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Assessment of Inadequate Use of Pediatric Emergency Medical Transport Services: The Pediatric Emergency and Ambulance
Martin Poryo1, Martin Burger2, Stefan Wagenpfeil3
1Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany.
Insights
A significant portion of pediatric emergency medical transport services (EMTS) are not medically indicated. Factors like non-acute symptoms and parental perception contribute to overuse, suggesting educational interventions could reduce unnecessary transports.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Resource Utilization
- Public Health Policy
Background:
- Emergency medical transport services (EMTS) are critical for acute pediatric conditions.
- Understanding the appropriateness of EMTS use in children is essential for resource optimization.
- Previous data on pediatric EMTS utilization and its contributing factors remain limited.
Purpose of the Study:
- To quantify the rate of inadequate use of pediatric emergency medical transport services (EMTS).
- To identify underlying factors associated with both inadequate and adequate EMTS utilization in children.
- To analyze the financial implications of inappropriate EMTS use in pediatric care.
Main Methods:
- Prospective single-center cohort study conducted from January 2017 to December 2017.
- Inclusion of 379 patients aged 20 years or younger transported by EMTS for suspected acute illness or trauma.
- Analysis of EMTS use adequacy, contributing factors, and associated costs, with logistic regression for parameter association.
Main Results:
- 33.5% of pediatric EMTS transports were deemed medically indicated, while 46.7% were not.
- Inadequate EMTS use was significantly associated with non-acute symptom onset (OR 2.2), parental perception of non-life-threatening condition (OR 1.7), and subsequent outpatient treatment (OR 4.0).
- Adequate EMTS use correlated with transport by an emergency physician (OR 3.3), first-time parental EMTS calls (OR 1.8), and need for inpatient treatment (OR 4.0).
Conclusions:
- A substantial proportion of pediatric emergency medical transport services (EMTS) are utilized for non-medically indicated reasons.
- Factors such as symptom acuity, parental perception, and educational background influence EMTS overuse.
- Targeted educational initiatives and policy adjustments may be necessary to optimize pediatric EMTS utilization and reduce unnecessary costs.
Abstract:
Aim: To provide data on the inadequate use of emergency medical transports services (EMTS) in children and underlying contributing factors. Methods: This was a prospective single-center cohort study (01/2017-12/2017) performed at the Saarland University Children's Hospital, Homburg, Germany. Patients ≤20 years of age transported by EMTS for suspected acute illness/trauma were included and proportion of inadequate/adequate EMTS use, underlying contributing factors, and additional costs were analyzed. Results: Three hundred seventy-nine patients (mean age: 9.0 ± 6.3 years; 55.7% male, 44.3% female) were included in this study. The three most common reasons for EMTS use were: central nervous system (30.6%), respiratory system affection (14.0%), and traumas (13.2%). ETMS use was categorized as inadequate depending on physician's experience: senior physician (58.8%), pediatrician (54.9%), resident (52.7%). All three physicians considered 127 (33.5%) cases to be medically indicated for transportation by EMTS, and 177 (46.7%) to be medically not indicated. The following parameters were significantly associated with inadequate EMTS use: non-acute onset of symptoms (OR 2.5), parental perception as non-life-threatening (OR 1.7), and subsequent out-patient treatment (OR 4.0). Conversely, transport by an emergency physician (OR 3.5) and first time parental EMTS call (OR 1.7) were associated with adequate use of EMTS. Moreover, a significant relation existed between maternal, respectively, paternal educational status and inadequate EMTS use (each p = 0.01). Using multiple logistic regression analysis, non-acute onset of symptoms (OR 2.2) was associated with inadequate use of EMTS while first time parental EMTS call (OR 1.8), transport by an emergency physician (OR 3.3), and need for in-patient treatment (OR 4.0) were associated with adequate use of EMTS. Conclusion: A substantial number of pediatric EMTS is medically not indicated. Possibly, specific measures including multifaceted educational efforts may be helpful in reducing unnecessary EMTS use.
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