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Retrospective Evaluation of Risk Factors for Pediatric Secondary Transport
Insights
Pediatric secondary transport for non-trauma cases, like seizures and asthma, is common. Specific prehospital interventions and patient factors influence the need for this specialized emergency medical services (EMS) transport.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Prehospital Care
Background:
- Emergency medical services (EMS) typically transport pediatric patients to the nearest emergency department (ED).
- Secondary transport is required for children needing specialized care, increasing risks and delaying treatment.
- Current EMS direct transport protocols primarily cover major trauma and adult conditions, not pediatric medical issues or minor trauma.
Purpose of the Study:
- To describe the population of pediatric secondary transport patients with medical conditions or minor trauma.
- To identify prehospital risk factors associated with secondary transport in this population.
- To inform the development of future direct transport protocols for pediatric patients.
Main Methods:
- Identified 211 pediatric secondary transport patients (0-18 years) between 2013-2014, excluding trauma protocol or unstable patients.
- Conducted chart reviews of EMS, community ED, and specialty hospital records.
- Compared secondary transport patients to similar control patients who did not require secondary transport.
Main Results:
- Seizures, orthopedic injuries, and asthma/respiratory distress were the most common conditions (n=52, 49, 27 respectively).
- Prehospital factors like oxygen, glucose checks, and medical direction increased secondary transport odds for seizures and asthma.
- Higher GCS, age, and oxygen saturation decreased secondary transport odds for certain conditions.
Conclusions:
- Seizures, orthopedic injuries, and asthma/respiratory distress constitute the majority of non-trauma pediatric secondary transports.
- Specific prehospital interventions and patient characteristics are linked to the need for secondary transport.
- Findings support further research and the creation of direct transport protocols for these pediatric populations.
Objective:
Emergency medical services (EMS) typically transports patients to the nearest emergency department (ED). After initial presentation, children who require specialized care must undergo secondary transport, exposing them to additional risks and delaying definitive treatment. EMS direct transport protocols exist for major trauma and certain adult medical conditions, however the same cannot be said for pediatric medical conditions or injuries that do not meet trauma center criteria ('minor trauma'). To explore the utility of such future protocols, we sought to first describe the pediatric secondary transport population and examine prehospital risk factors for secondary transport.
Methods:
Pediatric secondary transport patients aged 0-18 years were identified. Patients meeting state EMS trauma protocol criteria or who were clinically unstable were excluded. Data were abstracted by chart review of EMS, community hospital ED, and specialty hospital records. Patients were compared to control patients with similar conditions who did not require secondary transport.
Results:
This study identified 211 medical or minor trauma pediatric secondary transport patients between 2013 and 2014. The three most prevalent conditions were seizure (n = 52), isolated orthopedic injury (n = 49), and asthma/respiratory distress (n = 27). Increased odds of secondary transport for seizure patients were associated with administration of supplemental oxygen, glucose measurement, and online medical direction; for isolated orthopedic injuries, online medical direction; and for asthma/respiratory distress, administration of supplemental oxygen, and online medical direction. Decreased odds of secondary transport for seizure patients were associated with a higher GCS; for isolated orthopedic injuries, increased age and oxygen saturation; and for asthma/respiratory distress, administration of albuterol only.
Conclusions:
Children with seizures, isolated orthopedic injuries, and asthma/respiratory distress comprised the majority of the medical or minor trauma pediatric secondary transport population. Each of those conditions had specific risk factors for secondary transport. This study's results provide information to guide future prospective studies and the development of direct transport protocols for those populations.
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