University of Pittsburgh Medical Center, Department of Pediatrics, Section of Emergency Medicine, Pittsburgh, PA, USA.
Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TX, USA.
Am J Emerg Med. 2021 Dec;50:360-364. doi: 10.1016/j.ajem.2021.08.047. Epub 2021 Aug 23.
Pediatric patients comprise 13% of emergency medical services (EMS) transports, and most are transported to general emergency departments (ED). EMS transport destination policies may guide when to transport patients to a children's hospital, especially for medical complaints. Factors that influence EMS providers 'decisions about where to transport children are unknown. Our objective was to evaluate the factors associated with pediatric EMS transports to children's hospitals for medical complaints.
We performed a cross-sectional study of a large, urban EMS system over a 12-month period for all transports of patients 0-17 years old. We electronically queried the EMS database for demographic data, medical presentation and management, comorbidities, and documented reasons for choosing destination. Distances to the destination hospital and nearest children's and community hospital (if not the transport destination) were calculated. Univariate and multiple logistic regression analyses were conducted to determine the association between independent variables and the transport destination.
We identified 10,065 patients, of which 6982 (69%) were for medical complaints. Of these medical complaints, 3518 (50.4%) were transported to a children's hospital ED. Factors associated with transport to a children's hospital include ALS transport, greater transport distance, protocol determination, developmental delay, or altered consciousness. Factors associated with transport to general EDs were older age, unknown insurance status, lower income, greater distance to children's or community hospital, destination determined by closest facility or diversion, abnormal respiratory rate or blood glucose, psychiatric primary impression, or communication barriers present.
We found that younger patient age, EMS protocol requirements, and paramedic scene response may influence pediatric patient transport to both children's and community hospitals. Socioeconomic factors, ED proximity, diversion status, respiratory rate, chief complaints, and communication barriers may also be contributing factors. Further studies are needed to determine the generalizability of these findings to other EMS systems.
儿科患者占急诊医疗服务（EMS）转运的 13%，其中大多数转运至综合急诊科（ED）。EMS 转运目的地政策可能会指导何时将患者转运至儿童医院，尤其是针对医疗投诉。影响 EMS 提供者决定将儿童转运至何处的因素尚不清楚。我们的目的是评估与因医疗投诉而将儿科患者转运至儿童医院相关的因素。
我们对一个大型城市 EMS 系统进行了为期 12 个月的横断面研究，纳入了所有 0-17 岁患者的转运。我们通过电子方式查询 EMS 数据库，以获取人口统计学数据、医疗表现和管理、合并症以及记录的转运目的地选择原因。计算转运目的地医院以及最近的儿童医院和社区医院（如果不是转运目的地）的距离。进行单变量和多变量逻辑回归分析，以确定独立变量与转运目的地之间的关联。
我们确定了 10065 名患者，其中 6982 名（69%）因医疗投诉而转运。在这些医疗投诉中，3518 名（50.4%）转运至儿童医院 ED。与转运至儿童医院相关的因素包括 ALS 转运、转运距离更大、协议确定、发育迟缓或意识改变。与转运至综合 ED 相关的因素包括年龄较大、保险状态未知、收入较低、到儿童医院或社区医院的距离较大、根据最近的医疗机构或分流确定转运目的地、呼吸频率或血糖异常、精神病学初步印象或存在沟通障碍。
我们发现，患者年龄较小、EMS 协议要求以及护理人员现场反应可能会影响儿科患者转运至儿童医院和社区医院。社会经济因素、ED 接近程度、分流状态、呼吸频率、主要投诉和沟通障碍也可能是促成因素。需要进一步的研究来确定这些发现是否适用于其他 EMS 系统。
