Prehospital Factors Associated with Low-Acuity Status Among Pediatric Emergency Medical Services Transports in a...

To characterize rates of low-acuity emergency medical services (EMS) transports in children and identify factors associated with this status within a regional EMS system.

We performed a retrospective study of children (<18 years) transported by 242 EMS agencies to one of 17 hospitals between 2014-2023. Our outcome was a low-acuity status, defined as an ED discharge without advanced prehospital or ED interventions, medications beyond non-opioid analgesics or antipyretics, imaging or blood testing. We characterized rates of low-acuity encounters and used elastic-net penalized logistic regression to identify factors associated with this outcome.

Of 68,489 transports, we identified 5,229 encounters meeting low-acuity status (7.6%). These encounters were more common in younger children (median age 3.5 years) and were most often related to non-major trauma (28.7%), fever/general illness (20.6%), and seizure (19.8%), with most presenting to pediatric hospitals (79.7%). In multivariable modeling, low-acuity status was less likely in older ages (relative to 1 year of age) and among encounters for children with abnormal vitals or mental status. These events were more likely in encounters for children with seizure, fever/general illness, and neurologic presentations. The model showed moderate discrimination (area under the receiver operating characteristic curve 0.74, 95% confidence interval [CI] 0.734-0.748; specificity 70.9% [95% CI 70.6%-71.3%] and negative predictive value 95.9% [95% CI 95.7%-96.0%]).

Approximately 8% of pediatric EMS transports met our criteria for low-acuity illness. These findings highlight the need for prospective study and system-level strategies to safely identify and manage low-acuity pediatric EMS encounters.