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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00442

Assessment of inadequate use of pediatric emergency medical transport services: the Pediatric Emergency and Ambulance Critical Evaluation (PEACE) Study

 Martin Poryo1*,  Martin Burger2, Stefan Wagenpfeil3, Bennet Ziegler4,  Harald Sauer1,  Marina Flotats-Bastardas5, Ulrich Grundmann6,  Michael Zemlin7 and  Sascha Meyer7
  • 1Department of Pediatric Cardiology, Saarland University Hospital, Germany
  • 2Medical School, Saarland University, Germany
  • 3Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, Germany
  • 4Other, Germany
  • 5Department of Neuropediatrics, Saarland University Hospital, Germany
  • 6Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Germany
  • 7Department of Pediatrics and Neonatology, Saarland University Hospital, Germany

Aim: To provide data on the inadequate use of emergency medical transports services (EMTS) in children and underlying risk factors.

Methods: This was a prospective single-center cohort study (01/2017-12/2017) performed at the Saarland University Children´s Hospital, Homburg, Germany. Patients ≤20 years of age transported by EMTS for suspected acute illness/trauma were included and proportion of inadequate/adequate EMTS use, underlying contributing factors, and additional costs were analyzed.

Results: 379 patients (mean age: 9.0±6.3 years; 55.7% male, 44.3% female) were included in this study. The three most common reasons for EMTS use were: central nervous system (30.6%), respiratory system affection (14.0%), and traumas (13.2%). ETMS use was categorized as inadequate depending on physician´s experience: senior physician (58.8%), pediatrician (54.9%), resident (52.7%). All three physicians considered 127 (33.5 %) cases to be medically indicated for transportation by EMTS, and 177 (46.7 %) to be medically not indicated.
The following parameters were significantly associated with inadequate EMTS use: non-acute onset of symptoms (OR 2.5), parental perception as non-life-threatening (OR 1.7), subsequent out-patient treatment (OR 4.0). Conversely, transport by an emergency physician (OR 3.5) and first time parental EMTS-call (OR 1.7) were associated with adequate use of EMTS. Moreover, a significant relation existed between maternal respectively paternal educational status and inadequate EMTS use (each p = 0.01).
Using multiple logistic regression analysis, non-acute onset of symptoms (OR 2.2) was associated with inadequate use of EMTS while first time parental EMTS call (OR 1.8), transport by an emergency physician (OR 3.3), and need for in-patient treatment (OR 4.0) were associated with adequate use of EMTS.

Conclusion: A substantial number of pediatric EMTS is medically not indicated. Possibly, specific measures including multifaceted educational efforts may be helpful in reducing unnecessary EMTS use.

Keywords: Ambulance, emergency medical transport service, Misuse, Pediatric emergency, Risk factors

Received: 30 Mar 2019; Accepted: 10 Oct 2019.

Copyright: © 2019 Poryo, Burger, Wagenpfeil, Ziegler, Sauer, Flotats-Bastardas, Grundmann, Zemlin and Meyer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Martin Poryo, Saarland University Hospital, Department of Pediatric Cardiology, Homburg, Germany,