Rapid Discharge Following Air Transport in Children

Air transport can play a crucial role in the care of critically ill or injured children. Use of air emergency medical services (EMS) can be subject to both over- and undertriage, with prior work suggesting that some air transports in children may be unnecessary. Our objective was to evaluate the association of pediatric air transport with emergency department (ED) discharge and short (<48 h) hospitalization.

We performed a multicenter retrospective study of children's hospitals participating in the Pediatric Emergency Care Applied Research Network Registry between 2012 and 2021, including encounters for children (<18 years) transported to the ED by air EMS. Our outcomes were (1) ED discharge and (2) hospitalization with short admission (length of stay <48 h). We evaluated clinical, demographic, and diagnostic factors associated with each outcome using multivariable logistic regression.

We included 7722 encounters [60.9% male, median age 5.9 years (IQR 1.9-12.3 years)]; with 35.8% having a trauma-related principal diagnosis (with 38.4% of reporting encounters based on ED and admission codes, and the remainder as ED diagnosis codes only). Overall, 1545 (20.0%) encounters were discharged from the ED. Among admitted patients (n = 6139), 3548 (57.8%) had a short admission. Discharge from the ED was associated with Black non-Hispanic race/ethnicity, other payer status relative to private payer status, and lower triage acuity relative to Emergency Severity Index (ESI) level 1. Certain traumatic, musculoskeletal, neurological, psychiatric, toxicologic, and gastrointestinal diagnoses were also associated with ED discharge. Conditions associated with lower odds of admission for <48 h included genital/reproductive diseases, toxicologic emergencies, brain/skull trauma, facial and dental trauma, contusions, otolaryngological diseases, neurological diseases, and psychiatric, behavioral, and substance abuse disorders.

More than two-thirds of children transported to the ED by air are either discharged from the ED or within 48 h of admission. Race, ethnicity, payer status, low triage acuity, and missing vital sign information were associated with ED discharge. While this dataset lacks information on the rationale for initiating air transport, these findings emphasize the need for additional research into the decision-making processes surrounding pediatric air EMS to support optimal resource utilization and patient care.