Dayal Parul, Horeczko Timothy, Wraa Cheryl, Karsteadt Larry, Chapman Wendy, Bruhnke Louis, Litman Rebecca, Ruttan Timothy, Kuppermann Nathan, Marcin James
From the Departments of Pediatrics, University of California, Davis.
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance.
Pediatr Emerg Care. 2019 Dec;35(12):846-851. doi: 10.1097/PEC.0000000000001143.
The aim of this study was to compare demographic and clinical features of children (0-14 years old) who arrived at general emergency departments (EDs) by emergency medical services (EMS) to those who arrived by private vehicles and other means in a rural, 3-county region of northern California.
We reviewed 507 ED records of children who arrived at EDs by EMS and those who arrived by other means in 2013. We also analyzed prehospital procedures performed on all children transported to an area hospital by EMS.
Children arriving by EMS were older (9.0 vs 6.0 years; P < 0.001), more ill (mean Severity Classification Score, 2.9 vs 2.4; P < 0.001), and had longer lengths of stay (3.6 vs 2.1 hours; P < 0.001) compared with children who were transported to the EDs by other means. Children transported by EMS received more subspecialty consultations (18.7% vs 6.9%; P < 0.05) and had more diagnostic testing, including laboratory testing (22.9% vs 10.6%; P < 0.001), radiography (39.7% vs 20.8%; P < 0.001), and computed tomography scans (16.8% vs 2.9%; P < 0.001). Children arriving by EMS were transferred more frequently (8.8% vs 1.6%; P < 0.001) and had higher mean Severity Classification Scores compared with children arriving by other transportation even after adjusting for age and sex (β = 0.48; 95% confidence interval, 0.35-0.61; P < 0.001). Older children received more prehospital procedures compared with younger children, and these were of greater complexity and a wider spectrum.
Children transported to rural EDs via EMS are more ill and use more medical resources compared with those who arrive to the ED by other means of transportation.
本研究旨在比较加利福尼亚州北部一个农村三县地区通过紧急医疗服务（EMS）抵达综合急诊科（ED）的0至14岁儿童与通过私家车及其他方式抵达的儿童的人口统计学和临床特征。
我们回顾了2013年通过EMS抵达ED的儿童以及通过其他方式抵达的儿童的507份ED记录。我们还分析了由EMS转运至地区医院的所有儿童的院前处置情况。
与通过其他方式转运至ED的儿童相比，通过EMS抵达的儿童年龄更大（9.0岁对6.0岁；P<0.001），病情更严重（平均严重程度分类评分，2.9对2.4；P<0.001），住院时间更长（3.6小时对2.1小时；P<0.001）。通过EMS转运的儿童接受更多专科会诊（18.7%对6.9%；P<0.05），进行更多诊断检查，包括实验室检查（22.9%对10.6%；P<0.001）、放射检查（39.7%对20.8%；P<0.001）和计算机断层扫描（16.8%对2.9%；P<0.001）。即使在调整年龄和性别后，通过EMS抵达的儿童比通过其他交通方式抵达的儿童更频繁地被转诊（8.8%对1.6%；P<0.001），且平均严重程度分类评分更高（β=0.48；95%置信区间，0.35 - 0.61；P<0.001）。与年幼儿童相比，年长儿童接受更多院前处置，且这些处置更为复杂、范围更广。
与通过其他交通方式抵达ED的儿童相比，通过EMS转运至农村ED的儿童病情更严重，使用更多医疗资源。
