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Pandya L, Morshedi B, Miller B, Hennes H, Badawy M. Pediatric Outcomes of Emergency Medical Services Non-Transport Before and During the COVID-19 Pandemic. West J Emerg Med 2024; 25:246-253. [PMID: 38596926 PMCID: PMC11000546 DOI: 10.5811/westjem.18408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Pediatric patients account for 6-10% of emergency medical services (EMS) activations in the United States. Approximately 30% of these children are not transported to an emergency department (ED). Adult data in the literature reports higher hospitalization and complications following non-transport. Few studies discuss epidemiology and characteristics of pediatric non-transport; however, data on outcome is limited. Our primary aim was to determine outcomes of non-transported children within our urban EMS system before and during the COVID-19 pandemic. Our secondary objective was to explore reasons for non-transport. Methods This was a prospective, descriptive pilot study. We compared EMS data for September 2019 (pre-COVID-19) to September 2020 (pandemic). Included were children aged 0-17 years who activated EMS and did not receive transport to the primary hospital for the EMS capture area. We defined outcomes as repeat EMS activation, ED visits, and hospital admissions, all within 72 hours. Data was obtained via electronic capture. We used descriptive statistics to analyze our data, chi square for categorical data, stepwise logistic regression, and univariate logistic regression to test for association of covariates with non-transport. Results There were 1,089 pediatric EMS activations in September 2019 and 780 in September 2020. Non-transport occurred in 633 (58%) in September 2019 and 412 (53%) in September 2020. Emergency medical services was reactivated within 72 hours in the following: 9/633 (1.4%) in 2019; and 5/412 (1.2%) in 2020 (P = 0.77). Visits to the ED occurred in 57/633 (9%) in 2019 and 42/412 (10%) in 2020 (P = 0.53). Hospital admissions occurred in 10/633 (1.5%) in 2019 and 4/412 (0.97%) in 2020 (P = 0.19). One non-transported patient was admitted to the intensive care unit in September 2020 (<1%) and survived. Hispanic ethnicity, age >12 years, and fever were associated with repeat EMS activation. The most common reason for non-transport in both study periods was that the parent felt an ambulance was not necessary (47%). Conclusion In our system, non-transport of pediatric patients occurred in >50% of EMS activations with no significant adverse outcome. Age >12 years, fever, and Hispanic ethnicity were more common in repeated EMS activations. The most common reason for non-transport was parents feeling it was not necessary. Future studies are needed to develop reliable EMS guidelines for pediatric non-transport.
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Affiliation(s)
- Lori Pandya
- University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Emergency Medicine, Dallas, Texas
| | - Brandon Morshedi
- University of Arkansas for Medical Sciences, Deprtment of Emergency Medicine, Little Rock, Arkansas
| | - Brian Miller
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Halim Hennes
- University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Emergency Medicine, Dallas, Texas
| | - Mohamed Badawy
- University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Emergency Medicine, Dallas, Texas
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Nehme E, Nehme Z, Cox S, Smith K. Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study. J Accid Emerg Med 2023; 40:12-19. [PMID: 36202623 DOI: 10.1136/emermed-2022-212350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Data on the safety of non-transport decisions for paediatric patients attended by Emergency Medical Services (EMS) are lacking. We describe the characteristics and outcomes of paediatric non-transported patients in Victoria, Australia. METHODS A retrospective data linkage study of consecutive paediatric (aged <18 years) non-transported patients between January 2015 and June 2019. Patients were linked to ED, hospital admission and death records. Multivariable logistic regression analyses were used to determine factors associated with EMS recontact, ED presentation, hospital admission and an adverse event (death/cardiac arrest, intensive care unit admission or highest ED triage category) within 48 hours of the initial emergency call. RESULTS In total, 62 975 non-transported patients were included. The mean age was 7.1 (SD 6.0) years and 48.9% were male. Overall, 2.2% recontacted the EMS within 48 hours, 13.7% self-presented to a public ED, 2.4% were admitted to hospital and 0.1% had an adverse event, including two deaths. Among patients with paramedic-initiated non-transport (excluding transport refusals and transport via other means), 5.6% presented to a public ED, 1.1% were admitted to hospital and 0.05% had an adverse event. In the overall population, an abnormal vital sign on initial assessment increased the odds of hospital admission and an adverse event. Among paramedic-initiated non-transports, cases occurring in the early hours of the morning (04:00-08:00 hours) were associated with increased odds of subsequent hospital admission, while the odds of ED presentation and hospital admission also increased with increasing prior exposure to non-transported cases. CONCLUSION Adverse events were rare among paramedic-initiated non-transport cases. Vital sign derangements and attendance by paramedics with higher prior exposure to non-transports were associated with poorer outcomes and may be used to improve safety.
