Pediatric secondary transports within a regional emergency medical services system

Secondary transport, defined as transferring a patient to a different hospital after initial EMS transport and hospital evaluation, is increasingly used in the care of ill and injured children. We described pediatric secondary transport within a regional EMS system, identified prehospital factors associated with its use, and characterized children meeting established higher level of care criteria.

We performed a multi-EMS agency and multicenter study of pediatric transports from scene to one of 17 hospitals within an integrated health system. We described the longitudinal movement of encounters from the initial prehospital contact, the initial ED visit, and secondary transport and used a generalized linear mixed model to characterize factors associated with secondary transport. We identified the number of encounters meeting consensus criteria for requiring a higher level of care.

We included 68,890 pediatric EMS transports (median age 7.8 years [IQR 2.2-14.5]). Of the 21,879 (31.8%) evaluated in a non-pediatric community or tertiary hospital, secondary transport occurred in 6.3%. Older children had lower odds of secondary transport (ORs 0.74-0.84). Secondary transport was more common with neurologic (1.44, 95% CI 1.16-1.78), respiratory (1.52, 95% CI 1.19-1.95), toxicology/ingestion (3.26, 95% CI 2.44-4.36), and psychiatric encounters (4.99, 95% CI 3.91-6.36) relative to trauma; occurred more when there was greater distance to the children's hospital; and occurred more in children with abnormal vital signs or impaired consciousness. Overall, 6.0% of encounters met at least one criterion requiring a higher level of care. The most common criteria met were the use of one of the medications in the Pediatric Advanced Life Support guideline (2.8% of all encounters), and airway management (1.6%).

Approximately 6% of children evaluated at non-pediatric hospitals underwent secondary transport, particularly those with neurologic, respiratory, psychiatric, or toxicologic conditions. One-fifth who met higher-level care criteria were transported, underscoring the need to refine criteria, improve EMS triage, and develop standardized decision support.