Abstract
Objective
To characterize pediatric Emergency Medicine Service (EMS) transports to the Emergency
Department (ED) using a national claims database.
Methods
We included children, 18 years and younger, transported by EMS to an ED, from 2007
to 2016 in the OptumLabs Data Warehouse. ICD-9 and ICD-10 diagnosis codes were used
to categorize disease system involvement. Interventions performed were extracted using
procedure codes. ED visit severity was measured by the Minnesota Algorithm.
Results
Over a 10-year period, 239,243 children were transported. Trauma was the most frequent
diagnosis category for transport for children ≥5 years of age, 35.1% (age 6–13) and
32.7% (age 14–18). The most common diagnosis category in children <6 years of age
was neurologic (29.3%), followed by respiratory (23.1%). Over 10 years, transports
for mental disorders represented 15.3% in children age 14 to 18, and had the greatest
absolute increase (rate difference + 10.4 per 10,000) across all diagnoses categories.
Neurologic transports also significantly increased in children age 14 to 18 (rate
difference + 6.9 per 10,000). Trauma rates decreased across all age groups and had
its greatest reduction among children age 14 to 18 (rate difference − 6.8 per 10,000).
Across all age groups, an intervention was performed in 15.6%. Most children (83.3%)
were deemed to have ED care needed type of visit, and 15.8% of the transports resulted
in a hospital admission.
Conclusion
Trauma is the most frequent diagnosis for transport in children older than 5 years
of age. Mental health and neurologic transports have markedly increased, while trauma
transports have decreased. Most children arriving by ambulance were classified as
requiring ED level of care. These changes might have significant implication for EMS
personnel and policy makers.
Abbreviations:
ALS (Advanced Life Support), BLS (Basic Life Support), BVM (bag-valve-mask), CI (confidence intervals), ED (Emergency Department), EMS (Emergency Medical Services), HCPCS/CPT (Healthcare Common Procedure Coding System), IV (intravenous), NEMSIS (National EMS Information System), NHAMCS (National Hospital Ambulatory Medical Care Survey), OLDW (OptumLabs Data Warehouse), PECARN (Pediatric Emergency Care Research Network), RECORD (Reporting of Studies Conducted Using Observational Routinely-Collected Health Data)Keywords
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Article Info
Publication History
Published online: October 18, 2018
Accepted:
October 17,
2018
Received in revised form:
October 5,
2018
Received:
July 15,
2018
Footnotes
☆Meetings: An abstract of this study was presented at the Society for Academic Emergency Medicine annual meeting on May 2017 in Orlando, FL.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
