Documentation of Weight in Pediatric 9-1-1 Responses with Administration of Weight-Based Medications

Determining a child's weight is a critical first step in administering the appropriate dose of a medication in an emergency. The National Emergency Medical Services Quality Alliance (NEMSQA) patient safety process measure, "Pediatrics-03b," calls for weight documentation in kilograms or length-based weight estimate for pediatric patients who receive weight-based medications in the prehospital setting. To date, no publication has identified compliance with this measure at a national level. The goal of this study was to describe weight documentation in pediatric 9-1-1 responses and factors associated with this quality measure.

Using the ImageTrend Collaborate 2024 national dataset, we analyzed 9-1-1 responses for pediatric patients (<18 years of age) who received medication by EMS clinicians consistent with the Pediatrics-03b definition denominator. Weight documentation was obtained from eExam01 and eExam02 National EMS Information System fields. Differences in weight documentation were assessed by patient demographics, unit, and scene characteristics. Furthermore, medication type and administration routes were examined. Statistical analyses included chi-square tests for comparison of proportions and population averaged univariable logit regression models for the binary outcome of weight documentation with clustering for state.

Overall, 57,378 responses met inclusion criteria, and 41,963 (73.1%) had a documented weight. Weights were less likely to be documented in cases involving adolescent (age 13-17) patients (Odds Ratio [OR]: 0.87, 95% Confidence Interval [95% CI]: 0.75-0.99), patients described as Black (OR: 0.72, 95% CI: 0.61-0.85), or those with lower acuity (OR: 0.59, 95% CI: 0.50-0.71). Weights were more likely to be documented in cases managed by advanced life support units (OR: 2.02, 95% CI: 1.31-3.11) and in patients described as male (OR: 1.08, 95%: 1.03-1.14).

Three quarters of 9-1-1 responses meeting the Pediatrics-03b case definition were compliant with the measure. Future studies should be focused on evaluating the case definition for the measure to determine how to best evaluate and improve care in this domain. Establishing a benchmark, evaluating that benchmark, and understanding barriers to optimal implementation are critical to improving prehospital care and documentation of pediatric patients by EMS clinicians.