The Journal of pediatrics · 2026
Using Vital Signs to Predict Disposition of Children Transported to the Hospital by Emergency Medical Services.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Ramgopal Sriram, Macy Michelle L, Horvat Christopher M, Cash Rebecca E, Okubo Masashi, Janofsky Stephen, Martin-Gill Christian
Аннотация
OBJECTIVE: To compare prehospital and emergency department (ED)-based vital sign assessments for children with out-of-hospital emergencies and to evaluate the relationships between vital signs and mental status assessment on patient mortality or intensive care unit (ICU) admission.
STUDY DESIGN: We performed a retrospective, multiagency and multicenter study of pediatric transports from the scene to the hospital within an integrated health system between 2014 and 2023. We compared 3 sets of vital signs (first prehospital, last prehospital, and first ED). We evaluated the multivariable association of vital signs with outcomes of ICU admission and in-hospital mortality.
RESULTS: We included 68 489 children. ICU admission occurred in 2.4%, and in-hospital mortality in 0.1%. All vital signs demonstrated high agreement between the first prehospital, last prehospital, and ED phases of care (Gwet's AC1 > 0.80). For ICU admission, the area under the receiver operator characteristic curve of the initial prehospital model (0.79, 95% CI: 0.77-0.80) was lower than the last prehospital (0.81, 95% CI: 0.80-0.83) and first-ED model (0.83, 95% CI: 0.82-0.85). Models predicting ICU admission had moderate accuracy (sensitivities of 0.72-0.79; specificities of 0.80-0.87). The area under the receiver operator characteristic curve for models predicting mortality based on prehospital vital signs and ED vital signs reached highly accurate criteria (initial prehospital: 0.91, 95% CI: 0.85-0.97; last prehospital: 0.95, 95% CI: 0.91-0.99; first ED: 0.96, 95% CI: 0.93-0.99). Models for mortality demonstrated high sensitivity (0.90-0.98) and specificity (0.90-0.97). Across models, altered mental status showed the strongest associations with both outcomes, and predictive performance improved modestly from initial prehospital to ED assessment.
CONCLUSIONS: Prehospital and ED vital signs are predictive of in-hospital outcomes. Following prospective evaluation, these findings may inform pediatric clinical decision-making in prehospital and initial hospital management. These results support the use of age-adjusted physiologic measures together with mental status assessment to strengthen early risk stratification of children transported by emergency medical services.
STUDY DESIGN: We performed a retrospective, multiagency and multicenter study of pediatric transports from the scene to the hospital within an integrated health system between 2014 and 2023. We compared 3 sets of vital signs (first prehospital, last prehospital, and first ED). We evaluated the multivariable association of vital signs with outcomes of ICU admission and in-hospital mortality.
RESULTS: We included 68 489 children. ICU admission occurred in 2.4%, and in-hospital mortality in 0.1%. All vital signs demonstrated high agreement between the first prehospital, last prehospital, and ED phases of care (Gwet's AC1 > 0.80). For ICU admission, the area under the receiver operator characteristic curve of the initial prehospital model (0.79, 95% CI: 0.77-0.80) was lower than the last prehospital (0.81, 95% CI: 0.80-0.83) and first-ED model (0.83, 95% CI: 0.82-0.85). Models predicting ICU admission had moderate accuracy (sensitivities of 0.72-0.79; specificities of 0.80-0.87). The area under the receiver operator characteristic curve for models predicting mortality based on prehospital vital signs and ED vital signs reached highly accurate criteria (initial prehospital: 0.91, 95% CI: 0.85-0.97; last prehospital: 0.95, 95% CI: 0.91-0.99; first ED: 0.96, 95% CI: 0.93-0.99). Models for mortality demonstrated high sensitivity (0.90-0.98) and specificity (0.90-0.97). Across models, altered mental status showed the strongest associations with both outcomes, and predictive performance improved modestly from initial prehospital to ED assessment.
CONCLUSIONS: Prehospital and ED vital signs are predictive of in-hospital outcomes. Following prospective evaluation, these findings may inform pediatric clinical decision-making in prehospital and initial hospital management. These results support the use of age-adjusted physiologic measures together with mental status assessment to strengthen early risk stratification of children transported by emergency medical services.