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Affiliation(s)
- Emily Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
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Listo I, Salmi H, Hästbacka M, Lääperi M, Oulasvirta J, Etelälahti T, Kuisma M, Harve-Rytsälä H. Pediatric traumas and neighborhood socioeconomic characteristics: A population based study. J Pediatr Surg 2021; 56:760-767. [PMID: 32646665 DOI: 10.1016/j.jpedsurg.2020.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Identifying pediatric populations at risk for traumas would enable development of emergency medical services and emergency departments for children. Elucidation of the nature of socioeconomic differences in the incidence of pediatric out-of-hospital emergencies is needed to overcome inequities in child health. METHODS We retrieved all ambulance contacts during 17.12.2014-16.12.2018 involving children (0-15 years) in Helsinki, Finland and separated traumatic and nontraumatic emergencies. We compared the incidences of these emergencies in the pediatric population with socioeconomic markers of the scene of the emergency and of the residential area of the child. RESULTS Of 11,742 ambulance contacts involving children 4113 (35.0%) were traumatic. Traumatic emergencies occurred more often in neighborhoods with lower median income/household (P=0.043) and were more common in children living in areas with lower median income/inhabitant (P=0.001), higher unemployment (P<0.001), and lower education (P<0.001). The associations were weaker for traumatic than nontraumatic emergencies. Higher proportion of a pediatric population in a residential area (P=0.005) had a protective effect. Exclusion of clinically unnecessary ambulance responses did not change the results. CONCLUSION Traumatic emergencies in children are more common in areas with lower socioeconomic status. The possible protective effect of urban planning merits further studies. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Inari Listo
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland; New Children's Hospital, University of Helsinki and Helsinki University Hospital, P.O. Box 347, Helsinki, FI-00029, HUS, Finland.
| | - Heli Salmi
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland; New Children's Hospital, University of Helsinki and Helsinki University Hospital, P.O. Box 347, Helsinki, FI-00029, HUS, Finland
| | - Matti Hästbacka
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
| | - Mitja Lääperi
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
| | - Jelena Oulasvirta
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
| | - Tiina Etelälahti
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
| | - Markku Kuisma
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
| | - Heini Harve-Rytsälä
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, P.O. Box 340, Helsinki, FI-00029, HUS, Finland
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Oulasvirta J, Harve-Rytsälä H, Lääperi M, Kuisma M, Salmi H. Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study. Scand J Trauma Resusc Emerg Med 2021; 29:13. [PMID: 33413571 PMCID: PMC7789394 DOI: 10.1186/s13049-020-00816-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics. Methods In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit. Results 1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants. Conclusions Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.
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Affiliation(s)
- Jelena Oulasvirta
- Division of Anesthesiology; Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 340, FI-00029, Helsinki, Finland. .,Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland.
| | - Heini Harve-Rytsälä
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Mitja Lääperi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Markku Kuisma
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Heli Salmi
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 347, FI-00029, Helsinki, Finland
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Oulasvirta J, Pirneskoski J, Harve-Rytsälä H, Lääperi M, Kuitunen M, Kuisma M, Salmi H. Paediatric prehospital emergencies and restrictions during the COVID-19 pandemic: a population-based study. BMJ Paediatr Open 2020; 4:e000808. [PMID: 34192175 PMCID: PMC7607513 DOI: 10.1136/bmjpo-2020-000808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children are less vulnerable to serious forms of the COVID-19 disease. However, concerns have been raised about children being the second victims of the pandemic and its control measures. Therefore, we wanted to study if the pandemic, the infection control measures and their consequences to the society projected to paediatric prehospital emergency medical services (EMS) contacts. METHODS We conducted a population-based cohort study concerning all children aged 0-15 years with EMS contacts in the Helsinki University Hospital area during 1 March 2020-31 May 2020 (study period) and equivalent periods in 2017-2019 (control periods). We analysed the demographic characteristics, time of EMS contact, reason for EMS contact, priority of the dispatch, reason for transportation, priority of transportation, if any consultations were made or additional units required, any medication or oxygen or fluids given, if intubation was performed, and whether paramedics took precautions when COVID-19 infection was suspected. RESULTS The number of paediatric EMS contacts decreased by 30.4% from mean of 1794 contacts to 1369 (p=0.003). The EMS contacts were more often due to trauma (+23.7%, p<0.05), dispatched in the most urgent category (+139.9%, p=0.001), additional help and the mobile intensive care unit were more frequently requested (+43.3%, p=0.040 and+46.3%, p=0.049, respectively). However, EMS contacts resulted less often in ambulance transport (-21.1%, p<0.001). Alarmingly, there were four deaths during the study period compared with 0-2 during the control periods. CONCLUSIONS The number of EMS contacts decreased during the pandemic. Nevertheless, the children encountered by the EMS were more seriously ill than during the control periods.
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Affiliation(s)
- Jelena Oulasvirta
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Pirneskoski
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heini Harve-Rytsälä
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mitja Lääperi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikael Kuitunen
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Kuisma
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heli Salmi
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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