is crucial for optimizing emergency department (ED) operations.
Purpose of the Study:
- To compare demographic and clinical characteristics of pediatric patients arriving at rural EDs via EMS versus other transportation methods.
- To analyze prehospital procedures and resource utilization based on mode of arrival.
Main Methods:
- Retrospective review of 507 pediatric ED records (0-14 years) in a rural northern California region (2013).
- Comparison of children arriving by EMS versus private vehicles/other means.
- Analysis of prehospital procedures for EMS-transported children.
Main Results:
- EMS-transported children were older (9.0 vs. 6.0 years), sicker (mean Severity Classification Score 2.9 vs. 2.4), and had longer ED stays (3.6 vs. 2.1 hours).
- EMS patients received more subspecialty consultations, diagnostic testing (labs, radiography, CT scans), and had higher transfer rates (8.8% vs. 1.6%).
- Higher Severity Classification Scores persisted after adjusting for age and sex (β = 0.48; P < 0.001).
Conclusions:
- Children transported to rural EDs by EMS represent a sicker population with higher resource needs.
- Mode of arrival significantly impacts ED resource utilization and patient outcomes in pediatric emergency care.
- Targeted interventions may be needed to address disparities in rural pediatric emergency healthcare access.
Objective:
The aim of this study was to compare demographic and clinical features of children (0-14 years old) who arrived at general emergency departments (EDs) by emergency medical services (EMS) to those who arrived by private vehicles and other means in a rural, 3-county region of northern California.
Methods:
We reviewed 507 ED records of children who arrived at EDs by EMS and those who arrived by other means in 2013. We also analyzed prehospital procedures performed on all children transported to an area hospital by EMS.
Results:
Children arriving by EMS were older (9.0 vs 6.0 years; P < 0.001), more ill (mean Severity Classification Score, 2.9 vs 2.4; P < 0.001), and had longer lengths of stay (3.6 vs 2.1 hours; P < 0.001) compared with children who were transported to the EDs by other means. Children transported by EMS received more subspecialty consultations (18.7% vs 6.9%; P < 0.05) and had more diagnostic testing, including laboratory testing (22.9% vs 10.6%; P < 0.001), radiography (39.7% vs 20.8%; P < 0.001), and computed tomography scans (16.8% vs 2.9%; P < 0.001). Children arriving by EMS were transferred more frequently (8.8% vs 1.6%; P < 0.001) and had higher mean Severity Classification Scores compared with children arriving by other transportation even after adjusting for age and sex (β = 0.48; 95% confidence interval, 0.35-0.61; P < 0.001). Older children received more prehospital procedures compared with younger children, and these were of greater complexity and a wider spectrum.
Conclusions:
Children transported to rural EDs via EMS are more ill and use more medical resources compared with those who arrive to the ED by other means of transportation.