407 - Prevalence and Characteristics of Low Acuity Pediatric Calls in an Urban Emergency Medical Services (EMS) System

Poster Number: 407
Publication Number: 407.315

Caleb E. Ward, Children's National Hospital, Washington, DC, United States; Gia M. Badolato, Children's National Health System, Washington, DC, United States; Michael Taylor, Children's National Health System, Clifton Park, NY, United States; Kathleen M. Brown, Childrens National, Silver Spring, MD, United States; Joelle Simpson, Children's National Health System, Washington, DC, United States; James Chamberlain, Children's National Health System, Washington, DC, United States

Background: Many Emergency Medical Services (EMS) agencies have developed alternative disposition programs for low acuity adult patients. A prerequisite to including children in such programs is an accurate understanding of the pediatric EMS illnesses and injuries that could be managed without transport to an Emergency Department (ED). Estimates for the rate of medically unnecessary pediatric EMS calls vary widely and are usually based on physician judgment or ESI triage level. A more accurate definition should include patient assessments, medical interventions, and patient disposition.

Objective: Our objective was to describe the prevalence and characteristics of low acuity pediatric calls in an urban EMS system.

Design/Methods: We conducted a cross-sectional study of children transported by EMS to our tertiary-care pediatric ED. Our state has one 911-responding agency and transports >90% of children to our facility. Low acuity was defined as the absence of any of the following during the encounter: unstable vital signs (hypoxia or hypotension); EMS medications or procedures; ED intravenous medications, procedures, or radiographic or blood tests; or ED disposition of admission to hospital. We performed multivariable logistic regression to identify factors associated with low acuity status.

Results: We enrolled 996 patients, the majority of whom were Black, Non-Hispanic, with a mean age of 7.0 yrs. (Table 1). 33% [95% CI 30%, 36%] were classified as low acuity. The most common reasons for children being excluded from the low acuity group were completion of radiographs (36%) or blood tests (30%) (Table 2). When compared to adolescents, children < 1 yrs. were more likely to be low acuity (aOR 3.1 [1.9, 5.1]). Patients in a motor vehicle crash were also more likely to be low acuity (aOR 2.4 [1.4, 4.0]). All other variables, including patient gender, race/ethnicity, insurance status, chief complaint and time of dispatch were not significantly associated with low acuity status (Table 3).Conclusion(s): One third of pediatric calls in our EMS system are for low acuity illnesses/injuries. Young children and those involved in a motor vehicle crash are more likely to be low acuity. These encounters have minimal resource needs and may be candidates for alternative dispositions, such as primary care clinics or urgent care centers. Further work is needed to assess the generalizability of these findings and to use such data to inform the development of alternative EMS disposition programs for children with low acuity illnesses and injuries.
Table 1: Characteristics of enrolled pediatric patients transported to the emergency department (ED) by Emergency Medical Services (EMS) (Total n = 996)
Table 2: Indication for a pediatric patient transported to the emergency department (ED) by Emergency Medical Services (EMS) being excluded from the low acuity group1