Patient and Emergency Medical Services Agency Factors Associated With Quality Care for Children

Authors

Caleb E. Ward, Children's National Hospital and The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Rebecca E. Cash, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Christian Martin-Gill, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Kenneth A. Michelson, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Sriram Ramgopal, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

Pediatrics

Volume

156

Issue

6

DOI

10.1542/peds.2025-073047

Abstract

BACKGROUND: Emergency medical services (EMS) system characteristics that promote quality pediatric care are uncertain. We evaluated agency and patient demographic factors associated with improved performance. METHODS: We evaluated care for children (aged <18 years) with a ground scene-level response using the 2020-2023 National EMS Information System (NEMSIS) datasets. We identified outcomes based on the NEMSIS Prehospital Pediatric Quality Measures Dashboard, including beta agonist for asthma/wheezing; glucagon/glucose for hypoglycemia; epinephrine for anaphylaxis; intravenous fluids for hypotension; pain improvement in trauma; pain assessment in trauma; and vital sign documentation in trauma. We evaluated the association of agency- and patient-level factors with high performance on each performance measure using mixed-effects logistic models. RESULTS: We identified 2 739 756 encounters. The proportion of cases achieving the performance measure ranged from 22.5% (improvement in pain for children with trauma reporting pain) to 85.2% (documentation of vital signs for children with trauma). Older age was associated with higher performance for most measures. Black and Hispanic and Latino children with trauma were less likely to have an improvement in pain compared with white children (adjusted odds ratio [aOR], 0.84 and 0.89, respectively) but were more likely to receive epinephrine for anaphylaxis (aOR, 1.50 and 1.32, respectively). There was improved performance over time for 4 measures. Most agency-level factors were not consistently associated with quality of care. CONCLUSION: EMS pediatric care quality is associated with multiple patient factors, including age. Further research is needed to determine whether these associations impact patient outcomes and to develop strategies to reduce unwarranted variability in prehospital pediatric care.

APA Citation

Ward, Caleb E.; Cash, Rebecca E.; Martin-Gill, Christian; Michelson, Kenneth A.; and Ramgopal, Sriram, "Patient and Emergency Medical Services Agency Factors Associated With Quality Care for Children" (2025). GW Authored Works. Paper 8480.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8480

Department

Pediatrics