Video-assisted versus telephone-only pediatric emergency calls: a predefined substudy of the cluster randomized...

Assessment of pediatric emergencies by telephone is challenging and may be associated with uncertainty and overtriage. Video streaming has been introduced in emergency medical dispatch, but evidence regarding its impact in pediatric emergency calls remains limited. We evaluated associations between video-assisted dispatch assessment and urgency allocation, EMS resource use, and patient safety in pediatric calls.

This predefined substudy of the cluster-randomized CAM-VISION trial included emergency calls concerning children ≤ 15 years handled at the Emergency Medical Dispatch Center in the Central Denmark Region between January 1 and April 30, 2023. Dispatchers were randomized to video-assisted or telephone-only communication. Prespecified pediatric outcomes were the proportion of children assigned the lowest urgency level (response E), hospital admission within 24 h after response E, and the distribution of all urgency levels (A-E). Additional analyses included EMS resource allocation, urgency changes between dispatch and scene, non-conveyance, time intervals, ICU admission, and 30-day mortality. Analyses followed an intention-to-treat approach using clustered regression models.

Among 1,303 pediatric emergency calls, 586 were allocated to video-assisted dispatch and 717 to telephone-only communication. Video was successfully established in 74.7% of calls in the video group. Among predefined outcomes, the lowest urgency level (response E) was assigned more frequently in the video-assisted group (34.8% vs 28.0%; absolute difference 6.8 percentage points, 95% CI 0.1 to 13.4). No hospital admissions within 24 h occurred among children dispatched at response E in either group. The highest urgency level (response A) was less frequent in the video-assisted group (37.9% vs 45.0%; absolute difference - 7.2 percentage points, 95% CI - 14.0 to - 0.3). Additional analyses showed that physician-staffed vehicles arrived less often in the video-assisted group (35.3% vs 44.2%; absolute difference - 8.9 percentage points, 95% CI - 16.8 to - 0.9). Median time from call to dispatch was one minute longer in the video-assisted group, while on-scene time and hospital length of stay were similar between groups.

Video-assisted dispatch in pediatric emergency calls was associated with more frequent assignment of the lowest urgency level and reduced use of physician-staffed vehicles without evidence of compromised patient safety.

ClinicalTrials.gov identifier NCT05742412.