Factors associated with EMS transport decisions for pediatric patients after motor vehicle collisions

Abstract

Objective

Prehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions.

Methods

We searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients.

Results

We identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol.

Conclusions

Pediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.

Key Words:

• EMS
• pediatrics
• prehospital medical transport
• MVC
• NEMSIS

Acknowledgments

National Highway Traffic Safety Administration (NHTSA), National Emergency Medical Services Information System (NEMSIS). The content reproduced from the NEMSIS Database remains the property of the National Highway Traffic Safety Administration (NHTSA). The National Highway Traffic Safety Administration is not responsible for any claims arising from works based on the original Data, Text, Tables, or Figures.

The work of the primary author was conducted with the support of the iTHRIV Scholars Program. The iTHRIV Scholars Program is supported in part by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data and code availability

The authors of this manuscript are committed to transparency and reproducibility in research. The data used for this analysis can be requested by contacting the National Emergency Medical Services Information System (NEMSIS) at https://nemsis.org/using-ems-data/request-research-data/. The R scripts used for this analysis are publically available at https://github.com/thartka/Peds_MVC_EMS. This code is reusable under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.