Division of Emergency Medicine, UPMC Children's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Prehosp Emerg Care. 2024;28(2):243-252. doi: 10.1080/10903127.2023.2178563. Epub 2023 Mar 1.
Pediatric prehospital encounters are proportionally low-frequency events. National pediatric readiness initiatives have targeted gaps in prehospital pediatric assessment and management. Regional studies suggest that pediatric vital signs are inconsistently obtained and documented. We aimed to assess national emergency medical services (EMS) data to evaluate completeness of assessment documentation for pediatric versus adult patients and to identify the documentation of condition-specific assessments.
We performed a retrospective cross-sectional analysis of EMS encounters from the National Emergency Medical Services Information System for 2019, including all 9-1-1 encounters resulting in transport. Our primary outcome was the proportion of encounters with complete vital signs (heart rate, respiratory rate, and systolic blood pressure) documented by pediatric age category relative to adult encounters. Pediatric patients were considered as those less than 18 years old. Our secondary outcome was condition-specific assessments for encounters with respiratory emergencies, cardiac complaints, and trauma. We performed multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for vital signs documentation by age after adjusting for sex, injury status, transport type (advanced vs basic life support), census region, urbanicity, organization nonprofit status, and organization type.
Of 18,918,914 EMS encounters, 6.4% involved pediatric patients. Documentation of complete vital signs was lowest in those <1 month old (30.8%) and rose with increasing age (highest in adults; 91.8%). Relative to adults, the adjusted odds of documented complete vital signs in patients <1 month old was 0.03 (95% CI 0.03-0.03) and increased with age to 0.76 (95% CI 0.75-0.77) in those 12-17 years old. Among those patients with respiratory, cardiac, and traumatic complaints, children had lower proportions of documented pulse oximetry, monitor use, and pain scores, respectively, compared to adults.
Documentation of complete vital signs and condition-specific assessments occurs less frequently in children, especially in younger age groups, as compared to adults, which is a finding that exists across urbanicity, region, and level of response. These findings provide a benchmark for clinical care, quality improvement, and research in the prehospital setting.
儿科院前急救的发生率相对较低。全国儿科急救准备计划的目标是解决院前儿科评估和管理方面的差距。区域研究表明，儿科生命体征的获取和记录不一致。我们旨在评估国家紧急医疗服务（EMS）数据，以评估儿科和成人患者评估文件的完整性，并确定特定病情评估的记录情况。
我们对 2019 年国家紧急医疗服务信息系统的 EMS 接触情况进行了回顾性横断面分析，包括所有导致转运的 9-1-1 接触。我们的主要结局是根据儿科年龄组与成人接触，记录完整生命体征（心率、呼吸频率和收缩压）的接触比例。儿科患者被认为是 18 岁以下的患者。我们的次要结局是有呼吸紧急情况、心脏投诉和创伤的接触的特定病情评估。我们进行了多变量逻辑回归，以计算在调整性别、受伤状态、转运类型（高级与基本生命支持）、人口普查区域、城市度、非营利组织地位和组织类型后，按年龄分组的生命体征记录的比值比（OR）和 95%置信区间（95%CI）。
在 18918914 次 EMS 接触中，有 6.4%涉及儿科患者。在 <1 个月大的婴儿中，记录完整生命体征的比例最低（30.8%），随着年龄的增长而升高（在成人中最高；91.8%）。与成人相比，<1 个月大的患者记录完整生命体征的调整后 OR 为 0.03（95%CI 0.03-0.03），随着年龄的增长而增加，在 12-17 岁的患者中为 0.76（95%CI 0.75-0.77）。在有呼吸、心脏和创伤性投诉的患者中，与成人相比，儿童记录脉搏血氧饱和度、监护仪使用和疼痛评分的比例较低。
与成人相比，完整生命体征和特定病情评估的记录在儿童中更不频繁，尤其是在年龄较小的组中，这一发现存在于城市度、区域和反应水平。这些发现为院前环境中的临床护理、质量改进和研究提供了基准。
