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Regional variation of pediatric interhospital critical care transport in Japan
Shinya Miura1,2, Satoshi Miyata1, Atsushi Kawaguchi2,3
1Graduate School of Public Health, Teikyo University, Tokyo, Japan.
Insights
Pediatric interhospital transport in Japan shows significant regional variations in critical care transport (CCT) numbers. Understanding these differences is key for effective public health planning and resource allocation for child medical transport services.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Services
- Healthcare Epidemiology
Background:
- Understanding pediatric interhospital transport epidemiology is vital for regional medical transport services.
- Data on pediatric interhospital transport in Japan is limited.
- This study describes pediatric interhospital transport numbers and examines regional variations and trends in Japan over a decade.
Purpose of the Study:
- To describe the number of pediatric interhospital transportations in Japan.
- To examine regional variations and trends in pediatric interhospital transport over the past decade.
- To inform policymaking for pediatric interhospital transportation.
Main Methods:
- Cross-sectional analysis of children (<15 years) undergoing interhospital transport in Japan (2010, 2013, 2016-19).
- Data sourced from the national database of public ambulances (Fire and Disaster Management Agency).
- Cases stratified into critical care transport (CCT) and non-critical care transport (NonCCT); population-adjusted CCT numbers calculated and prefectural variations analyzed.
Main Results:
- A total of 23,506 CCTs and 138,347 NonCCTs were recorded.
- National average population-adjusted CCT rate was 255 per 1,000,000 person-years, with significant prefectural variation (25-536 per 1,000,000 person-years).
- Annual CCT trends varied by prefecture: increasing in nine, decreasing in six, and static in 31; regional variations linked to transport services and hospital referral thresholds, not geography or population size.
Conclusions:
- Public ambulance services are extensively utilized for both critical and non-critical pediatric interhospital transports in Japan.
- Significant regional disparities in pediatric interhospital transport necessitate consideration in future public health policy.
- Policymaking for pediatric interhospital transportation must account for these identified regional variations.
Background:
An in-depth understanding of the epidemiology of ill or injured children transported between hospitals is crucial in building regional medical transport services in public health. Although the epidemiological situation varies by nation and region, it has not been well documented in Japan. In this report we described the number of pediatric interhospital transportations and examined the regional variations and trends in the recent decade.
Methods:
We performed repeated, cross-sectional analyses of children (<15 years) undergoing interhospital transportation in 2010, 2013, and 2016-19, using the national database of public ambulances of the Fire and Disaster Management Agency in Japan. We stratified the cases into critical care transport (CCT) or non-critical care transport (NonCCT) by the illness/injury severity of the transported children. We calculated the national population-adjusted number of CCTs and described prefectural variations in CCT numbers with analytical thinking.
Results:
There were 23,506 CCTs and 138,347 NonCCTs. The national average of population-adjusted CCT numbers was 255 per 1,000,000 person-years. The statistics varied by prefectures, ranging from 25-536 per 1,000,000 person-years. The annual trends were also diverse across prefectures, increasing in nine, decreasing in six, and static in 31 prefectures. In analytical thinking of regional variations, potential contributing factors included available interhospital transport services and the threshold of direct admission and referral to tertiary-care hospitals, whereas regional variations were not well associated with geographical patterns or population size.
Conclusions:
Public ambulance services were substantially used for CCTs and NonCCTs in Japan. Regional variations should be taken into account for the future policymaking on pediatric interhospital transportation.
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