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EMS Pediatric Trauma Transport: Do Disparities Exist?
Andreina Giron1, John Schomberg2, Peter N Dinh2
1Division of Pediatric General & Thoracic Surgery, Children's Hospital Orange County, Orange, CA, USA; Department of Surgery, Montefiore Medical Center, New York City, New York, USA.
Insights
Racial disparities affect pediatric trauma care. Most children transported by Emergency Medical Services (EMS) go to non-trauma centers, with younger patients and African Americans less likely to reach specialized pediatric trauma centers (PTCs).
Area of Science:
- Pediatric Trauma Care
- Emergency Medical Services (EMS)
- Health Disparities
Background:
- Trauma is a leading cause of death and disability in US children.
- Pediatric Trauma Centers (PTCs) offer specialized care for optimal outcomes.
- Existing disparities impact the delivery of pediatric trauma care.
Purpose of the Study:
- Investigate disparities in Emergency Medical Services (EMS) transport for pediatric and adolescent trauma patients.
- Identify factors influencing destination decisions for pediatric trauma patients.
- Analyze the association between patient demographics and transport to specialized centers.
Main Methods:
- Utilized 2017-2019 National Emergency Medical Services Information System (NEMSIS) data.
- Included pediatric and adolescent patients (0-18 years) requiring EMS transport.
- Conducted descriptive and regression analyses, adjusting for trauma severity.
Main Results:
- 896,881 pediatric patients identified; 129,627 met trauma criteria.
- Most (89.4%) were transported to non-trauma centers (NTCs).
- Younger patients and African Americans had lower odds of transport to trauma centers (TCs), even after accounting for geography.
Conclusions:
- Significant racial disparities exist in EMS transport for pediatric trauma patients.
- Equitable healthcare delivery requires addressing these transport disparities.
- Ensuring access to PTCs is crucial for all children experiencing trauma.
Introduction:
Trauma is the leading cause of disability and death among children in the United States. Optimal outcomes are achieved at pediatric trauma centers (PTCs), which are specialized to address the unique needs of this population. Disparities in trauma have been reported, affecting optimal delivery of care. This study aims to investigate disparities in Emergency Medical Services (EMS) transport of pediatric and adolescent trauma patients and the factors influencing destination decisions.
Methods:
This study utilized data from the National Emergency Medical Services Information System (NEMSIS) from 2017 to 2019, including EMS, sociodemographic, clinical, and decision-making variables. Patients aged 0-18 years that required EMS transport were included. Descriptive and regression analyses were conducted to identify factors influencing EMS transport destinations.
Results:
896,881 pediatric and adolescent patients requiring EMS transport were identified. After adjusting for trauma severity using NEMSIS Revised Trauma Score, 129,627 pediatric trauma patients were found. Most (89.4 %) were transferred to a non-trauma center (NTC). Transport times to trauma centers (TCs) were slightly longer than NTCs (16.1 vs. 14.0 min, p < 0.0001). Transports to TCs were more likely to be associated with a clinical reason (p < 0.001); transports to NTCs were more likely to be associated with geography (p < 0.001). Younger patients (p < 0.0001) and African Americans (p < 0.0001) had reduced odds of transport to TCs, even after adjusting for geography as the destination reason.
Conclusions:
Racial disparities exist in EMS transport of pediatric and adolescent trauma patients. Addressing these disparities is critical to the equitable delivery of healthcare for children in the United States.
Level Of Evidence:
Level III.
