School of Medicine and Health Sciences Poster Presentations

Title

Clinical and Demographic Factors Associated with Emergency Medical Services Arrival to a Pediatric Emergency Department

Document Type

Poster

Keywords

emergency medical services; prehospital care; emergency medicine; pediatrics; epidemiology

Publication Date

Spring 2017

Abstract

Objective: To examine demographic and clinical factors associated with emergency medical services [EMS] use in a pediatric emergency department [PED].

Methods: We performed a retrospective cross-sectional review of encounters with patients aged 0-21 years during calendar years 2014-2015 in an urban academic PED with two campuses, a tertiary-care site and an urban satellite community site. Encounters with patients arriving by interfacility or police transport were excluded. Acuity was classified by Emergency Severity Index [ESI]. Chi-square and logistic regression were used to analyze associations between demographic and clinical factors and EMS arrival.

Results: There were 220,792 eligible encounters over a 2 year period, with 15,605 encounters arriving by EMS (7.1%). In bivariable analysis, patients arriving by EMS were more likely to have encounters involving seizure (OR 10.19; 95%CI 9.55-10.87), poisoning (OR 6.22; 5.51-7.03), psychiatric concerns (OR 2.05; 1.87-2.27) and injury (OR 1.86; 1.79-1.92). In multivariable analysis of demographic factors, EMS arrival was associated with gender (aOR 0.85; 95%CI 0.80-0.89 for females) and older age (aOR 0.75; 0.69-0.82 for infants, aOR 0.64; 0.60-0.68 for ages 1-4, and aOR 0.72; 0.67-0.77 for ages 5-11 compared with ages 12-21). The odds of EMS arrival for Hispanic patients was lower (aOR 0.59; 0.55-0.64) and for non-Hispanic white patients was greater (aOR 2.0; 1.86-2.19) than the odds EMS arrival for non-Hispanic black patients. These demographic associations were not significant in analysis of the highest acuity patients.

Patients with public insurance had decreased odds of EMS arrival (OR 0.80; 0.77-0.83) but no significant difference after adjusting for acuity. Subgroup analysis showed patients living within the surrounding city limits with public insurance had increased odds of EMS arrival (aOR 1.30; 1.18-1.43) after adjusting for acuity. Patients arriving by EMS had increased odds of admission (OR 3.33; 3.18-3.45) and this remained true in the subgroup of lowest acuity patients, ESI levels 4-5 (aOR 2.44; 2.07-2.92).

Conclusion: Pediatric encounters for seizure, ingestion, psychiatric concerns, and injury are more likely to utilize EMS. Odds of EMS arrival to PED varies with age, gender, and race. Associations between public insurance and EMS use may vary with proximity to the hospital or jurisdiction.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster to be presented at GW Annual Research Days 2017.

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Clinical and Demographic Factors Associated with Emergency Medical Services Arrival to a Pediatric Emergency Department

Objective: To examine demographic and clinical factors associated with emergency medical services [EMS] use in a pediatric emergency department [PED].

Methods: We performed a retrospective cross-sectional review of encounters with patients aged 0-21 years during calendar years 2014-2015 in an urban academic PED with two campuses, a tertiary-care site and an urban satellite community site. Encounters with patients arriving by interfacility or police transport were excluded. Acuity was classified by Emergency Severity Index [ESI]. Chi-square and logistic regression were used to analyze associations between demographic and clinical factors and EMS arrival.

Results: There were 220,792 eligible encounters over a 2 year period, with 15,605 encounters arriving by EMS (7.1%). In bivariable analysis, patients arriving by EMS were more likely to have encounters involving seizure (OR 10.19; 95%CI 9.55-10.87), poisoning (OR 6.22; 5.51-7.03), psychiatric concerns (OR 2.05; 1.87-2.27) and injury (OR 1.86; 1.79-1.92). In multivariable analysis of demographic factors, EMS arrival was associated with gender (aOR 0.85; 95%CI 0.80-0.89 for females) and older age (aOR 0.75; 0.69-0.82 for infants, aOR 0.64; 0.60-0.68 for ages 1-4, and aOR 0.72; 0.67-0.77 for ages 5-11 compared with ages 12-21). The odds of EMS arrival for Hispanic patients was lower (aOR 0.59; 0.55-0.64) and for non-Hispanic white patients was greater (aOR 2.0; 1.86-2.19) than the odds EMS arrival for non-Hispanic black patients. These demographic associations were not significant in analysis of the highest acuity patients.

Patients with public insurance had decreased odds of EMS arrival (OR 0.80; 0.77-0.83) but no significant difference after adjusting for acuity. Subgroup analysis showed patients living within the surrounding city limits with public insurance had increased odds of EMS arrival (aOR 1.30; 1.18-1.43) after adjusting for acuity. Patients arriving by EMS had increased odds of admission (OR 3.33; 3.18-3.45) and this remained true in the subgroup of lowest acuity patients, ESI levels 4-5 (aOR 2.44; 2.07-2.92).

Conclusion: Pediatric encounters for seizure, ingestion, psychiatric concerns, and injury are more likely to utilize EMS. Odds of EMS arrival to PED varies with age, gender, and race. Associations between public insurance and EMS use may vary with proximity to the hospital or jurisdiction.