"Inappropriate" Pediatric Emergency Medical Services Utilization Redefined

OBJECTIVES:Previous reports on emergency medical services (EMS) transportation of pediatric patients have demonstrated a high rate of overutilization. However, there is also a concern that pediatric patients may underutilize EMS for emergencies that might benefit from EMS. This article compares EMS utilization rate between adult and pediatric patients for high-acuity patients and for the most common reasons for transport. METHODS:This study was a secondary analysis of the National Hospital Ambulatory Medical Care Survey to compare hospital arrival by EMS to walk-in arrivals. Primary variables were age category, mode of arrival, immediacy to be seen (triage category), reason for visit, and disposition. RESULTS:There were 253,898 records, weighted to represent 914.4 million emergency department visits, included. Emergency medical services mode of arrival was significantly higher for adult patients at 19.1% as compared with pediatric patients at 6.5% (odds ratio, 3.38). For the subgroup of patients requiring critical care interventions, adult patient arrival by EMS was 87.3% as compared with pediatric patients at 66.3% (odds ratio, 3.50). When considering the top 20 most common medical complaints in which pediatric patients used EMS transport, adult patients utilized EMS more frequently in 85% (17/20) of those complaints. CONCLUSIONS:As compared with adults, pediatric patients are less likely to utilize EMS for transport to the hospital for both routine and emergent complaints. The definition of inappropriate utilization of EMS for pediatric transport, which has largely focused on inappropriate overutilization, should also incorporate the potential of underutilization for critical patients.