Poryo Martin, Burger Martin, Wagenpfeil Stefan, Ziegler Bennet, Sauer Harald, Flotats-Bastardas Marina, Grundmann Ulrich, Zemlin Michael, Meyer Sascha
Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany.
Medical School, University of Saarland, Homburg, Germany.
Front Pediatr. 2019 Oct 25;7:442. doi: 10.3389/fped.2019.00442. eCollection 2019.
To provide data on the inadequate use of emergency medical transports services (EMTS) in children and underlying contributing factors. This was a prospective single-center cohort study (01/2017-12/2017) performed at the Saarland University Children's Hospital, Homburg, Germany. Patients ≤20 years of age transported by EMTS for suspected acute illness/trauma were included and proportion of inadequate/adequate EMTS use, underlying contributing factors, and additional costs were analyzed. Three hundred seventy-nine patients (mean age: 9.0 ± 6.3 years; 55.7% male, 44.3% female) were included in this study. The three most common reasons for EMTS use were: central nervous system (30.6%), respiratory system affection (14.0%), and traumas (13.2%). ETMS use was categorized as inadequate depending on physician's experience: senior physician (58.8%), pediatrician (54.9%), resident (52.7%). All three physicians considered 127 (33.5%) cases to be medically indicated for transportation by EMTS, and 177 (46.7%) to be medically not indicated. The following parameters were significantly associated with inadequate EMTS use: non-acute onset of symptoms (OR 2.5), parental perception as non-life-threatening (OR 1.7), and subsequent out-patient treatment (OR 4.0). Conversely, transport by an emergency physician (OR 3.5) and first time parental EMTS call (OR 1.7) were associated with adequate use of EMTS. Moreover, a significant relation existed between maternal, respectively, paternal educational status and inadequate EMTS use (each = 0.01). Using multiple logistic regression analysis, non-acute onset of symptoms (OR 2.2) was associated with inadequate use of EMTS while first time parental EMTS call (OR 1.8), transport by an emergency physician (OR 3.3), and need for in-patient treatment (OR 4.0) were associated with adequate use of EMTS. A substantial number of pediatric EMTS is medically not indicated. Possibly, specific measures including multifaceted educational efforts may be helpful in reducing unnecessary EMTS use.
提供有关儿童紧急医疗运输服务（EMTS）使用不足及潜在影响因素的数据。这是一项前瞻性单中心队列研究（2017年1月至2017年12月），在德国洪堡萨尔州大学儿童医院开展。纳入由EMTS运送的疑似急性疾病/创伤的20岁及以下患者，分析EMTS使用不足/充足的比例、潜在影响因素及额外费用。本研究纳入了379例患者（平均年龄：9.0±6.3岁；男性占55.7%，女性占44.3%）。使用EMTS的三个最常见原因是：中枢神经系统（30.6%）、呼吸系统疾病（14.0%）和创伤（13.2%）。根据医生经验，ETMS使用被归类为不足：主任医师（58.8%）、儿科医生（54.9%）、住院医师（52.7%）。所有三位医生认为127例（33.5%）病例在医学上适合通过EMTS运送，177例（46.7%）在医学上不适合。以下参数与EMTS使用不足显著相关：症状非急性发作（OR 2.5）、父母认为无生命危险（OR 1.7）以及后续门诊治疗（OR 4.0）。相反，由急诊医生运送（OR 3.5）和父母首次拨打EMTS电话（OR 1.7）与EMTS的充分使用相关。此外，母亲和父亲的教育程度与EMTS使用不足之间存在显著关系（均P = 0.01）。使用多元逻辑回归分析，症状非急性发作（OR 2.2）与EMTS使用不足相关，而父母首次拨打EMTS电话（OR 1.8）、由急诊医生运送（OR 3.3）和需要住院治疗（OR 4.0）与EMTS的充分使用相关。大量儿科EMTS在医学上并无必要。可能包括多方面教育努力在内的具体措施有助于减少不必要的EMTS使用。
