Repeat 9-1-1 Calls and Clinical Outcomes of Children After Non-Transport by Emergency Medical Services

Pediatric non-transport by emergency medical services (EMS) is common but there are limited data assessing patient outcomes. Our primary objective was to determine the proportion of children not transported by EMS who have a repeat 9-1-1 call and transport within 72 hours. Our secondary objective was to determine whether patient demographic or clinical characteristics are associated with repeat 9-1-1 call and transport.

We conducted a retrospective cross-sectional study using the 2018 - 2022 ESO Data Collaborative research dataset. Of these records, one third are linked to hospital data which allowed for inclusion of discharge and ICD-10 diagnosis codes for some of the cases. We used descriptive statistics to compare cases (non-transported children aged 0 - 17 years with repeat 9-1-1 call and transport within 72 hours) to controls (no repeat 9-1-1 call or repeat 9-1-1 call with non-transport). We conducted a multivariable logistic regression analysis to evaluate factors associated with a repeat 9-1-1 call and transport within 72 hours. We generated descriptive statistics summarizing emergency department (ED) dispositions for the subset of patients where this data was available.

Of 1,849,925 pediatric 9-1-1 calls, 732,525 (40%) were not transported by EMS. Within 72 hours, 7,544 (1%) had repeat 9-1-1 call with transport to the ED. Repeat 9-1-1 call was associated with young age (0-4 years), Black, non-Hispanic race, male sex, calls from areas with a very low Child Opportunity Index (Opportunity Index), calls during out-of-office hours, and neurologic primary impressions. There were 11 (0.1%) deaths on scene upon repeat 9-1-1 call within 72 hours of initial non-transport. Of the 1,001 (13%) patients with hospital-linked data, 814 (89%) were discharged from the ED, 162 (16%) were hospitalized, and two (0.2%) died.

Only 1% of children not transported by EMS had a repeat 9-1-1 call and transport within 72 hours. Hospitalization and death after non-transport were rare. These results may inform the development of safe and efficient pediatric non-transport protocols.