Ramgopal Sriram, Crowe Remle P, Jaeger Lindsay, Fishe Jennifer, Macy Michelle L, Martin-Gill Christian
Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
ESO, Inc, Austin, Texas.
Prehosp Emerg Care. 2025;29(1):1-9. doi: 10.1080/10903127.2024.2333493. Epub 2024 Apr 10.
Children have differing utilization of emergency medical services (EMS) by socioeconomic status. We evaluated differences in prehospital care among children by the Child Opportunity Index (COI), the agreement between a child's COI at the scene and at home, and in-hospital outcomes for children by COI. We performed a retrospective study of pediatric (<18 years) scene encounters from approximately 2,000 United States EMS agencies from the 2021-2022 ESO Data Collaborative. We evaluated socioeconomic status using the multi-dimensional COI v2.0 at the scene. We described EMS interventions and in-hospital outcomes by COI categories using ordinal regression. We evaluated the agreement between the home and scene COI. Data were available for 99.8% of pediatric scene runs, with 936,940 included EMS responses. Children from lower COI areas more frequently had a response occurring at home (62.9% in Very Low COI areas; 47.1% in Very High COI areas). Children from higher COI areas were more frequently not transported to the hospital (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86-0.87). Children in lower COI areas had lower use of physical (OR 1.23, 95% CI 1.13-1.33) and chemical (OR 1.41, 95% CI 1.29-1.55) restraints for behavioral health problems. Among injured children with elevated pain scores (≥7), analgesia was provided more frequently to children in higher COI areas (OR 1.73, 95% CI 1.65-1.81). The proportion of children in cardiac arrest was lowest from higher COI areas. Among 107,114 encounters with in-hospital data, the odds of hospitalization was higher among children from higher COI areas (OR 1.14, 95% CI 1.11-1.18) and was lower for in-hospital mortality (OR 0.75, 95% CI 0.65-0.85). Home and scene COI had a strong agreement (Kendall's = 0.81). Patterns of EMS utilization among children with prehospital emergencies differ by COI. Some measures, such as for in-hospital mortality, occurred more frequently among children transported from Very Low COI areas, whereas others, such as admission, occurred more frequently among children from Very High COI areas. These findings have implications in EMS planning and in alternative out-of-hospital care models, including in regional placement of ambulance stations.
儿童因社会经济地位不同而对紧急医疗服务（EMS）的利用率存在差异。我们通过儿童机会指数（COI）评估了儿童院前护理的差异、儿童在现场和家中的COI之间的一致性，以及按COI划分的儿童住院结局。我们对来自2021 - 2022年ESO数据合作项目中约2000个美国EMS机构的儿科（<18岁）现场遭遇情况进行了回顾性研究。我们在现场使用多维COI v2.0评估社会经济地位。我们使用有序回归按COI类别描述了EMS干预措施和住院结局。我们评估了家中和现场COI之间的一致性。99.8%的儿科现场出诊有数据可用，共纳入936,940次EMS响应。来自COI较低地区的儿童在家中发生响应的情况更为频繁（极低COI地区为62.9%；极高COI地区为47.1%）。来自COI较高地区的儿童更常未被送往医院（优势比[OR] 0.87，95%置信区间[CI] 0.86 - 0.87）。COI较低地区的儿童因行为健康问题使用身体约束（OR 1.23，95% CI 1.13 - 1.33）和化学约束（OR 1.41，95% CI 1.29 - 1.55）的情况较少。在疼痛评分升高（≥7）的受伤儿童中，COI较高地区的儿童更常接受镇痛治疗（OR 1.73，95% CI 1.65 - 1.81）。心脏骤停儿童的比例在COI较高地区最低。在107,114次有住院数据的遭遇中，COI较高地区的儿童住院几率更高（OR 1.14，95% CI 1.11 - 1.18），住院死亡率较低（OR 0.75，95% CI 0.65 - 0.85）。家中和现场COI具有很强的一致性（肯德尔系数=0.81）。有院前紧急情况的儿童的EMS使用模式因COI而异。一些指标，如住院死亡率，在从极低COI地区转运来的儿童中更常出现，而其他指标，如入院，在极高COI地区的儿童中更常出现。这些发现对EMS规划和替代院外护理模式有影响，包括救护车车站的区域布局。
