Journal of pediatric surgery · 2024
EMS Pediatric Trauma Transport: Do Disparities Exist?
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Giron Andreina, Schomberg John, Dinh Peter N, Flyer Zoe E, Goodman Laura F, Guner Yigit S, Yu Peter T
Аннотация
INTRODUCTION: Trauma is the leading cause of disability and death among children in the United States. Optimal outcomes are achieved at pediatric trauma centers (PTCs), which are specialized to address the unique needs of this population. Disparities in trauma have been reported, affecting optimal delivery of care. This study aims to investigate disparities in Emergency Medical Services (EMS) transport of pediatric and adolescent trauma patients and the factors influencing destination decisions.
METHODS: This study utilized data from the National Emergency Medical Services Information System (NEMSIS) from 2017 to 2019, including EMS, sociodemographic, clinical, and decision-making variables. Patients aged 0-18 years that required EMS transport were included. Descriptive and regression analyses were conducted to identify factors influencing EMS transport destinations.
RESULTS: 896,881 pediatric and adolescent patients requiring EMS transport were identified. After adjusting for trauma severity using NEMSIS Revised Trauma Score, 129,627 pediatric trauma patients were found. Most (89.4 %) were transferred to a non-trauma center (NTC). Transport times to trauma centers (TCs) were slightly longer than NTCs (16.1 vs. 14.0 min, p < 0.0001). Transports to TCs were more likely to be associated with a clinical reason (p < 0.001); transports to NTCs were more likely to be associated with geography (p < 0.001). Younger patients (p < 0.0001) and African Americans (p < 0.0001) had reduced odds of transport to TCs, even after adjusting for geography as the destination reason.
CONCLUSIONS: Racial disparities exist in EMS transport of pediatric and adolescent trauma patients. Addressing these disparities is critical to the equitable delivery of healthcare for children in the United States.
LEVEL OF EVIDENCE: Level III.
METHODS: This study utilized data from the National Emergency Medical Services Information System (NEMSIS) from 2017 to 2019, including EMS, sociodemographic, clinical, and decision-making variables. Patients aged 0-18 years that required EMS transport were included. Descriptive and regression analyses were conducted to identify factors influencing EMS transport destinations.
RESULTS: 896,881 pediatric and adolescent patients requiring EMS transport were identified. After adjusting for trauma severity using NEMSIS Revised Trauma Score, 129,627 pediatric trauma patients were found. Most (89.4 %) were transferred to a non-trauma center (NTC). Transport times to trauma centers (TCs) were slightly longer than NTCs (16.1 vs. 14.0 min, p < 0.0001). Transports to TCs were more likely to be associated with a clinical reason (p < 0.001); transports to NTCs were more likely to be associated with geography (p < 0.001). Younger patients (p < 0.0001) and African Americans (p < 0.0001) had reduced odds of transport to TCs, even after adjusting for geography as the destination reason.
CONCLUSIONS: Racial disparities exist in EMS transport of pediatric and adolescent trauma patients. Addressing these disparities is critical to the equitable delivery of healthcare for children in the United States.
LEVEL OF EVIDENCE: Level III.