Purpose Emergency Medical Services (EMS) personnel perform pre-hospital triage of pediatric emergencies. Standing orders and on-line medical direction provide triage guidelines to determine the level of care required by the patient during ambulance transport. Children with special healthcare needs (CSHCN) have been identified as a unique sub-group of pediatric emergencies. The purpose of this study is to characterize the level of care required by CSHCN during ambulance transport and identify a correlation between this level of care and subsequent hospital admission.
Hypothesis We assessed the hypothesis that CSHCN with emergencies requiring Advanced Life Support (ALS) transport are more likely to be admitted to the receiving hospital compared to children requiring Basic Life Support (BLS) transport.
Methods CSHCN were defined as children, 21 years of age or younger, with a congenital or acquired condition or chronic physical or mental illness, affecting physical or mental growth and development. During a 22-month period, 1,697 EMS responses for CSHCN were identified and evaluated for the nature of the emergency, level of care required during transport, and admission status.
Results 71% of CSHCN required ALS transport. Medical emergencies were twice as likely to result in hospital admission compared to traumatic emergencies (1.25≤OR≤3.04, p≤0.01). For all emergencies, children requiring ALS transport were 4.5 times more likely to be admitted to the hospital compared to those requiring BLS transport (2.74≤OR≤7.73, p≤0.01). When excluding emergencies directly related to the child's special need, children requiring ALS transport were 7.63 times more likely to be admitted to the hospital compared to those requiring BLS transport (3.48≤OR≤17.14, p≤0.01).
Conclusions This study shows a significant correlation between level of transport and hospital admission in the studied population, suggesting that current pre-hospital triage protocols correctly identify CSHCN who require a more advanced or specialized level of care.